ACCOUNT OPENING FORM FOR RESIDENT INDIVIDUAL (PART -I)

(Must accompanied with Terms and Conditions)

CUSTOMER INFORMATION SHEET (CIF Creation/Amendment)
Date D D M M Y Y Y Y
(In case of joint accounts, Part -I (CIF Sheet) and Terms & Conditions to be taken for each customer)

Branch Name Branch Code

Fields marked asterix (*) are mandatory.Please �ll up in BLOCK letters only and use black ink for signature Bank/Branch to a�x rubber stamp of
(For o�ce use only) name and code no.

Customer ID Application type New Update

Account No. CKYC No.

(Mandatory for CKYC update request)
Account type Normal Small Minor
Sta� PF NO.

A Personal Details

1.Name*: F I R S T N A M E M I D D L E N A M E
(Same as ID Proof)
L A S T N A M E

2.Maiden Name : F I R S T N A M E M I D D L E N A M E L A S T N A M E

3.Date of Birth*: D D M M Y Y Y Y 4.Gender* Male Female Third Gender

5.Marital Status Married Unmarried Single Divorced Living Apart. Defacto

6.Name of Father Mother Spouse*

F I R S T N A M E M I D D L E N A M E L A S T N A M E
(Father's name is mandatory if PAN is not provided)
7.No. of Dependents 8.Illiterate YES NO if yes : Identi�cation Marks :

9.Name of Guardian F I R S T N A M E M I D D L E N A M E L A S T N A M E

(In Case Of Minor*) Relationship with Guardian

10.Nationality: In-Indian Others Country Name 11.Citizenship:

12.Occupation Type Service State Govt. Central Govt. Public Sector Undertaking Defence Pvt. Sector

Business Industrialist Trade Sect. Serv. Sect Migrant Labour Contractor Jeweller / Bullion Trader Pawn Shop

Import / Export Customer Other Self Employed

Others Medical Prof. Legal Prof. CA/ICWA/Taxation/ Finance Eng./Architect/Tech. Consultant Retired Journalist

Housewife Student Share and Stock Broker Oth. Professional Agriculture Political / Social Worker

X-Not categorised-Please specify

13.Organization's Name: Designation/Profession:

Nature of Business:

14. Annual Income Rs. 15.Net Worth (approx value) Rs.

16.Religion: Hindu Muslim Christian Sikh Others

17.Category: General OBC SC ST

18.Person with disability Yes No If yes, i. Visually impaired ii. Di�erently abled

19.Educational Quali�cation: upto 9th Class passed 10th Class passed Graduate (Gen.) Post Graduate(Gen.)

Med. Graduate/Post Graduate Eng. Graduate/Post Graduate Law Gradutae/Post Graduate

CA/ICWA/MBA/CFA Computer Degree/Diploma/MCA Other Professional Degree/Diploma Illiterate

20.Please Tick the Applicable box*: Politically exposed Person Related to politically Exposed Person None

(Politically Exposed Persons are individuals who are or have been entrusted with prominent public functions in a foreign countary e.g. Heads of State / Governments , Senior Politicians / Senior Governments/
Judicials /Military O�cers, Senior Executives of State-owned Corporations, important Political Party O�cials, etc.)

21.Country of Tax Residence in India only and not in any other country or territory outside India* Yes No (If No, please �ll the FATCA details form - Annexure II)

22.PAN* (If PAN is not submitted, submit Form 60 - Annexure I)

B Contact Details (All communications will be sent on provided Mobile No./Email-ID)

Mobile No. Email ID

STD Tel. (O�): S T D

Tel. (Res):
S T D

1
C Proof of Identity/Address (Please tick the appropriate Box (any one ID type) and give details)*

A-PASSPORT B-VOTER'S IDENTITY CARD C-DRIVING LICENCE D-Proof of possession of Aadhaar Number (Veri�cation E-KYC O�ine

E-NREGA JOB CARD F-LETTER ISSUED BY NATIONAL POPULATION REGISTER CONTAINING DETAILS OF NAME & ADDRESS

Document No/Identi�cation Number*

Issued By

Issue Date:* D D M M Y Y Y Y Expiry Date (If applicable):* D D M M Y Y Y Y

Small Accounts : Only Self Attested Photograph

D Address details Current Permanent Overseas

Address type* Residential/Business Residential Business Registered O�ce Unspeci�ed

Address*

City/Village* District*:

State:* Pin:* Country Name*

E Address details Correspondence Local Same as Current/Permanent Address

Address type* Residential/Business Residential Business Registered O�ce Unspeci�ed

Address*

City/Village* District*:

State:* Pin:* Country Name*

F If the O�cally Valid Document (OVD) does not contain current address-please provide any of the documents below.

