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nceejs meeLe mebyebOe jKeves kes efueS DeeHekees OeveJeeo / We thank you for having chosen a relationship with us.
Keelee Keesueves kes efueS DeHesef#ele omleeJespe efvecveevegmeej nQ (Iejsuet Keeles) :- The documents required for opening an account are as under (Domestic accounts) :JeeqkeleeeW kes efueS / For Individuals :
Heneeve eceeCe (keesF& Yeer) / Identity Proof (any one)
Helee kee eceeCe (keesF& Yeer) / Address Proof (any one)
HeemeHees& keer eefle/Copy of Passport
egveeJe veeceeJeueer jKevesJeeues Jee[& DeefOekeejer mes DeeJeemeere Helee kee eceeCeHe$e/Certificate of residential address from ward officer maintaining electoral roll
Hewve kee[&/PAN Card
Deeleve efJeegle efyeue/Latest Electricity Bill
efveeeskelee Heneeve He$e/Employers ID Card
Deeleve sueerHeesve efyeue/Latest Telephone Bill
mejkeej/megj#eemesvee eje peejer efkeee ieee Heneeve He$e
Helee meefnle Deeleve Deeekej/mebHeoe kej DeeosMe
Govt./Defence ID Card
GHee&gkele kes Deefleefjkele, efvecveefueefKele omleeJespe Yeer DeHesef#ele nQ:Hewve/peer.DeeF&.Deej mebKee ee Heece& mebKee 60
Deeleve mwcHe Deekeej kee HeeseseeHe (2 eefleee@) Deewj eenke eesHeeFue Heece&
efHeues 6 cenerves mes nceejs yeQke kes meeLe yeQefkebie kejves Jeeues eenke mes Heefjee ee DeeHekes
Jele&ceeve yeQkej mes Heefjee.
mJeeefcelJe/Yeeieeroejer Heceex kes efueS
mJeeefcelJe/Yeeieeroejer keer Iees<eCee.
Hece& kee HebpeerkejCe eceeCeHe$e (Yeeieeroejer Heceex kes efueS).
Helee kee eceeCe, Deeleve mwcHe Deekeej kee HeeseseeHe (2 eefleee@), SJeb mJeeceer/Yeeieeroej
kee eenke eesHeeFue Heece&.
Hece/&Yeeieeo
r ejeW kes veece kee useeHreevse eyfeue, Hee ee ekfejeee kejej, emeebJfeoe eJfeueKse Deeeof.
efueefces[ kecHeefveeeW kes efueS
kecHeefveeeW kes efveieefcele nesves kee eceeCeHe$e.
keejesyeej eejcYe kejves kee eceeCeHe$e (meeJe&peefveke efue. kecHeefveeeW kes ceeceues ceW).
kecHeveer kes efveosMeke/kecHeveer kes meefeJe eje efJeefOeJele eceeefCele eLee mele SJeb Deeleve
%eeHeve SJeb Deble&efveece.
kecHeveer keer Deesj mes keejesyeej mebeeueve kes efueS eyebOekeeW/DeefOekeeefjeeW ee kece&eeefjeeW kees
eoe cegKleejveecee.
efveosMekeeW/eeefOeke=le nmlee#ejkelee&DeeW keer Deeleve mwcHe Deekeej Jeeueer HeeseseeHe
(2 eefleee@) Deewj eenke eesHeeFue Heece&.
wve DeeJebve He$e keer eefle.
kecHeveer kes sueerHeesve efyeue keer eefle (eefo GHeueyOe nes).
efvecveefueefKele vecetveW kes Devegmeej kecHeveer kes efveosMeke ceC[ue eje Heeefjle efJeefOeJele
eceeefCele mebkeuHe.
________________
mebkeuHe efkeee ieee efke kecHeveer kee yeQefkebie Keelee osvee yeQke
MeeKee
ceW Keesuee peeSiee Deewj en ________________________________________
efke Gkele yeQke kees eeefOeke=le efkeee peeS Deewj Sleodeje
eeefOeke=le efkeee peelee nw efke
eje kecHeveer keer Deesj mes mJeerke=le, Hejebefkele ee efveefce&le meYeer eskeeW, efyeueeW, JeeveHe$eeW SJeb
Deve DeeosMeeW kees mJeerkeej kejs Deewj Keeles mes mebyebefOele Deye leke efoS ieS efkemeer Yeer
DevegosMe kee Heeueve kejW, eens Gkele Keeles ceW pecee Mes<e nes ee Jen Deefle Deenefjle nes ~
efnvot DeefJeYeeefpele HeefjJeejeW kes efueS
efnvot DeefJeYeeefpele HeefjJeej keer Iees<eCee
Deeleve mwcHe Deekeej kee HeeseseeHe (2 eefleee@)Deewj kelee& SJeb menoeefeke kee eenke
eesHeeFue Heece&)
efnvot DeefJeYeeefpele HeefjJeej kee sueerHeesve efyeue (eefo GHeueyOe nes)
keueyeeW/mebmLeeDeeW/meefceefleeeW/veemeeW Deeefo kes efueS
mebefJeOeeve GHeefveeceeW, veeme efJeuesKe Deeefo keer efJeefOeJele eceeefCele eefleee@
HebpeerkejCe kee eceeCeHe$e
Keelee Heefjeeueve kes efueS DeefOeosMe meefnle Keelee Keesueves kees eeefOeke=le kejves Jeeues eyebOe
efvekeee eje Heeefjle mebkeuHe.
Deeleve mwcHe Deekeej kee HeeseseeHe (2 eefleee@) Deewj HeoOeejer leLee eeefOeke=le
nmlee#ejkelee&DeeW kee eenke eesHeeFue Heece&.
keueye/mebmLee/veeme/meefceefle kes keeee&uee kes veece kee sueerHeesve efyeue (eefo GHeueyOe nes)
eeefOeke=le nmlee#ejkelee&DeeW kes efueS
eeefOeke=le nmlee#ejkelee&DeeW kes Heles kee eceeCe, Deeleve mwcHe Deekeej kee HeeseseeHe
(2 eefleee@) Deewj eeefOeke=le nmlee#ejkelee&DeeW kee eenke eesHeeFue Heece&.
,
efHHeCeer : yeQke `DeHeves eenke kees peeefveS mes mebyebefOele efoMeeefveoxMeeW leLee ceveeruee@C[efjbie-efJejesOeer
GHeeeeW kes DevegHeeueve kes efueS efkemeer Yeer Deve euesKe / metevee keer ceebie kejves kes yeejs ceW DeHeves
DeefOekeejeW kees megjef#ele jKelee nw.
ovsee yekQe ceW nce DeHeves eenkeeW kees yenslej meJsee eoeve kejves Deejw Gvekeer DeeJeMekeleeDeeW kees Hejte
kejves kes eufeS meoJwe lelHej nQ ~ nce DeeHemes eeHle mePgeeJeeW / eelfemetevee kees yencgeute mecePeles nQ leLee
DeHeveer JeysemeeF& www.denabank.com ee F-&ceuse helpdesk@denabank.co.in Hej Jen eeHle nevses
Hej yenlge emeVelee neiseer ~ DeeHemes eeHle elekse mePgeeJe nceW DeHeveer meJseeDeeW ceW Deejw meOgeej ueeves kes
eufeS evfeeMfele He mes meneeke neiWes ~
Certificate of registration.
Resolution passed by the Managing Body authorizing opening of account
including mandate for operation of the Account.
Latest stamp size photograph (2 copies) and Customer Profile Form of office
bearers and authorized signatories.
Telephone bill in the name of the office of the club/association/Trust/Society.
For Authorized Signatories
Proof of address, latest stamp size photographs (2 copies) and Customer
Profile Form of authorized signatories.
N.B. Bank reserves its right to call for any other document / information to comply
with KYC guidelines and Anti Money Laundering measures.
At Dena Bank we are continuing our initiatives to provide better service to our
customers and cater to their needs. We value your suggestions / feedback and
would be happy to receive the same on our website www.denabank.com . or email at helpdesk@denabank.co.in. Every suggestion made by you would
certainly help us in improving our service.
mesJee ceW,
MeeKee eyebOeke,
osvee yeQke
efoveebke ___________________
ceQ/nce DeeHekeer MeeKee ceW Ske yeQke Keelee Keesueves kes efueS DeeHemes DevegjesOe kejlee ntB/kejles nQ efpemekes efueS ceQ/nce efvecveefueefKele metevee emlegle kejlee ntB/kejles nQ :Keeles kee veece/Meer<e&ke eer/eerceleer/megeer/cesmeme& ____________________________________________________________________________________
keee&keueeHe/keejesyeej/JeJemeee kee mJeHe : _____________________________________________________________________________________
mebegkele Oeejke/Yeeieeroej/mJeeceer/efveosMeke kee veece : _________________________________________________________________________________
eLece veece
ceOe veece
Gheveece
eLece Oeejke
efleere Oeejke
le=leere Oeejke
pevceefleefLe
(efove/ceen/Je<e&)
efuebie
(Heg./m$eer)
je^erelee
eLece Oeejke
efleere Oeejke
le=leere Oeejke
* ke=Heee Hewve/peer DeeF& Deej mebKee keer DevegHeueyOelee kes ceeceues ceW mebueive Heece& 60 kees YejW.