Utility Bill PPO/FPPO Property or Municipal tax receipt

Letter of allotment of accomodation issued by employer/ issued by State or Central Government departments, statutory or regulatory bodies, Public sector undertaking, scheduled commercial banks,
�nancial institutions and listed companies. Similarly, leave and license agreements with such employers allotting o�cial accomodation.
Self-Declaration ( If Aadhar is voulatray provided for identi�cation purpose and current address is di�erent form address avilable in Central Identities Data Repository Authentication of Aadhaar number
using e-KYC authentication facility providede by the UIDAI is mandatory)

Document No. Date D D M M Y Y Y Y

G DECLARATION CUM UNDERTAKING CUM SELF–CERTIFICATION

1. I have read the copy of Terms and Conditions of the Account Opening Form given to me. The Terms and Conditions have been explained to me/us and having understood, I accept the same.
2. I hereby declare that I have submitted the Aadhaar Card issued by UIDAI voluntarily for identi�cation and /or address proof towards the compliance of KYC norms under the PMLA, 2002
3. I hereby consent that the Bank may verify the same with the UIDAI and authorise the UIDAI expressly to release the identity and address

through biometric / OTP based authentication to the Bank. YES NO (E-KYC authentication and Aadhaar seeding is mandatory for availing DBT bene�t)

PHOTO*
Please Paste Signature/Thumb impression of the Applicant
Please sign in black ink only
Recent passport Size
(Do not Staple)

Place Date D D M M Y Y Y Y

H FOR OFFICE USE Documents received Self-certi�ed True Copies Notary

i.Self-certi�cation & documents received as part of account opening process have been veri�ed and found correct.
ii.Certi�ed that Copy of Terms and Conditions signed by Customer obtained
iii.Certi�ed that the implications and conditions for the operation of the account have been explained to the depositor (only in case of illiterate applicant)

iv.Threshold Limt v. BIS Organistion Code vi. Customer Segment

vii. Depositor Illiterate Blind Sta� Risk Category:* High Medium Low

Details of one or two identi�cation marks, if any, such as a mole or scar (mandatory for illiterate applicant) Permitted to open CIF
In person veri�cation carried out and Signature/LTI of the applicant veri�ed.

O�cial Name: PF No. Designation

Date D D M M Y Y Y Y SS No. Signature

2
 ACCOUNT OPENING FORM FOR INDIVIDUAL (PART -II)
(SAVING BANK, CURRENT ACCOUNT AND TERM DEPOSITS)
Fields marked asterix (*) are mandatory. Please �ll up in BLOCK letters only and use black ink for signature
(For o�ce use only) Date D D M M Y Y Y Y

First Applicant Customer ID

Second Applicant Customer ID Bank / Branch to a�x rubber stamp of

name and code no.

Account No.

I/We request you to open my / our deposit account with your branch / bank as under: (Tick (√) relevant type of account)

A Type of Account

Savings Bank Account BSBDA BSBDA Small Account Current Account (Individual) Fixed Deposit / MOD / RD Caps Gain (SB)

B Mode of Operation

Self Either or Survivor Former or Survivor Any one or Survivor Jointly Operated Other____________

C Services Required

1 ATM-CUM-DEBIT CARD Name as would appear on the card Card Type

Ist Applicant 2nd Applicant
1st Applicant Yes No
a) Rupay a) Rupay
2nd Applicant Yes No
b) Visa b) Visa

Additional Factor of authentication is not mandotory for transactions on International E-Commerce merchants.Card will be supplied with Interantional c) Master c) Master
transactions disabled status which can be enabled with avilable channel as and when required.Card can be used for Conatactless transaction upto limit
prescibed by the Banks from time to time without PIN.

(Mobile no. is mandatory for services 2 to 6)

2. CHEQUE BOOK Yes No 4. SMS ALERTS on Registered mobile number Yes No
(Only for Regular SB/Current Accounts/Caps Gain(SB)
(Not available for Regular BSBD/Small Accounts)
5. PHONE BANKING SERVICES: Yes No
3. INTERNET BANKING REQUIRED:
Transaction rights required
6. MOBILE BANKING : Yes No
1st Applicant Yes No
7. PASSBOOK REQUIRED:
2nd Applicant Yes No (For Savings Bank Account) Yes No

(Available only for singly operated accounts and joint accounts operated by Either or Survivor mode. 8. e-Statement (at monthly intervals),
In case of accounts operated as Former or Survivor mode INB facility is available to 1st applicant only) in lieu of paper copy: Required Not Required

D Fixed Deposit : For the following products/facilities, please furnish options/details:

TERM DEPOSIT TERM DEPOSIT (REINVESTMENT) ANNUITY DEPOSIT TAX SAVING SCHEME CAPS GAIN (TDR)

Amount: Rs. Rs. (in words)…………………………………………………………………………………….

Name of Depositor(s), Amount and Period of
Initials of Cash
Deposit authenticated by Cash O�cer in case
Period: Year(s) Month(s) Days O�cer
of Illiterate Depositor

In case of Term Deposit, interest payable# Monthly Quarterly Calendar Quarter Half Yearly Yearly

Maturity instruction@ Auto renew* principal & payback interest Auto renew* principal & interest Pay principal & interest Auto Renew* with part amount for Rs…………

* (Auto Renewal will be done for the similar term at the prevailing interest rate on the date of renewal.)
@#( All Interest payable and Maturity instructions options will not be o�ered by all Banks. Contact respective Banks for the options available.)
Payment instruction (Maturity Proceeds/Residual amount):

By credit to my Bank Account No. Issue Banker's Chq / Draft

E MULTI-OPTION DEPOSIT SCHEME (MOD) / AUTO SWEEP

Type of Deposit Term Deposit Term Deposit (Reinvestment) Period of Deposit ……….. Year(s) …………….. Month(s)

I/We hereby give consent for debiting my/our account for recovering service charges as normally applicable to Savings Bank and Current Account.
I/We hereby give consent for debiting my/ our Savings Bank/ Current Account for creating MODS/AUTO SWEEP as per the Terms and Conditions.

Linked Saving Bank/Current Account No.

Under reverse sweep facility for breaking the MOD, the MOD to be broken by:* Last in �rst out First in �rst out

(* In case the applicant does not opt for any option, Last in �rst out will be the default option.)

F RECURRING DEPOSIT FLEXI DEPOSIT

Monthly / Core Monthly installment: Rs. Rs. (In words) Period: Years: Month(s)

Standing instruction (if any) Debit Account No.

On Maturity, credit proceeds to Account No.

Issue Banker's Chq /Draft Issue STDR for a period of Year(s) Month(s) Day(s)

For the above Term Deposit Account, please deduct applicable TDS from (SB/CA Account No.)

In Case of Joint Accounts, Income Tax provision will applicable to primary / First Account holder only.
3
G Nomination (If required, �ll Form DA-1)

FORM DA-1 (Nomination Form)

Details of Nomination:
Registration No.
Nomination under section 45ZA of the Banking Regulation Act, 1949 and Rules 1985 in respect of Bank Deposits.
I/We ……………………………………………… nominate the following person to whom in the event of my / minor's death the amount of this deposit, particulars of which are given
below, may be returned by the State Bank of India, ……………………………………………………………………………………………....(Name & address of the branch /o�ce in which the deposit is held.)

I/We want the name of the nominee to be printed on the passbook

Details of Deposit
Type of Deposit: ……………………………………………………………………………………. Account Number:
Details of Nominee

Name:

Mobile Number of the Nominee

Relationship with the Depositor……………………….. Age………Years Date of Birth of nominee (in case of minor) D D M M Y Y Y Y

As the nominee is a minor on this date, I appoint Shri / Smt / Kum………………………………………………………………………………………………………… Age Years

Address……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………to receive the amount of deposit on behalf of the nominee in the event of my / minor's death during the minority of the nominee
(Nimination in favour of other than Individual is invalid)

(Signature of the Applicant/Thumb impression of the Applicant) (Signature of the Applicant/Thumb impression of the Applicant)

Signature of the �rst witness Signature of the second witness

Name:………………………………………………………. Signature : ………………………………………… Name:………………………………………………………. Signature : …………………………………………

Address ………………………………………………………..…………………………………………………………................ Address ………………………………………………………..…………………………………………………………................