Gme Deee kej Jee[&/meke&ue/#es$e kee veece YejW pene@ Deeekej keer efHeueer efJeJejCeer oeej keer ieF& Leer.
esCeer
DeJeemke
Jeefj veeieefjke
HeWMeveYeesieer
meHe
DeefMeef#ele
efnerve
DeJeemke kes ceeceues ceW
DeJeemke keer pevce efleefLe
ceelee-efHelee/vewmeefie&ke mebj#eke kee veece
ceelee-efHelee/
mebj#eke kee
Helee
efHelee
ceelee
veeeeuee kes DeeosMe eje (eefle mebueive kejW)
DeJeemke kes mebyebOe
Deve
ceQ Sleodeje Iees<eCee kejlee ntB efke DeJeemke, pees cesje ....................... nw, keer pevce efleefLe ......./......./............... nw leLee ceQ Gmekee vewmeefie&ke mebj#eke ntB / efoveebke ............................. kes
veeeeuee DeeosMe (eefle mebueive) eje efveegkele JewOe mebj#eke ntB. peye leke GHee&gkele DeJeemke Jeemke veneR nes peelee GHee&gkele Keeles ceW efkemeer Yeer ekeej kes meYeer YeeJeer uesve-osveeW ceW ceQ Gkele DeJeemke kee eefleefveefOelJe
kebiee ~ Gmekes KeeleW ceW cesjs eje efkeS ieS efkemeer Yeer DeenjCe / uesve-osve kes efueS GHee&gkele DeJeemke kes efkemeer Yeer oeJes kes efJe ceQ yeQke kees #eefleHetefle& kebiee ~
mebj#eke kee veece :
efoveebke :
DeHee&cesv/kees.DeeHejsefJe meesmeeeer :
Heneeve :
#es$e/ieueer :
Menj :
Heesve (keeee&uee)
ceesyeeF&ue
F&-cesue :
efleere Oeejke
Heuew veb.:
efHeve :
jepe :
Heesve (efveJeeme)
Hewkeme
DeHee&cesv/kees.DeeHejsefJe meesmeeeer :
Heneeve :
#es$e/ieueer :
Menj :
Heesve (keeee&uee)
ceesyeeF&ue
F&-cesue :
efHeve :
jepe :
Heesve (efveJeeme)
Hewkeme
veeme
Deve (efJeefveefo& kejW)
Authorized by : (Name)
Customer ID
Sign :
Account No.
P. A. No. :
Account Type
Date ____________________________
I/we request you to open a bank account with you for which I / we furnish the following information
Name / Title of A/c Mr/Mrs/Ms/ Messers ________________________________________________________________________________________________
Name of Joint Holders / Partners / Proprietor / Director : ____________________________ Nature of Activity / Business / Occupation ____________________
FIRST NAME
1
ST
HOLDER
ND
HOLDER
RD
HOLDER
MIDDLE NAME
DATE OF BIRTH
(DD/MM/YYYY)
1
ST
HOLDER
ND
HOLDER
RD
HOLDER
SURNAME
SEX
(M/F)
NATIONALITY
RELATIONSHIP WITH
FIRST HOLDER
# Please fill in the attached form 60 in case of non-availability of PAN / GIR No.
Name of Income tax Ward / Circle / Range where the last return of income was filed
CATEGORY
Minor
IN CASE OF MINOR :
Senior citizen
Staff
Illiterate#
Blind person#
Others
Pensioner
Father
Mother
I hereby declare that the date of birth of the minor is ____/____/_______ who is my ______________________ and I am his/her natural guardian/lawful guardian
appointed by the court order dated ___________ (copy enclosed). I shall represent the said minor in all future transactions of any description in the above account until
the said minor attains majority. I indemnify the Bank against any claim of the above minor for any withdrawal/transactions made by me in his/her account.
Date :
Name of Guardian :
Signature of Guardian
State :
Ph (O)
Mobile
Ph (R)
Fax
Email :
2nd
HOLDER
Flat No.
Area / Street :
City :
Pin :
State :
Ph (O)
Mobile
Ph (R)
Fax
Email :
le=leere Oeejke
Heuew veb.:
DeHee&cesv/kees.DeeHejsefJe meesmeeeer :
Heneeve :
#es$e/ieueer :
Menj :
Heesve (keeee&uee)
ceesyeeF&ue
F&-cesue :
efHeve :
jepe :
Heesve (efveJeeme)
Hewkeme
keejesyeej kee Helee / mLeeeer Helee (Hecee&X, efn.De.efJe.He., efueefces[ kebHeefveeeW Deeefo kes ceeceueW ceW Hebpeerke=le keeee&uee kee Helee)
kesJeue leYeer
efyeefu[bie/kee@cHueskeme
keeee&uee/ogkeeve meb.
osvee nw peye
Heneeve :
#es$e/ieueer :
Ghejeskele mes
Deueie nes ~
efHeve :
Menj :
jepe :
Heesve (keeee&uee)
ceesyeeF&ue
F&-cesue :
Heesve (efveJeeme)
Hewkeme
emlegle efkeS ieS Heneeve/Heles kee eceeCe (JeeqkeleeeW kes efueS) : (ke=Heee eleske Keeves ceW mes efkemeer Ske Hej efveMeeve ueieeSb)
Heneeve eceeCe
Heneeve eceeCe
Helee meefnle Deeleve Deeekej/mebHeoe kej DeeosMe
HeemeHees& keer eefle
mejkeejer/megj#ee mesvee
egveeJe veeceeJeueer jKevesJeeues Jee[& DeefOekeejer mes
Heneeve He$e mebKee
DeeJeemeere Helee kee eceeCe He$e
mebKee
efoveebke
efveeeskelee kee Heneeve He$e
JewOe Heeses HeWMeve Hegefmlekee
Deeleve efJeegle efyeue
He$e Meer<e& Hej efveeeskelee mes peejer He$e
mebKee
efoveebke
jeMeve kee[&
mebKee
Hewve kee[&
mJeleb$elee mesveeveer kee
Deeleve esef[ kee[& efJeJejCe
Deeleve sueerHeesve efyeue
mebKee
efoveebke
efoveebke
JewOe Heeme
[^eFefJebie ueeFmeWme
mebKee
* He$eMeer<e& Hej eceeefCele HeeseseeHe SJeb/Gvekeer Hegefmlekee ceW eLee efjkee[&ye kece&eejer kee DeeJeemeere eceeCe
DeJeefOe
ueeiet veneR
ueeiet veneR
ueeiet veneR
ueeiet veneR
ueeiet veneR
ueeiet veneR
ueeiet veneR
ueeiet veneR
3rd
HOLDER
Flat No.
Area / Street :
City :
Pin :
State :
Ph (O)
Mobile
Email :
Ph (R)
Fax
BUSINESS ADDRESS / PERMANENT ADD / (ADDRESS OF REGISTERED OFFICE IN CASE OF FIRMS, HUF, LTD COMPANIES, ETC.)
(To be
Bldg/Complex :
Office/Shop No.
given only if
Land Mark :
Area / Street :
different
from the
Pin :
City :
State :
above)
Ph (O)
Mobile
Email :
Ph (R)
Fax
PROOF OF IDENTITY / ADDRESS SUBMITTED (Individuals) : (Please tick any one from each column)
IDENTITY PROOF
ADDRESS PROOF
Latest Income tax/wealth tax order with address
Passport Copy
Govt./Defence
Certificate of residential address from
ID Card No.
ward officer maintaining electoral roll
No.
Date:
Employers ID Card
Valid photo Pension Book
Latest Electricity Bill
Letter from employer on letter head #
No.
No.
Date:
Ration Card
Pan Card
Valid Freedom
Latest Credit card statement
Latest Telephone Bill
fighters pass
No.
Date:
Date:
Driving Licence
No.
# On letter head certifying the photograph and residence proof of the employee as recorded in their books
Section-IV
CHOICE OF ACCOUNT TO BE OPENED
Type of Account
Account No. (For Bank use only)
q Current
Savings
Minor Saving Scheme
Alpa Bachat Yojna
Salary accounts (Corporate)
Fixed Deposit (with monthly or
quarterly interest)
Dena Freedom Deposit scheme
Samruddhi Deposits Receipt
Senior Citizen FDR/SDR
Savifix Account
Recurring Deposit #
Amount
Not Applicable
Monthly Inst. Amount
Period
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Not Applicable
No
Bank
Branch
Yes
No
Yeeie - IX
Heemeyegke
eeLeefcekelee
eefo efJeJejCe nw lees DeeJeefOekelee
owefveke
F&-cesue eje
es<eCe kee mJeHe
Hewkeme eje
mecYeeefJele HeefjceeCe Deewj keee&keueeHeeW kee mlej (Devegceevele: eefle ceen) jkece npeej ceW
uesve-osve
mebKee
vekeo pecee
vekeo DeenjCe
Yeeie - X
DeHesef#ele megefJeOeeSB
S.er.Sce kee[&*
sueer yeQefkebie
[sefye kee[&*
efJeJejCe
meeHleeefnke
[eke eje*
ceeefmeke
cetue
Fvjves yeQefkebie
ceesyeeF&ue yeQefkebie
Keelee mebKee
jeefMe
Yeeie - XII
Iees<eCee SJeb JeeveHe$e
1. ceQ/nce Keeles mes mebyebefOele efveeceeW kes eeHle nesves, GvnW He{ efueS peeves Deewj mecePe efueS peeves keer Hegef kejlee ntB/kejles nQ leLee Sleodeje SerSce kee[& / sueeryeQefkebie / ceesyeeF&ue yeQefkebie / efyeue Hes / Fbjves yeQefkebie kees es[kej osvee yeQke kes
2.