(Witnesess are required only in case of applicant is illiterate and if a�xing thumb impression)
Date D D M M Y Y Y Y Place ………………………..............
I/We do not want to nominate any person in this account

(Signature of the Applicant/Thumb impression of the Applicant) (Signature of the Applicant/Thumb impression of the Applicant)

H DECLARATION CUM UNDERTAKING CUM SELF – CERTIFICATION

1. I/We have read the copy of Terms and Conditions of the Account Opening Form given to me / us. The Terms and Conditions have been explained to me/us and having understood, I / we accept the same.
2. (In case of Minor Accounts)
I hereby declare that date of birth of the minor who is my ………………………. is ……………………………and I am his/her natural and lawful guardian/guardian appointed by court order dated…………………………..(copy enclosed)
I shall represent the said minor in all future transactions of any description in the above account until the said minor attains majority. I indemnify the bank against the claim of the above minor for any
withdrawal/transactions made by me in his/her account).
3. (Applicable in case of Term Deposit Accounts-(Strike out if not required))
I/We undertake that in case of term deposits with operating instructions "Either or Survivor", or "Former or Survivor" in line with the operating instructions of the application-cum-deposit slip, premature
termination/payment will be allowed to the survivor in event of the death of the either of the depositors or former as the case may be on submission of the death certi�cate of the deceased depositors along with
application without obtaining consent of the legal heirs of the deceased depositors.
4 I hereby declare that I do not maintain a Basic Savings Bank Deposit Account (BSBDA) with any other Bank/Branch (Applicable in case of BSBD Account)

Place: ……………………………………………..…………..

(Signature of the Applicant/Thumb impression of the Applicant) (Signature of the Applicant/Thumb impression of the Applicant)
Date: D D M M Y Y Y Y

FOR OFFICE USE/ATTESTATION

(for o�ce use only) Queue No. Initials

Open Account Account

Date: D D M M Y Y Y Y (Authorised signatory) CIF Linking

i) Internet Banking (INB) Kit No.:………………………………………………………….. INITIALS Personalised Cheque