3.
4.
5.
6.
7.
8.
9.
Heeme ceW / nce pees Keeles Keesue jne ntB / Keesue jns nQ, GveceW mecee-mecee Hej ngS HeefjJele&veeW meefnle Gve KeeleeW mes mebyebefOele efveeceeW eje DeefYeMeeefmele nesves kes efueS menceefle Jekele kejlee ntB/kejles nQ~ ceQves/nceves SerSce/[sefye kee[& Deeefo
kees DeefYeMeeefmele kejves Jeeueer MeleeX SJeb efveyebOevees kees He{ efueee nw ~
ceQ/nce yeQke keer oseleeDeeW kees meerefcele kejves Jeeueer MeleeX SJeb efveyebOeveeW meefnle Thej JeefCe&le Gkele MeleeX SJeb efveyebOeveeW kees mJeerkeej kejlee ntB/kejles nQ leLee Gvemes yeeOe nesves kes eefle DeHeveer menceefle Jekele kejlee ntB/kejles nQ~
ceQ/nce mecePelee ntB/mecePeles nQ efke cegPes/nceW efkemeer Yeer ekeej keer metevee efoS efyevee yeQke DeHeves mebHetCe& efJeJeske Hej efkemeer Yeer mesJee kees HetCe&le: ee DeebefMeke He mes mebMeesefOele ee DeJe kej mekelee nw~ ceQ/nce Fme yeele mes mencele ntB/nQ efke
yeQke mecee-mecee Hej ueeiet nesves Jeeues mesJee eYeejeW kees cesjs /nceejs Keeles ceW veeces [eue mekelee nw ~
ceQ/nce en Yeer Iees<eCee kejlee ntB/kejles nQ efke FmeceW cesjs/nceejs eje yeQke kees eoe eeefOekeej / keer ieF& Iees<eCeeSB cesjer/nceejer HetCe&le: mJese mes efkeS ieS nQ leLee Jes cesjer/nceejer HetCe&le: peevekeejer SJeb megefJe%elee kes DeeOeej Hej efkeS ieS nQ~
ceQ/nce Sleodeje Iees<eCee kejlee ntB / kejles nQ efke Fmekes Thej leLee mebueive eenke eesHeeFue Heece& ceW Yeer oer ieF& metevee cesjer/nceejer meJeexece peevekeejer kes Devegmeej mener Deewj erke nw~
ceQ/nce yeQke / Gmekes _________________________
eefleefveefOeeeW kees Fme yeele kes efueS eeefOeke=le kejlee ntB/kejles nQ efke Jes Gefele kele&JeHejeeCelee kes efueS Fve HeeceeX ceW efoS ieS efJeJejCeeW kee meleeHeve kej ueW ~
yeQke kees eer/eerceleer
, nceceW mes Henues Jeeues Jeeqkele / yeeo Jeeues Jeeqkele, Henues veece Jeeues / otmejs veece Jeeues Deeefo ee nceces mes efkemeer Yeer Ske ee GejpeerJeer, efkemeer Yeer Ske ee nceceW mes
GejpeerJeer kes GejpeerefJeeeW mes efueefKele DeeJesove eeHle nesves Hej yeQke eje eLeeefveOee&efjle Gve MeleeX Deewj efveyebOeveeW kes DeOeerve (ke) nceejs mebegkele veeceeW Hej peejer keer peeves Jeeueer meeJeefOe pecee jmeero keer eefleYetefle Hej $eCe / Deefece cebpetj
kejves (Ke) nceceW mes Henues Jeeues Jeeqkele, yeeo Jeeues Jeeqkele nceceW mes Henues veece Jeeues Jeeqkele ee efHej otmejs veece Jeeues Jeeqkele ee GejpeerJeer Deeefo, nceceW mes meYeer kes veece / nceceW mes efkemeer Yeer Jeeqkele ee nceceW mes GejpeerJeer/GejpeerefJeeeW
kees Gkele peceejeefMe kes DeeieceeW kee meceeHetJe& Yegieleeve kejves kee Hetje DeefOekeej nesiee~
kesJeue ``DeuHe yeele eespevee,, kes ceeceues ceW ueeiet ~ ceQ/nce MeeKee kees Fme yeele kes efueS eeefOeke=le kejlee ntB/kejles nQ efke Jen efkemeer Yeer efJee Je<e& kes oewjeve efkemeer Yeer mecee cesjs/nceejs meYeer KeeleeW ceW MeeKee kes Heeme He[s pecee Mes<e kes kegue
efceueekej (.50,000/-) HeS Heeeme npeej mes DeefOeke nes peeves ee Keeles / KeeleeW ceW kegue $eCe keer jkece kes (.1,00,000/-) HeS Ske ueeKe mes DeefOeke nes peeves Hej cesjs/nceejs eje `DeHeves eenke kees peeefveS, keee& efJeefOe kee
Hetjer lejn Heeueve ve efkeS peeves leke Deeies uesve-osve keer Devegceefle ve eoeve kejW~
Heece& mebyebOeer efkemeer Yeer ekeej kee efJeJeeo nesves keer efmLeefle ceW Debespeer Hee kes Devegmeej JeeKee keer peeSieer~
mLeeve :
Heeses
1)
2)
3)
efoveebke
yeQke DeefOekeeefjeeW
keer GHeefmLeefle ceW
nmlee#ej
Heeses
--------------------------------------
Heeses
--------------------------------------
efleefLe :
--------------------------------------
efkemeer otmejs yeQke mes Heefjee nesves keer efmLeefle ceW (kesJeue yeele yeQke Keeles kes efueS ueeiet)
ke=Heee Heefjeekelee& yeQke mes meleeHeve kejW.
yeQke Deewj MeeKee kee veece
ceQ Hegef kejlee efke ceQ/nce osvee yeQke ceW 6 cenerveW mes DeefOeke mecee mes Keelee Oeejke ntB/nQ.
ceQ Hegef kejlee ntB efke ceQ eer/eerceleer _________________________________ kes megHeg$e/Helveer/megHeg$eer/eer/eerceleer/megeer _________________________________ kees
efHeues _______ cenerveW/Je<eeX mes peevelee ntB, Deewj Keelee Keesueves kes Fme DeeJesove Heece& ceW GefuueefKele Gvekes/Gvekeer/Heneeve, JeJemeee Deewj Heles keer
Hegef kejlee ntB~ ceQ/nce KeeleeOeejke kes HeeseseeHe keer Hegef kejlee ntB/kejles nQ~
mLeeve
efleefLe
Heefjeekelee& kee nmlee#ej
eceeefCele efkeee peelee nw efk,e Heefjeekelee& kes Keeles kee Heefjeeueve Deewj mebeeueve mevlees<epeveke nw ~ DeeJesoke ves nceejer GHeefmLeefle ceW nmlee#ej efkeee nw ~ nce en Yeer eceeefCele kejles nQ efke nceves
`DeHeves eenke kees peeefveS mes mebyebefOele efoMeeefveoxMeeW kee DevegHeeueve efkeee nw ~ nce Deve otmejs yeQke eje efoS ieS Heefjee kees meleeefHele kejves keer Hegef kejles nQ ~
mLeeve
efoveebke
cegKleejveecee mebKee
Section-IX
Passbook
PREFERENCE
Statement
If Statement :- Periodicity
Daily
Weekly
by post
via email
Mode of Despatch
by fax
Excepted Volume and level of activity (per month approximately) Amount in thousands
Transactions
Number
Cash Deposits
Cash Withdrawal
Section-X
FACILITIES REQUIRED
ATM card #
Tele Banking
Debit Card #
Monthly
Value
Internet Banking
Mobile Banking
Account No.
Nature of Facility
Amount
Date
Signature of applicant/s
PHOTO
1) Photograph to be
pasted here and not
stapled.
2) Applicant should
sign across
photographs.
3) Branch Round
stamp to be affixed
on the corner of the
pasted photo
Signatures in
the presence of
Bank Officials
PHOTO
PHOTO
Date :
Signature of witness
I confirm that I/we am/are account holder/s with Dena Bank for over 6 months.
I confirm that I have known Mr. / Mrs. / Miss ____________________________________ S/o, W/o, D/o Mr/Mrs _______________________________________
since last ___________________ months / years and confirm his / her / their identity, Occupation & address stated
in this application to open the account. I/We confirm the photographs of the account holder.
Place :
Date :
Certified that operation and conduct of the introducers account is satisfactory. Applicant has signed in our presence. We also certify that we have complied with KYC
guidelines. We confirm having verified the introduction given by other Bank.
Place :
Date :
Signature of Officer
P A No.
eenke Heneeve e.