ii) INB Viewing rights Transaction rights given on: INITIALS RINB

iii) ATM Card data transmitted on: INITIALS MBS

iv) Nomination Serial No.: INITIALS SMS Alert

v) Threshold (KYC) limit: INITIALS Removal of Posting

vi) Phone Banking INITIALS Scanning

4
 TERMS AND CONDITIONS FOR OPENING OF DEPOSITS ACCOUNTS
1. I a�rm and declare that I have read over and understood the rules and regulations of the “Bank” and those relating to various services o�ered by the Bank including but not limiting to debit card/internet
banking/SMS banking/Tele-Banking/Mobile Banking/Virtual Banking and any other facilities. I agree to abide by the same as amended/modi�ed from time to time by the Bank/Regulator/Government
published through circulars, noti�cations, notice board/websites/newspaper publications, etc. I waive the rights, if any, to have personal notice in respect of such amendments/modi�cations.I agree
that the transactions and requests executed in my account(s)through internet, mobile, tele- banking or virtual banking under my User ID and password/PIN/OTP will be legally binding on me & I am
responsible for the maintenance of secrecy and con�dentiality of the authentication credentials and any other information/details/OTP/PIN, etc., in such matters. I agree that Bank has got all the rights
to debit my account for any service charge, expenses or other dues which the Bank is entitled/ liable to recover from me. I also authorise the Bank and agree to close/discontinue my account without
any notice to me(under normal circumstance , bank will not close account without giving 30 days notice indicating reason for closure).I hereby undertake to inform the Bank on any change in my
communication address or constitution.
2. In respect of accounts opened on the basis of Aadhaar details, I hereby declare that I have submitted the Aadhaar Card issued by UIDAI voluntarily for identi�cation and /or address proof towards the
compliance of KYC norms under the PMLA, 2002 and I hereby consent that the Bank may verify the same with the UIDAI and authorise the UIDAI expressly to release the identity and address through
biometric authentication to theBank. I wish to seed this account with NPCI mapper to enable me to receive Direct Bene�tTransfer (DBT) including LPG subsidy from Govt of India (GOI) in this account.
I understand that if more than one bene�t transfer is due to me, I will receive all the bene�t transfer in this account.
3. I con�rm and declare that I am not prevented/prohibited/restricted by any applicable legal/regulatory/contractual or other provisions from opening and/or maintaining the accounts or to transact with
the Bank in any other way.
4. I agree that my personal KYC details may be shared with Central KYC registry or any other competent authority. I hereby consent to receive information from the Bank/Central KYC Registry/GoI/RBI
or any other authority through SMS/e-mail on my registered mobile number/ e-mail address. I also agree that the non-receipt of any such SMS/e-mail shall not make the Bank liable for any loss or
damage whatsoever in nature.
5. I hereby certify that I have declared my status as per the rules applicable under section 285BA of the Income Tax Act, 1961 as noti�ed by Central Board of Direct Taxes (CBDT) vide Noti�cation No. S.O.
2155(E) dated 7 August 2015 and RBI Circular Ref No. DBR.AML.BC.No.36/ 14.01.001/2015-16 dated 28 August 2015 in the matter including any subsequent modi�cation/amendment thereof.
6. I understand, acknowledge and authorize that as per the provisions of Income Tax Act, Rules made thereunder and the guidelines issued by the Government/RBI in the matter,depending upon the
residential status and/or other criteria stipulated therein, the Bank may have to report the details in respect of my account(s) as per the prescribed format to the Central Board of Direct Taxes (CBDT)or
other Government Agencies to comply with the obligations as per the Inter- Governmental Agreements (IGA) in respect of Foreign Accounts Tax Compliance Act (FATCA) and Common Reporting
Standards (CRS) and / or any other similar arrangements.
7. I certify & declare that the information provided by me for opening loan account and availing other services herein or through website/electronically as applicable to me signed/authenticated by me as
well as in the documentary evidence provided by me for opening loan account and availing other services are, to the best of my knowledge and belief, true, correct and complete and that I have not
withheld any material information that may a�ect the assessment/categorization of my account as a U.S. Reportable Account or Other Reportable Account or otherwise. In case any of the information
or details provided by me is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.
8. I undertake the responsibility to declare and disclose immediately and in no case beyond 30 days from the date of change, any changes that may take place in the information provided herein/or
otherwise, as well as in the documentary evidence provided by me or if any certi�cation becomes incorrect or undergoes a change. I further undertake to provide fresh and valid self–certi�cation along
with documentary evidence as and when so required;nevertheless all declaration and undertaking given herein will also be applicable to all such modi�ed/amended document/information provided by
me unless revised self–certi�cation as above is provided to the Bank.
9. I also agree that my failure to disclose any material fact/information known to me now or in future or my failure to remedy any de�ciency in documents/information/other details within the stipulated
period, may invalidate me from transacting in the account and the Bank would be within its right to put restrictions in the operations of my account or to close it or to report to any regulator and/or any
authority designated by the Government of India(GoI)/RBI for the said purpose or take any other action as may be deemed appropriate by the Bank under the guidelines issued by CBDT/RBI/GoI from
time to time.
10. I also agree to furnish and intimate to the Bank any other particulars that are called upon me to provide on account of any change in law either in India or abroad in the above matter or otherwise.
11. I shall indemnify the Bank from any loss/damage that may be caused to the Bank on account of any defect/mistake in the details provided herein or on account of providing incorrect or incomplete
information by me.
12. I undertake to submit data/information together with fresh KYC documents for updation of KYC details at periodical intervals as may be required by the Bank.
13. I understand that the account will be activated and debits will be allowed only after completion of Customer Due Diligence relating to KYC by the Bank.
14. In case the account is opened without PAN, I undertake to submit PAN on or before such date as may be noti�ed by the Government of India, failing which the account shall cease to be operational till
the time PAN is submitted, as per Prevention of Money -Laundering (Maintenance of Records ) Rules 2005.
15. In case, deemed OVDs are submitted for Current Address at the time of Account opening, I undertake to submit Aadhaar or any of the OVD having Current Address within 3 months from the date of
account opening, failing which I understand that my account may cease to be operational as per GOI guidelines at the material time.
16. I have received the Welcome Kit containing INB Kit and ATM card/cheque book and understand that in case of any misuse/misplacement of the contents of the Kit, the Bank will not be liable for any
loss/damage.
17. I hereby certify that the Savings Bank Account would be used by me to route transactions of only non-business/non-commercial nature.In the event of occurrence of such transactions or any such
transactions that may be construed as commercial/business/dubious or undesirable, the Bank reserves the right to unilaterally freeze operations in such accounts and /or close the account.
18. I have been advised of Average Monthly Balance(AMB) requirement for the account to be opened and given to understand that these requirements are subject to revision/changes and such
revision/changes will be uploaded in the Bank's site which will be acceptable to me as a notice to that e�ect.
19. I con�rm that the product features of BSBD account have been explained to me(applicable to BSBD account applicant)
20. Applicable for Small Accounts: I undersatnd that this account shall remain operational initially for twelve months,can be extended for further twelve months on submission of evidence applied for
OVD.The entire relaxation/ provisions shall be reviewed after twenty four months.
21. I have been advised that if I do not provide my mobile number, I will not be eligible for any facility of electronic transactions other than ATM cash withdrawals.
22. (Applicable for accounts opened for credit of Social Welfare Bene�ts)
I understand that this account will be opened under BSBD category. I also understand that in case, I do not wish to continue in this BSBD account, and switch over to Regular Savings Bank account, I will
have to maintain the Average Monthly Balance(AMB) applicable for Regular Savings Bank Account .I therefore undertake to maintain AMB in the account if I switch over to Regular Savings Bank Account
from BSBD.
23. (Applicable for accounts opened in the name of Minors)
I understand that the requirements of Average Monthly Balance(AMB) and penalty for non-maintenance will be applicable in this account once the applicant becomes Major.I therefore undertake to
maintain Average Monthly Balance(AMB) from the date of attaining majority.
24. I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately in case any of the above
information is found to be false or untrue or misleading or misrepresenting. I am aware that I may be held liable for it.
25. I con�rm and undertake that I will not deal in virtual currencies and will not use my account for any services relating to virtual currencies or facilitate any person or entity in delaing with or settling Virtual
Virtual Currencies.
26. I understand that in the event of failed Standing Instruction for Loan Repayment / dishonour of a cheque/NACH/ECS due to lack of funds / insu�cient funds on 04 occasions during �nancial yearno fresh
cheque book would be issued.,closure of account may also be considerd.
27. I/We con�rm that the product features of account have been explained to me 28. I acknowledge receipt of rules and regulations of Savings Bank Account.