DeeHekees yesnlej {bie mes mecePeves -- DeeHekees yesnlej mesJee eoeve kejves kes efueS DeeHe nceejer meneelee kejW~ GheueyOe eoe meteveeDeeW kees ieesHeveere jKee peeSiee ~
nce DeeHekes eeemeeW Deewj efoS ieS yengcetue mecee kes efueS DeeHekees OeveJeeo osles nQ ~
I Jeeqkeleiele efJeJejCe :
Hetje veece :
ie=n veiej
JewJeeefnke efmLeefle: efJeJeeefnle / DeefJeJeeefnle
sueerHeesve/ceesyeeFue mebKee :
Heefle/Helveer
DeeefeleeW keer mebKee :
Deeeg mecetn kes
Heg<e
HeeefjJeeefjke
m$eer
meomeeW keer mebKee
Mew#eefCeke
mJeeb
eesielee
Heefle Helveer
sueerHeesve mebKee
efHeve kees[ :
JeJemeee kes efueS DeefOeceeve mecee
ceelee-efHelee
kee@ue ve kejW
FveceW mes keesF& veneR
yees
18 mes 40 Je<e&
41 mes 60 Je<e&
meb.
meb.
meb.
meb.
meb.
meb.
mveeleke
meb.
mveelekeesej
Heer.Se.[er
meb.
HetJe&mveeleke
mveeleke
mveelekeesej
Heer.Se.[er
JeeJemeeefeke
efJekeueebie
Heoe&veMeeR
jkele etHe
S + Hee@efpeefJe
Syeer + Hee@efpeefJe
S - efveiesefJe
Syeer - efveiesefJe
yeer + Hee@efpeefJe
Dees + Hee@efpeefJe
yeer - efveiesefJe
Dees - efveiesefJe
II
HetJe&mveeleke
18 mes 40 Je<e&
41 mes 60 Je<e&
JeeJemeeefeke
JesleveYeesieer
mesJeeefveJe=e
[ekej
HesMee
Jekeerue
JeeHeejer
keejesyeej
efJeefvecee&lee
efveeesefpele
Heeqyueke efue. kebHeveer
Heoveece
Jeefj eyebOeve
Jele&ceeve efveeeskelee kes meeLe mesJee kes kegue Je<e& :
mJeefveeesefpele
JeeJemeeefeke
efJee
He$ekeej
efveee&le
Deeeele
eeF&Jes efue. kebHeveer
ceOe eyebOeve
JeJemeee
keejesyeej
ke=ef<e SJeb Gmemes mebye
Fbpeerefveej
HejeceMe&oelee
Leeske efJeeslee
Kegoje JeeHeejer
yengje^ere
keefve eyebOeve
kece&eejer mebKee :
keueekeej
ie=nefvecee&lee
JeemlegefJeo
mJeemLe j#ee
mesJee #es$e
efJeeeLeea
Deve
metevee lekeveerke JeeJemeeefeke
DeOeeHeke
Deve
(efJeefveefo& kejW)
Deve
Deve
mejkeejer #es$e
efueefHeke
F&-cesue
5001 - 10,000
10,000 - 25,000
25,001 - 50,000
eefle Je<e&
eefle Je<e&
IV
mJeeefOeke=le/keypesJeeueer Deeefmle
efveJeeme
GHeYeeskelee efkeeT Jemleg
mJeeefOeke=le Jeenve
Hewle=ke
mJe-Deefpe&le
Jeeleevegketueve eb$e
jsefepejsj
ceeFeesJesJe
Hueepecee/Suemeer[er er.Jeer.
keej
oes Heefnee
ee kejves kee Je<e&
ee kejves kee Je<e&
efkejees kee
JeeefMebie ceMeerve
nesce efLeSj
Deve
DeeJeemeere YetKeC[
kecHetj
neB
JeeefCeeqpeke mecHeefe
ke=ef<e eesie Yetefce
DeefOeceevele: efveJesMe
kece
keee DeeHe nceejer [er cew mesJee eeHle kejvee eenWies
keee DeeHe nceejer iepees[ JeJemLee kes lenle cegegDeue Heb[ ceW efveJesMe kejvee eenWies ?
cegegDeue Heb[
meesvee
je^ere yeele eceeCe He$e
[ekeIej eespeveeS@
1 ueeKe mes 5
ueeKe leke
Mesej
kebHeveer keer peceejeefMe
ueeske YeefJe<e efveefOe
yeercee
Yeejleere efjpeJe& yeQke kes
Deve (efJeefveefo& kejW)
yeeC[
5 ueeKe mes 10
10 ueeKe mes
Metve
ueeKe leke
DeefOeke
neB
veneR
neB
veneR
veneR
Customer ID
Help us to know you better - To serve you better. The inputs provided would be kept confidential.
We thank you for your efforts and time.
I PERSONAL DETAILS:
Full Name :
Father/Husbands Name :
Home Town
Tel No. :
Pin Code :
Do not call
No. of Dependents
No. of family Male
members in
the age
Female
group
Educational Self
Qualification
Spouse
Below 18 years
No :
Below 18 years
No :
Undergraduate
Parents
Children
18 to 40 years
No :
18 to 40 years
No :
Graduate
None
41 to 60 years
No :
41 to 60 years
No :
Undergraduate
Graduate
Visually
impaired
A + ve
AB + ve
Orthopaedically
handicapped
A - ve
AB - ve
Post
graduate
Post
graduate
Deaf
Dumb
B + ve
O + ve
Doctorate
Above 60 years
No :
Above 60 years
No :
Professional
Doctorate
Professional
Pardanishin
None
B - ve
O - ve
II EMPLOYMENT DETAILS
Salaried
Retired
Doctor
Lawyer
Trader
Manufacturer
Public Ltd Co
Senior Mgmt
Occupation
Profession
Business
Employed
Designation
Self employed
Professional
Finance
Journalist
Export
Import
Pvt Ltd Co
Middle Mgmt
Business
Agri & allied
Engineer
Consultant
Wholesaler
Retailer
Multinational
Junior Mgmt
Artist
Home Maker
Architect
Healthcare
Service
Sector
Student
Others
IT Professional
Teacher
Others
(specify)
Others
Others
Govt Sector
Clerk
Employee No.
e-mail :
5001 - 10,000
10,000 - 25,000
25,001 - 50,000
Above Rs 50000
Rs.
p.a.
Rs.
p.a.
Ancestral
Refgerator
Plasma/LCD TV
Car
Year of purchase
Self-Acquired
Purchased
on loan
Washing
Machine
No of cars
Air conditioner
Microwave
Two wheeler
Year of purchase
Rented
Home
theatre
No of Two Wheelers
Company
provided
Others
Housing Plot
Yes
Commercial property
Agricultural Land
Bank deposits
Property
Senior citizens
scheme
Shares
PPF
RBI
Bonds
Company deposits
Insurance
Others (specify)
5 lacs to
10 lac
Yes
Above
10 lac
No
Would You like to invest in mutual funds under our tie up arrangement
Yes
No
Below
1 lacs
Mutual funds
Gold
NSCs
Post office schemes
1 lac to 5
lac
Nil
No
VI
2 ueeKe mes
5 ueeKe leke
neB
veneR
10 ueeKe mes
neB
veneR
keee DeeHe nceejer iepees[ JeJemLee kes lenle peerJeve yeercee uesvee eenWies
efeefkelmee/mJeemLe yeercee
VII
neB
1 ueeKe mes kece
1 ueeKe mes
3 ueeKe leke
veneR
3 ueeKe mes
5 ueeKe leke
keee DeeHe nceejer iepees[ JeJemLee kes lenle efeefkelmee/mJeemLe yeercee uesvee eenWies
neB
veneR
neB
veneR
VIII
keee DeeHe nceejer iepees[ JeJemLee kes lenle meeceeve peerJeve yeercee eeHle kejvee eenWies
$eCe
IX
keej $eCe
DeeJeemeere $eCe
JeeHeej/Geesie
GHeYeeskelee Jemleg
Metve
DeefOeke
eefo neB, lees peejerkelee& kee veece Deewj yeerceeke=le jeefMe
Mesej $eCe
mJeCe& $eCe
Mewef#eke $eCe
Deve $eCe
GHeYeeskelee
Jemleg
keej
6 mes 12 cenerveW leke
Deeweesefieke
efJee
1 mes 2 Je<e& leke
veneR
HeefjJenve
efJee
JeeHeej
efJee
2 Je<e& mes DeefOeke
veece :
XI
F&-cesue :
JeJemeee :
neB
kee[& mebKee :
veneR
neB
veneR
XII
Fvjves HengBe
XIII
ece mebKee
XIV
veece
Iej ceW
keeee&uee ceW
JeJemeee
efHeues leerve Je<ee&x kes oewjeve DeeHekes eje oewje efkeS ieS efJeosMeeW kee efJeJejCe
osMe kee veece
XVI
meercee jeefMe :
eefo neB, lees ke=Heee DeeJesove Heece& emlegle kejW
eeespeve
Yeejleere Meem$eere
efHeuceer ieerle
keLee
Hee@He
iewj keLee
efnvoer efHeuceW
Debespeer efHeuceW
keee&
keee&
ueeevme keueye
HeeefjJeeefjke ger
HeeefjJeeefjke ger
jesjer
FvjvesMeveue
HeeMeele Meem$eere
Jeee
efjefcekeme
ie]peue
Heef$ekeeSb
JeeJemeeefeke ekeeMeve
#es$eere efHeuceW
ceveesjbpeve ee$ee
ceveesjbpeve ee$ee
peeevdme
DeeOeeeqlceke ekeeMeve
Kesue/veeke
keuee emlegefle
leerLe&ee$ee
leerLe&ee$ee
Deve
(efJeefveefo& kejW)
Below 2 lac
2 lac to
5 lac
No
Yes
Above 5 lac
Above 10
lacs
If yes Name of the Issuer and sum assured
Yes
Would you like to avail life insurance under our tie up arrangement
Nil
No
Yes
Below 1 lac
1 lac to
3 lac
No
3 lac to 5 lac
Would you like to avail medical / health insurance under our tie up arrangement
Above 5 lac
Yes
No
Yes
No
IX LOANS
Loans availed
Car loan
Housing loan
Trade/Industry
Durables
Share Loan
Gold Loan
Education loan
Others
No loans
outstanding
Outstanding if
any (Rs)
Yes
Would you like to avail any loan from the Bank in the near future ?
If yes please provide the following information:
Purpose
Education
Housing
Consumer
Car
of Loan
Durables
Expected time of availing the
Less than 6
6 to 12
loan
months
months
Industrial
Finance
1 to 2 years
No
Transport
Trade
Finance
Finance
More than 2 years
X SPOUSE DETAILS
Name
e-mail :
Occupation
Yes
No
Card No.:
Yes
No
Limit
If yes please submit application form
If yes
At home
At office
Name
Occupation
XIV DETAILS OF FOREIGN COUNTRIES VISITED BY YOU DURING THE LAST THREE YEARS
Name of the Country
Year of visit
Purpose
Indian classical
Film songs
Western
Classical
You read
Fiction
Pop
Non Fiction
You watch
Hindi films
English films
Work
Work
Lions Club
Family holidays
Family holidays
Rotary
International
Instrumental
Remix
Ghazals
Magazines
Professional publications
Regional films
Leisure trips
Leisure trips
Giants
None of these
All of these
Spiritual
Publications
None of these
All of these
None of these
All of these
None
None
None
Plays / dramas
Performing arts
Pilgrimage
Pilgrimage
Others
(specify)
ceQ DevegjesOeHetJe&ke DeeHekees Fme yeele kes efueS eeefOeke=le kejlee ntB efke cesjs eje Gkele Keeles Hej Deenefjle, mJeerke=le ee efveefce&le meYeer eskeeW, efJeefvecee efyeueeW, Jeeve He$eeW Deewj Deve kees mJeerkeej kejW, eenW Gkele Keeles ceW
peceeMes<e nes ee Jen Deefle Deenefjle nes ~
efoveebke
nmlee#ej
mJeeefcelJe Hece&
ceQ Iee<seCee kejlee nBt ekfe Gkele Hece& kee ceQ Ske cee$e mJeeceer nBt Deejw DevejgeOseHeJtek&e DeeHekees Fme yeele kes eufeS eeeOfeke=le kejlee nBt ekfe Gkele Keeles Hej cejss Hece& kes veece mes cejss eje Deenejfle, mJeekre=le ee evfeecfel&e meYeer eksee,W
eJfeevfecee eyfeuee,W Jeeve He$eeW Deejw Deve DeeoMseeW kees mJeekreej kej,W eens Gkele Keeles ceW pecee Me<se nes ee Jen Deelfe Deenejfle neW ~ ceQ yekQe kes eelfe DeHeveer Gkele Hece& keer meYeer oseleeDeeW kes eufeS Ske cee$e Gejoeeer jniBtee ~ ceQ Fme yeele
mes mecenle nBt ekfe yekQe cejss Jeekqeleiele DeeemfleeeW kes meeLe-meeLe cejss Gkele Hece& _____________________ keer DeeemfleeeW mes DeHeves oeJes keer Jemeuteer kejW ~ peye keYeer Hece& kes ieve ceW keeFs& HeejfJelev&e neisee lees ceQ Gkele
HeejfJelev&e keer yekQe kees eufeeKfele He ceW meetfele kejves kee yeeve olsee nBt ~ neueeebkfe ceQ DeHeves Gkele Hece& keer meYeer ose jeeMfe kees yekQe kees ekgelee kejves kes eufeS nceMsee Jeekqeleiele He mes leye leke Gejoeeer jniBtee peye leke ekfe yekQe mes
cePges DeHeves He$e keer DeeYfemJeekre=elfe eeHle veneR nes peeleer Deejw Smses veeesfme keer yekQe eje eeeHqle keer leejeKre leke yekQe keer meYeer oseleeSB ekgelee vener nes peeleer ~
efoveebke
mJeeceer
Yeeieeroejer Hece&
nce Gkele Hece& ceW Yeeieeorej nQ Deejw nce DevejgeOseHeJtek&e Fme yeele kes eufeS DeeHekees eeeOfeke=le kejles nQ ekfe oevsees ceW mes ekfemeer Ske / nceceW mes ekfemeer Ske eje DeeHekees peye leke Fmekes eJfeHejelre eufeeKfele He ceW keeFs& veeesfme vener oer
peeleer nw leye leke DeeHe _______________ eje Gkele Hece& keer Deejs mes Deejw Gvekes veece mes Deenejfle, mJeekre=le ee evfeecfel&e meYeer eksee,W eJfeevfecee eyfeuee,W Jeeve He$eeW Deejw Deve DeeoMseeW kees mJeekreej kejW Deejw Keeles kes mecyevOe ceW
Deyeleke eofS ieS ekfemeer Yeer DeveogMseeW kee Heeueve kej,W eens Gkele Keeles ceW pecee Me<se nes ee Jen Deelfe Deenejfle nes ~ Smses ekfemeer Yeer veeesfme keer emfLeelfe ceW Keeles kees oevsee/WmeYeer YeeieeorejeW eje mebekgele He mes Heejfeeeufele ekfeee peeSiee~
peneB leke, eksee,W eyfeuee,W He$eeW Deejw Deve DeeoMseeW kes Hejekbeve kee meybeObe n,w GvnW nceejer Gkele Hece& keer Deejs mes Deejw Gmekes veeceHej oevseeW ceW mes ekfemeer Ske/nceceW mes ekfemeer Ske eje ekfeee peeSiee ~ Fmekes DeueeJee peye keYeer Hece&
kes ieve ceW ekfemeer lejn kee keeFs& HeejfJelev&e neisee, lees ce/Qnce Gmemes eufeeKfele He ceW yekQe kees meetfele kejves kee Jeeve olsee nBt ~ leLeeeHfe, ce/Qnce Gkele Hece& keer meYeer ose jeeMfeeeW kees yekQe kees Deoe kejves nlseg nceMsee Jeekqeleiele He mes
leye leke Gejoeeer jniBtee/jniWes peye leke ekfe yekQe mes cePge/snceW cejs/snceejs He$e keer DeeYfemJeekre=elfe eeHle veneR nes peeleer nw Deejw Smses veeesfme keer yekQe eje HeeJeleer keer leejeKre leke yekQe kees cejser meYeer oseleeSB ekgelee vener nes peeleer ~
efoveebke
___________________
___________________
___________________
Yeeieeroej
Yeeieeroej
Yeeieeroej
nce DevegjesOeHetJe&ke Fme yeele kes efueS DeeHekees eeefOeke=le kejles nw efke oesveeW ceW mes efkemeer Ske/nceces mes efkemeer Ske eje DeeHekees peye leke Fmekes eefleketue keesF& veesefme vener oer peeleer nw leye leke DeeHe
______________________ eje Gkele mebegkele HeefjJeej/efnvot DeefJeYeeefpele HeefjJeej keer Deesj mes mJeerke=le, Deenefjle ee efveefce&le meYeer eskeeW, efJeefvecee efyeueeW, JeeveHe$eeW Deewj Deve DeeosMeeW kees mJeerkeej kejW Deewj
Keeles mes mebyebefOele Deye leke efoS ieS efkemeer Yeer DevegosMeeW kee Heeueve kejW, eens Gkele Keeles ceW pecee Mes<e nes ee Jen Deefle Deenefjle nes ~ Ssmeer efkemeer veesefme keer efmLeefle ceW Keeles kee Heefjeeueve oesveeW/mebegkele He mes nce meYeer
menoeefeke eje efkeee peeSiee ~
peneB leke, eskeeW, efyeueeW, He$eeW Deewj Deve DeeosMeeW kes Hejebkeve kee mebyebOe nw GvnW Gkele Hece& keer Deesj mes Deewj Gmekes veeceHej oesveeW ceW mes efkemeer Ske/nceceW mes efkemeer Ske eje efkeee peeSiee ~ peye keYeer Hece& kes ieve ceW
efkemeer lejn kee keesF& HeefjJele&ve nesiee, lees ceQ Gmemes yeQke kees efueefKele He ceW metefele kejves kee Jeeve oslee ntB ~ neueebefke ceQ/nce Gkele Hece& keer meYeer ose jeefMeeeW kees yeQke kees Deoe kejves nsleg ncesMee Jeeqkeleiele He mes leye leke
Gejoeeer jntBiee/jnWies peye leke efke yeQke mes cegPes cesjs He$eeW keer DeefYemJeerke=efle eeHle veneR nes peeleer nw Deewj peye leke efke Ssmes veesefme keer yeQke eje eeeqHle keer leejerKe leke yeQke kees cesjer meYeer oseleeS@ egkelee vener nes peeleeR ~
efoveebke
mebegkele JeeqkeleieCe
nce DevegjesOeHetJe&ke DeeHekees Fme yeele kes efueS eeefOeke=le kejles nQ efke oesveeW ceW mes efkemeer Ske/nceces mes efkemeer eje DeeHekees peye leke Fmekes eefleketue keesF& veesefme veneR oer peeleer nw leye leke DeeHe
_____________________ eje Gkele Keeles Hej Deenefjle, mJeerke=le ee efveefce&le meYeer eskeeW, efJeefvecee efyeueeW, JeeveHe$eeW Deewj Deve DeeosMeeW kees mJeerkeej kejW Deewj Keeles kes mecyevOe ceW Deye leke efoS ieS efkemeer Yeer
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DeeHekes eje GHee&gkele He mes mJeerkeej efkeS ieS Ssmes meYeer eskeeW, efJeefvecee, efyeueeW, JeeveHe$eeW, SJeb Deve DeeosMeeW Deewj DeHeves Keeles ceW efveefce&le yeepe SJeb eYeej meefnle efkemeer Yeer DeesJej[^eHe nsleg nce mebegkele He mes Deewj
Deueie-Deueie He mes efpeccesoej neWies ~