(Signature of the Applicants/Thumb impression of the Applicants) (Signature of the Applicants/Thumb impression of the Applicants)

ACKNOWLEDGEMENT DA-1
We acknowledge receipt of nomination made by you in favour of:
Date:
Name of the Nominee................................................................................................................................Age:.................... Years:..................... Yours faithfully

With respect to your Account Number

Registration No. Signature of Bank O�cial with Seal

5
 Annexure-1
Income-tax Rules, 1962
FORM NO.60
[See second proviso to rule 114B]
Form for declaration to be �led by an individual or a person (not being a company or �rm) who does not have a permanent
account number and who enters into any transaction speci�ed in rule 114B
1 First Name Middle Name Surname
2 Date of Birth / Incorporation of declarant
3 Father’s Name (in case of individual)
4 Flat No./Floor No.
5 Name of premises / Block Name & No.
6 Road / Street / Lane
7 Area / Locality
8. Town/District/State
9 Pin code
10 Telephone Number (with STD code)
11 Mobile Number
12 Amount of Transaction (Rs.)
13 Date of Transaction
14 In case of transaction in joint names,
number of persons involved in
the transaction
15 Mode of transaction Cash Cheque Card Draft/Banker’s Cheque Online transfer Other
16 Aadhaar Number issued by UIDAI (if available) :
17 If applied for PAN and it is not yet generated, enter date of application and acknowledgement number: __________________
____________________________________________________________________________________ Date :_______________
18 If PAN not applied, �ll estimated total income (including income of spouse, minor child, etc., as per section 64 of Income-tax
Act, 1961) for the �nancial year in which the above transaction is held (a) Agricultural income (Rs.)_______________________
(b) Other than Agr. Income (Rs.) _________________________________________________
19 Details of document being produced in Document Document Name and address of the
support of identify in Column 1 (Refer code identi�cation authority issuing
Instruction overleaf) number the document
20 Details of document being produced in Document Document Name and address of the
support of identity in Column 4 to 13 code identi�cation authority issuing
(Refer Instruction overleaf) number the document
Veri�cation
I, _______________________________________________________________________ do hereby declare that what is stated
above is true to the best of my knowledge and belief. I further declare that I do not have a Permanent Account Number and
my / our estimated total income (including income of spouse, minor child etc., as per section 64 of Income Tax Act, 1961)
computed in accordance with the provisions of Income tax Act, 1961 for the �nancial year in which the above transaction is
held will be less than maximum amount not chargeable to tax.
Veri�ed today the ___________________________ day of________________20 ____________
Place : (Signature of declarant)
Note: Before signing the declaration, the declarant should satisfy himself that the information furnished in this form is true,
correct and complete in all respects. Any person making a false statement in the declaration shall be liable to prosecution
under section 277 of the Income-tax Act, 1961 and on conviction be punishable,
(i) in a case where tax sought to be evaded exceeds twenty-�ve lakh rupees, with rigorous imprisonment which shall not be
less than six months but which may extend to seven years and with �ne;
(ii) in any other case, with rigorous imprisonment which shall not be less than three months but which may extend to two
years and with �ne.
2. The person accepting the declaration shall not accept the declaration where the amount of income of the nature referred to in
item 22b exceeds the maximum amount which is not chargeable to tax, unless PAN is applied for and column 21 is duly �lled.

7
 Annexure-2

Details of Related Person (To be filled for minor)

Customer ID: CKYC No.:

Account No.:

Name*: F I R S T N A M E M I D D L E N A M E L A S T N A M E

Addition of Related Person Deletion of Related Person

KYC of Related Person (If Available)*

Related Person type* Guardian of Minor Assignee Authorised Representative

Name*: F I R S T N A M E M I D D L E N A M E L A S T N A M E
Pre�x
(If KYC Number and name are provided, below details are optional)
PROOF OF IDENTITY(POI) OF RELATED PERSON*

A-PASSPORT

B-VOTER'S IDENTITY CARD

C-DRIVING LICENCE

D-UID (AADHAAR)

E-NREGA JOB CARD

F-LETTER ISSUED BY NATIONAL POPULATION REGISTER CONTAINING DETAILS OF NAME & ADDRESS

G-OTHERS (Any Document noti�ed by the Central Government/RBI)

Document No/Identi�cation Number*

Issue date*: D D M M Y Y Y Y Expiry Date(If Applicable)*: D D M M Y Y Y Y

Remarks : _____________________________________________________________________________________________________________________________________________________________________

FATCA Declaration Form

Customer ID: CKYC No.:

Account No.:

Name*: F I R S T N A M E M I D D L E N A M E L A S T N A M E
Pre�x

Citizenship*: IN-India Others Country Name:

Place/City of Birth*: Country of Birth*:

Address*:

City/Village*: District*:

State*: Pin*:

Multiple Tax Residency: Details of Country of Tax Residence in India, and/or in USA@ and /or In any other Country or Territory Outside India as Under:

Country of Tax Residence# Tax Identi�cation number or equivalent if issued by jurisdiction Identi�cation type (TIN or Other, please specify)

@ * A citizen of US including individual born in US but resident in another country (who has not given up US citizenship)
* A person residing in US including US green card holder
* Certain persons who spend more than 180 days in US each year

Address in the Jurisdiction/Country - where the Applicant is Resident outside India for Tax Purposes

Address*:

City/Village*: District*:

Sub-District: State*:

Country Name*: ZIP/Post Code*:

Place:

Date:
Signature/thumb inpression of the Applicant/Applicants