ce=leg, efoJeeefueee nes peeves ee nceces mes efkemeer Yeer Ske ee Gmemes DeefOeke eje Gme mecee Deewj Gmekes yeeo Gkele Keeles ceW pecee Mes<e kes He ceW He[er OevejeefMeeeW kee DeenjCe efkeS peeves keer efmLeefle ceW Deewj/ee DeeHekes eje
nceejs Keeles ceW keesF& eefleYetefle jKeer peeves keer efmLeefle ceW Jen GejpeerJeer ee nceces mes GejpeerefJeees kees os oer peeSieer ~
peye keYeer Hece& kes ieve ceW keeFs& HeejfJelev&e neisee, lees cew Gkele HeejfJelev&e mes yekQe kees eufeeKfele He ceW meetfele kejves kee Jeeve olsee nBt ~ neueeebkfe cew Gkele Hece& keer meYeer ose jeeMfeeeW kees yekQe kees Deoe kejves nlseg Jeekqeleiele He mes
leye leke Gejoeeer jnitB ee peye leke ekfe yekQe mes cePges DeHeves He$eeW keer DeeYfemJeekre=elfe eeHle veneR nes peeleer Deejw peye leke ekfe Smses veeesfme keer yekQe eje eeeHqle keer leejeKre leke yekQe kees cejser meYeer oseleeSb ekgelee vener nes peeleeR ~
efoveebke
eeefOeke=le nmlee#ejkelee&
nce efvecveefueefKele Yeer Deesef<ele kej jns nw :mebIe kes %eeHeve Deewj Deble&efveece keer eceeefCele eefle
osvee yeQke ceW Keelee Keesueves nsleg mebkeuHe keer eceeefCele eefle
meboYee&Oeerve Keeles kes Heefjeeueve kes efueS eeefOeke=le DeefOekeeefjeeW kes nmlee#ej kes vecetveW
kecHeveer kes Jele&ceeve efveosMekeeW keer eceeefCele meteer
nce kecHeveer kes Deble&efveeceeW ee efveosMeke ceC[ue kes ieve ceW nesves Jeeues efkemeer Yeer HeefjJele&ve ee kecHeveer kes efkemeer lejn kes Hegve&ieve kes mecyevOe ceW efueefKele He mes yeQke kees metefele kejves kee Jeeve osles nQ ~
efoveeke ______________ kees Deeeesefpele ___________________________ kecHeveer (efue.) kes efveosMeke ceC[ue keer yewke kes mebkeuHe keer Ske eefle ~
mebkeuHe efkeee ieee efke Gkele kecHeveer kee yeQefkebie Keelee osvee yeQke ceW Keesuee peeSiee Deewj en efke Gkele yeQke kees Fme yeele kes efueS eeefOeke=le efkeee peeS Deewj Gmes Sleodeje Fme yeele kes efueS eeefOeke=le efkeee peelee nw efke
Jen Gkele kecHeveer keer Deesj mes _____________________________ eje mJeerke=le, Hejebefkele ee efveefce&le meYeer eskeeW, efJeefvecee efyeueeW, JeeveHe$eeW Deewj Deve DeeosMeeW kees mJeerkeej kejs Deewj Gkele Keeles kes mecyevOe
ceW Fme ekeej efoS ieS efkemeer Yeer DevegosMe kes Devegmeej keee& kejW, eens Keeles ceW pecee Mes<e nes ee Jen DeefleDeenefjle nes ~
q
q
q
q
efoveebke
eeefOeke=le nmlee#ejer
nce efvecveefueefKele keer eceeefCele eefleeeB Fmekes meeLe Deesef<ele kej jns nQ
q veeme efJeuesKe/mebefJeOeeve Deewj Ghe efveece
q HebpeerkejCe kee eceeCeHe$e
q osvee yeQke ceW Keelee Keesueves nsleg Heeefjle mebkeuHe keer eceeefCele eefle
q meboYee&Oeerve Keeles kes Heefjeeueve kes efueS eeefOeke=le DeefOekeeefjeeW kes nmlee#ejeW kes vecetves
q Jele&ceeve veeefmeeeW / eyevOeve meefceefle kes HeoOeeefjeeW ee mejkeejer efvekeeeeW keer meteer
nce ______________________________ kes mebefJeOeeve Deewj GHeefveeceeW ee veeefmeeeW/eyebOeve meefceefle/mebeeueve meefceefle keer mejkeejer efvekeeeeW keer mebjevee ceW nesves Jeeues efkemeer Yeer HeefjJele&ve keer efueefKele He ceW
yeQke kees metevee osves kee Jeeve osles nQ ~
efoveebke
eeefOeke=le nmlee#ejer
6
SIGNATURE
PROPRIETORY FIRM
I declare that I am the sole proprietor of the said firm and request and authorise you to honour all cheques, Bills of Exchange, Promissory Notes and other order drawn, accepted
or made by me, in the name of my firm on said account, whether the account be in credit or overdrawn. I shall be solely responsible for all liabilities of my said firm to the Bank. I
agree that the bank may recover its claims from my personal assets as well as from the assets of my said firm M/s. ____________________________. Further whenever any
change occurs in constitution of the firm, I undertake to inform the bank of the said in writing. I shall, however, continue to be personally liable for all dues of my said firm to the
bank until I receive from the bank an acknowledgement of my letter and until all my liabilities to the bank as on the date of the receipt of such notice by the bank, are fully satisfied.
Date :
PROPRIETOR
PARTNERSHIP FIRM
We are partners in the said firm and we request and authorize you until any notice in writing to the contrary is given to you by either/any of us, to honour all cheques, Bills of Exchange,
Promissory Notes and other orders, drawn, accepted or made on behalf and in the name of the said firm by __________________________________ and to act on any instructions
so given relating to the account, whether the account be in credit or overdrawn. In the event of any such notice, the account will be operated by both/all of us partners jointly.
As far as endorsement on cheques, Bills, Notes and other orders are concerned; they will be made by either/any one of us on behalf and in the name of our said firm.
Further whenever any change occurs in constitution of the firm, I/We undertake to inform the bank of the said in writing. I/We shall, however, continue to be personally liable for all
dues of my/our said firm to the bank until I/we receive from the bank an acknowledgement of my/our letter and until all my/our liabilities to the bank as on the date of the receipt of
such notice by the bank, are fully satisfied.
Date :
___________________
PARTNER
___________________
PARTNER
___________________
PARTNER
Date :
JOINT INDIVIDUALS
We request you and authorise you until any notice in writing to the contrary is given to you by either/any of us, to honour all cheques, Bills of Exchange, Promissory Notes, and
other orders, drawn accepted or made on the said Account by ________________________________________ and to act on any instructions so given relating to the account,
whether the account be in credit or overdrawn. In the event of such notice, the account will be operated by both / all of us jointly.
We shall be jointly and severally liable on all such cheques, Bills of Exchange, Promissory Notes and Orders honoured by you as aforesaid, and for any overdrafts created in our
account, together with interest and charges.
In the event of death, insolvency or withdrawal of any one or more of us the monies then and thereafter standing at the credit of the said account and/or any securities held by you
in our account be at the disposal of the survivor or survivors of us.
Whenever any change occurs in the mandate, I/We undertake to inform the bank of the said in writing. I/We shall, however, continue to be personally liable for all dues of my/our said
account to the bank until I/We receive from the bank an acknowledgement that all my/our liabilities to the bank are fully satisfied.
Date :
AUTHORISED SIGNATORY
AUTHORISED SIGNATORY
Date :
AUTHORISED SIGNATORY
Heece& mebKee 60
1.
2.
3.
4.
5.
6.
meleeHeve : ceQ/nce ______________________________________________ Sleodeje Iees<eCee kejlee ntB/kejles nQ efke GHee&gkele keLeve cesjer peevekeejer Deewj efJeMJeeme kes DeeOeej Hej mener nQ,
efpemekee meleeHeve Deepe ____________________ efove _______________________ kees efkeee ieee nw ~
efoveebke :
mLeeve :
nmlee#ej :
heles kes meceLe&ve ceW pees omleeJespe emlegle efkeS pee mekeles nw Jes Fme ekeej nQ :- 1) HeemeHees& 2) Jeenve eueeves kee ueeFmeWme 3) jeMeve kee[& 4) mebmLeeve eje peejer efkeee ieee Heneeve He$e 5) DeeJeemeere Heles kees oMee&ves Jeeues
Deeleve efyepeueer/sueerHeesve efyeue keer eefle 6) DeeJeemeere Heles kees oMee&ves Jeeuee kesvere mejkeej/jepe mejkeej ee mLeeveere efvekeeeeW kes efkemeer eeefOekeejer eje peejer efkeee ieee keesF& omleeJespe ee metevee 7) Deve keesF&
omleeJespeer eceeCe (efjkee[& kes He ceW jKeer ieF& cetue eefle keer meleeefHele eefleeeB)
osvee peerJeve yeele yeQke Keelee kes efueS veeceebkeve (He=< meb. 2 Hej Yeeie IV osKeW)
ceQ/nce Sleodeje eer/eerceleer/kegceejer ____________________________________________ kees cesjer/nceejer ce=leg nes peeves keer efmLeefle ceW yeercee kecHeveer eje ose jkece kees eeHle kejves nsleg
veeefcele kejlee ntB/kejles nQ ~ ceQ/nce en Yeer Ieesef<ele kejlee ntB/kejles nQ efke Gvekeer HeeJeleer yeQke keer egkeewleer oeefelJe cegeqkele kes efueS Heee&Hle nesieer ~ etBefke veeefceleer Fme leejerKe kees veeyeeefueie nw FmeefueS nce
eer/eerceleer/kegceejer _____________________________ kes megHeg$e/megHeg$eer ______________________________ efveJeemeer _______________________________________
Gce ____________ Je<e& kees veeefceleer kes veeyeeefueie nesves leke veeefceleer keer Deesj mes jkece eeHle kejves kes efueS efveegkele kejles nQ ~
efoveebke
nmlee#ej :
ogIe&vee yeerceeegkele kee[& Oeejke kes efueS veeceebkeve (He=< meb. 3 Hej Yeeie X osKeW)
ceQ/nce Sleodeje eer/eerceleer/kegceejer _____________________________________________ kees cesjs/nceejer ce=leg nes peeves keer efmLeefle ceW yeercee kecHeveer eje ose jkece kees eeHle kejves nsleg
veeefcele kejlee ntB/kejles nQ ~ ceQ/nce en Yeer Ieesef<ele kejlee ntB/kejles nQ efke Gvekeer HeeJeleer yeQke keer egkeewleer oeefelJe cegeqkele kes efueS Heee&Hle nesieer ~ etBefke veeefceleer Fme leejerKe kees veeyeeefueie nw FmeefueS nce
eer/eerceleer/kegceejer _____________________________ kes megHeg$e/megHeg$eer ______________________________ efveJeeme _______________________________________
Gce ____________ Je<e& kees veeefceleer kes veeyeeefueie nesves leke veeefceleer keer Deesj mes jkece eeHle kejves kes efueS efveegkele kejles nQ ~
efoveebke
nmlee#ej :
veeceebkeve (veeceebkeve Heece& [er.S. -1) (He=< meb. 2 Hej Yeeie VII osKeW)
yeQke peceejeefMeeeW kes mebyebOe ceW yeQefkebie efJeefveeceve DeefOeefveece 1949 keer Oeeje 45 pes[d S Deewj
yeQkekeejer kecHeveer (veeceebkeve) efveece, 1985 kes efveece 2(1) kes lenle veeceebkeve
ceQ/nce
__________________________________________________________________________________________________________________________
Deeeg
@ etBefke Fme leejerKe kees veeefceleer veeyeeefueie nw : veeefceleer kes veeyeeefueie nesves kes oewjeve cesjer / nceejer / veeefceleer keer ce=leg nes peeves keer efmLeefle ceW veeefceleer keer Deesj mes Keeles ceW peceejeefMeeeW kees eeHle kejves nsleg
ceQ/nce __________________________________________ kees efveegkele kejlee ntB/kejles nQ ~
mLeeve :
efoveebke :
veece :
Helee :
# pene@ peceejeefMe veeyeeefueie kes veece mes pecee keer ieF& nw, JeneB veeceebkeve veeyeeefueie keer Deesj mes keee& kejves kes efueS efJeefOemeccele Hee$e Jeeqkele kes eje veeceebkeve nmlee#eefjle nesvee eeefnS ~ @ eefo veeefceleer veeyeeefueie
vener nw, lees Gmes efvekeeue oW @Debiets kes efveMeeve/efveMeeveeW kees oes meeef#eeeW eje eceeefCele efkeee peeSiee ~
HeeJeleer
_____________ kes mecyevOe ceW veeceebkeve kejves kes efueS eer ________________________ mes veeceebkeve Heece& mebKee [er.S. 1 efoveebke
(Keelee kee veece)
(pecee Oeejke/OeejkeeW kes veece)
eeefOeke=le nmlee#ejkelee&
7
FORM NO 60
1.
2.
3.
4.
5.
6.
Verification : I / We ______________________________________________ do hereby declare that what is stated above is true to the best of my/our knowledge and
belief. Verified today the ____________________ day of _______________________.
Date :
Place :
Signature :
*Documents which can be produced in support of the address are 1) Passport 2) Driving license 3) Ration Card 4) Identity card issued by the institution 5) Copy of the
latest electricity / telephone bill showing residential address 6) Any document or communication issued by any authority of Central / State Govt. or local bodies
showing residential address 7) Any other documentary evidence (copies to be verified with originals held as records)
Nomination for Dena Jeevan Savings Bank Account : (Refer Section IV on Page No.2)
I / We hereby nominate Sh/Smt/Kumari ________________________________________________ to receive the money payable by the Insurance Company in the
event of my/our death. I/We further declare that his/her receipt shall be sufficient to discharge to the Bank. As the nominee is minor on this date we appoint
Sh/Smt/Kum __________________________________ S/D/o ______________________________________R/o ____________________________________
aged ____________ years to receive the money on behalf of the nominee during the minority of the nominee.
Date :
Signature :
Nomination for Card Holder Accident Insurance : (Refer Section X on Page No.3)
I / We hereby nominate Sh/Smt/Kumari ________________________________________________ to receive the money payable by the Insurance Company in the
event of my/our death. I/We further declare that his/her receipt shall be sufficient to discharge to the Bank. As the nominee is minor on this date we appoint
Sh/Smt/Kum __________________________________ S/D/o ______________________________________R/o ____________________________________
aged ____________ years to receive the money on behalf of the nominee during the minority of the nominee.
Date :
Signature :
Distinguishing No.
Relationship with
Depositor, if any
Age
If nominee is minor,
Date of Birth
@ As nominee is minor on this date, I/We appoint __________________________________________ to receive the amount of deposit in the account on behalf of
the nominee in the event of my/our/minors death during the minority of the nominee.
Place :
Date :
Name :
Address :
Signature of witness(es)$
# where deposit is made in the name of a minor, the nomination should be signed by a person lawfully entitled to act on behalf of the minor @ Strike out if nominee is not
a minor $ Thumb impression (s) shall be attested by two witnnesses
$
ACKNOWLEDGEMENT
Received on _________ nomination form no. DA-1 for making nomination from _____________________________ in respect of ___________________________
(Name of Deposit Holder/s)
(Name of the Account)
For DENA BANK
Date :
________________________________________________________________
AUTHORISED SIGNATORY
eenke mecyevOe Heece& meYeer ekeej keer peceejeefMeeeW kes meeLe meeLe iewj-efveefOe DeeOeeefjle meerceeDeeW meefnle GOeej Keeles kes efueS Yeer Fmlesceeue efkeee peeSiee ~
2.
3.
ke=Heee Keeles kes ekeej kes DeeOeej Hej meYeer mecyeefvOele #es$eeW kees Yejles ngS Heece& kees Hetje kejW ~
4.
JeJemeee, mJeHe Deewj Keeles kes ekeej Deeefo pewmes keF& #es$e DeefveJeee& nQ ~ peye leke DeefveJeee& #es$eeW kees Hetje veneR efkeee peelee, leye leke KeeleeW kes ceemj [ee keer jevee kej Heevee
mebYeJe veneR nesiee ~
5.
peneB keneR efJeefJeOe efJekeuHe efoS ieS nw, JeneB ke=Heee kesJeue Ske #es$e Hej mener kee efveMeeve ueieeles ngS kesJeue mecyeefvOele esCeer kees ner oMee&Sb ~
6.
mebegkele Keeles / Yeeieeroejer Keeles / kebHeveer Keeles Deeefo kes ceeceues ceW, peneb menYeeieer Deewj efveosMeke keer mebKee leerve mes DeefOeke nes, DeeHe Gmeer DeeHe ceW Deueie HeVes Hej eleske Heece&
kes efJeJejCe Meeefceue kej mekeles nQ ~
7.
Keelee Oeejke kee Helee nj lejn mes Hetje nesvee eeefnS ~ kesJeue [eke Heser mebKee ner Heee&Hle veneR nesleer ~
8.
peneb keneR Yeer Debiets kee efveMeeve ueieJeeee peeS, lees Gmes Gheegkele He mes mee#eebefkele kejeee peevee eeefnS ~
9.
meYeer Keelees kes efueS He= meb.3 (Yeeie III) keer efkemeer Yeer Ske esCeer mes keesF& Yeer Ske Heneeve eceeCe Deewj Ske Helee Heneeve eceeCe eeHle efkeee peevee nesiee ~
10.
iCe Deewj efJekeueebie JeeqkeleeeW kes Keeles Keesueles mecee ke=Heee Yeejleere efjpeJe& yeQke kes efoMeeefveoxMeeW kee Hetjer lejn mes DevegHeeueve kejW ~
11.
veeyeeefueieeW Deewj Jeefj veeieefjkeeW mes Gce kee eceeCe He$e eeHle kejvee nesiee ~
12.
eceeCe kes He ceW emlegle efkeS ieS meYeer omleeJespeeW kees cetue omleeJespeeW mes meleeefHele kejvee nesiee Deewj Gmekeer eefleee@ eenke mebyebOe Heece& (meer.Deej.SHe.) kes meeLe jKeveer nesieer~
13.
peneB keneR Yeer ueeiet nes, mebueive eeHe ceW Heece& 60 eeHle kejvee nesiee ~
14.
peneb keneR Yeer ueeiet nes, meeceeve eenkeeW kes efueS m$eesle Hej kej keer keewleer Heece& 15 (peer) leLee Jeefj veeieefjkeeW kes efueS 15 (Se) efyevee etke kes eeHle kejvee nesiee ~
15.
mesJeejle meHe kes KeeleeW kes ceeceues ceW YeefJe<e efveefOe mebKee Deewj Heneeve He$e keer eefle eeHle kejveer nesieer ~ mesJeeefveJe=e meHe kes ceeceues ceW mesJee efJeso He$e eeHle kejvee nesiee~
16.
Yeeie IV kes lenle Jelseve Keeles (keeHeejxs) kee eJfekeuHe kesJeue leYeer evgee peevee eeenfS, peye nceejs yekQe kes meeLe keeHeejxs kes Jelseve meebJfelejCe keer JeJemLee keer ieF& nes ~
17.
Hee$e KeeleeW kes efueS mebueive DeeHe ceW veeceebkeve (Yeeie VII) eeHle efkeee peevee nesiee leLee Gmes eCeeueer ceW Hebpeerke=le kejevee nesiee ~ eenke kees Gmekes efefle Yeeie ceW Gmekeer
HeeJeleer osveer nesieer ~
DeeJesoke JekeleJe mebKee 1 mes 8 kees OeeveHetJe&ke He{W Deewj efJeefYevve eeHeeW ceW efoes iees meleeHeveeW Deewj Iees<eCeeDeeW kees mJeerkeej kejW ~ ke=Heee FvnW DevegYeeie mebKee 12, He=< 3 kes
Devegmeej efveefMele Deewj meleeefHele efkeee peees ~
,,
19. ``DeuHe yeele eespevee ceW pecee Mes<e kes eceMe: .40,000/- Deewj .80,000/- kes mlej Hej Hengbe peeves Hej eenke kees Yeejleere efjpeJe& yeQke kes efveeceevegmeej DeHeves ``eenke
,,
kees peeefveS ceeveob[eW kees Hetje efkeS peeves kes yeejs ceW metefele efkeee peevee eeefnS ~
18.
20.
oesveeW keeve efoKeeF& osves Jeeues mwcHe Deekeej kes HeeseseeHe eeHle efkeS peeves neWies ~
21.
HeeseseeHe msHeue efkeS ieS veneR, DeefHeleg mecyeefvOele yeekemeeW ceW efeHekeeS ieS nesves eeefnS ~ HeeseseeHe Hej Keelee Oeejke kes nmlee#ej efkeS ieS neW ~ Gve Hej MeeKee kes meHe
eje ieesue cegnj ueieeF& ieF& nesveer eeefnS ~
22.
veece pees[s peeves / efvekeeues peeves, Heles ceW HeefjJele&ve nesves , nmlee#ej ceW HeefjJele&ve ee Keeles kees mLeeveebleefjle efkeS peeves keer efmLeefle ceW veee nmlee#ej kee[& HeeseseeHe kes meeLe eeHle
efkeee peevee nesiee ~
23.
eeHe nmlee#ej kee[& Deueie mes Yespee ieee nw ~ ke=Heee Fmes eenke mes nmlee#ej kejJeekej leeues SJeb eeyeer ceW megjef#ele jKeW ~
24.
Yejs ngS HeeceeX kees megjef#ele He mes meeJeOeeveerHetJe&ke jKevee nesiee, keeeWefke Jes cenlJeHetCe& omleeJespe nesles nQ ~
25.
Keelee Keesueves Jeeues meYeer JeeqkeleeeW DeLee&le mebegkele KeeleeW kes ceeceues ceW meYeer Keelee OeejkeeW, Yeeieeroejer KeeleeW kes ceeceues ceW meYeer YeeieeroejeW, kecHeveer KeeleeW, Deeefo kes ceeceues ceW
meYeer efveosMekeeW mes eenke eesHeeFue Heece& Deueie mes eeHle efkeS peeves neWies ~
eleske meHe meome mes en DeHesef#ele nw efke Jen eenke mecyevOe Heece& Deewj eenke eesHeeFue Heece& kes meYeer HenuetDeeW mes YeueerYeeBefle Heefjefele neW leLee Gmemes en Yeer DeHesef#ele nw
efke Jen Heece& kees Yejves ceW eenke keer nj ef mes meneelee kejW ~
,,
27. eleske meHe meome mes en DeHesef#ele nw efke Jen Keelee Keesueves ceW ``DeHeves eenke kees peeefveS mecyevOeer ceeveob[eW, eeefuele ceveerueeb[efjbie efJejesOeer efveeceeW kee meKleer mes
DevegHeeueve kejs leLee Fme mecyevOe ces mecee-mecee Hej efoS ieS efJeefJeOe DevegosMeeW kee Yeer Heeueve kejs ~
26.
28.
nceejs yeQke kee Hejce ue#e nw DeHes#eeke=le leerJe keejesyeej Je=ef kes efueS Ske meg{, mLeeeer Deewj ueeYeeo eenke DeeOeej eeHle kejvee ~
CUSTOMER RELATIONSHIP FORM is to be used for all types of Deposits as well as Borrowal accounts including non-fund
based limits.
2.
3.
Please complete the form by filling up the fields relevant to the type of account.
4.
Many fields like Occupation, Constitution, Type of account etc. are mandatory. Unless the mandatory fields are completed, the
creation of master data for the accounts would not be possible.
5.
Wherever various options are given, please indicate only the relevant category by tick marking ONLY ONE of the fields.
6.
In case of Joint A/c / Partnership A/c / Company A/c etc. where the number of Partners/Directors are more than three, you may
incorporate the details for each form in separate sheet in the same format.
7.
The address of the account holder should be complete in every respect. Post box number alone is not sufficient.
8.
9.
Any one Identity proof and one Address proof from either category (Section III) on Page No.2 to be obtained for all the accounts.
10. While opening the account for Sick and Physically handicapped persons, please refer the RBI guidelines scrupulously.
11. Proof of age for minors and Senior Citizens to be obtained.
12. All the documents submitted as proof are to be verified with the originals and copies thereof to be retained along with CRF.
13. Form 60 to be obtained in the enclosed format, wherever applicable.
14. TDS Form 15(G) for regular and 15(H) for senior citizen wherever applicable should be obtained without fail.
15. In case of accounts of serving staff the PF Number and copy of the ID card is to be obtained. In case of retired staff letter of
severance is to be obtained.
16. The option of Salary accounts (Corporate) under Section IV should be selected only when there is an arrangement with our
Bank for disbursement of Salary for the Corporate.
17. Nomination (Section VII) is to be obtained in the enclosed format for eligible accounts and to be registered in the system.
Acknowledgement in the perforated section is to be given to the customer.
18. The applicant should read carefully the statements 1 to 8 and various authorizations and declarations given in the format.
Please check and verify these from Section XII on Palge No.3.
19. In Alpa Bachat Yojana once the balance is reached the level of Rs.40,000/- & Rs.80,000/- respectively, the customer should
be intimated about fulfilling of KYC norms as per RBI rules.
20. Stamp size photographs with both ears visible are to be obtained.
21. Photographs are not to be stapled but to be pasted in the relevant boxes. Photograph to be Signed by the account holder. Round
stamp to be affixed by Branch staff.
22. In case of addition / deletion in name, change of address, change of Signature or transfer of account, fresh signature card is to
be obtained alongwith photograph.
23. The specimen signature card is sent separately. The same should be got signed by customer and preserve it under lock and key.
24. The filled up forms are to be preserved safely and carefully since they are important documents.
25. CUSTOMER PROFILE FORM is to be obtained separately for all the individuals opening the account i.e. all the account holders
in case of joint accounts, all the partners in case of Partnership accounts, all the directors in case of Company accounts, etc.
26. Every staff member is expected to be thorough with each and every aspect of the Customer Relationship Form and Customer
Profile Form and is also expected to help the customer in filling up the form in every respect.
27. Every staff member is expected to open the accounts in strict compliance with KYC norms, Anti Money Laundering rules
prevailing and also comply with the various instructions given from time to time in this regard.
28. Our Banks ultimate aim is to acquire a strong, sustainable and profitable customer base for faster business growth.
Account No.
eenke Heneeve
MeeKee/Branch _______________
Customer ID
Keeles kes ekeej Type of A/c _______________ Hewve (mLeeeer Keelee) mebKee PAN No. _________________
(He=< meb. 2 Hej Yeeie IV kees osKeW /Refer Section IV on Page No.2)
Keelee Heefjeeueve kes efueS DeefOeosMe (ke=Heee Gefele yeekeme ceW efveMeeve ueieeSB) / MANDATE FOR ACCOUNT OPERATION (Please tick the appropriate box)
vecetvee nmlee#ej (kesJeue keeueer meener kee eeesie kejW) / Specimen Signature (use BLACK INK only)
PHOTO
2)
Heeses
Heeses
PHOTO
PHOTO
----------------------------------------
efoveebke :
cegKleejveecee mebKee
Date :