PUNJAB NATIONAL BANK
ACCOUNT OPENING FORM – PNB MITRA (SAVINGS FUND) (All BRANCHES)
The Manager,
Branch Office………………………….
Dist. No…….…………………………..
(FOR OFFICE USE ONLY)
Customer ID No:
(Sole/ first A/c holder only)
Account No.
(16 digits)
I/we request you to open savings fund account as per details given below.
1. Name of sole/first Account Holder (In block letters)
Mr./Ms.
First Name
Middle Name
Last Name
2. Names of the joint account holders (If applicable) (in block letters)
i. Mr./Ms.
First Name
Middle Name
Last Name
Customer ID No.
ii. Mr./Ms.
First Name
Middle Name
Last Name
Customer ID No.
3. Address of sole/first account holder (in block letters) :
Address
City (State)
PIN
Telephone No. (with STD Code)
E-mail
Mobile No.
4. Minor: YES NO If yes, furnish details of guardian
a. Relationship with Minor
Father
Mother
Guardian
b. Name of Guardian: Mr./Ms.
c. Address of Guardian
5. Mode of operation (tick whichever is applicable)
Self
Either or Survivor
Former or Survivor
Any one of us or Survivor(s)
Jointly
Any Other
Any other (to be specified)__________________________
6. Nomination required : YES NO If Yes, please fill form DA-1.
7. ATM/DEBIT CARD: I/we may please be issued ATM Card/ATM cum Debit Card as per following details. I/we have read the terms and conditions governing the use of ATMDEBIT card.
Name of Ist Card holder
Name of 2nd Card holder
Name of 3rd Card holder
FOR RESIDENT INDIVIDUALS (SINGLE / JOINT) ACCOUNTS
8.Nomination for DEBIT/ATM Card holder (ACCIDENTAL INSURANCE): (delete whichever is not applicable)
i) I/We_________________________________________________ hereby nominate Mr./Ms. s/d/w/o___________________ r/o ____ aged___________years to receive the money payable by the Insurance Company in the event of my/our death. I further declare that his/her receipt shall be sufficient discharge to the bank.
(ii) As the nominee is minor on this date, I appoint Mr./Ms.______________________________________________________________
s/d/w/o r/o ____ aged___________years to receive the money on behalf of nominee during the minority of nominee.
9. For identification either (i) or (ii)
(i) INTRODUCTION: I know Mr./Ms._____________________________for the past _______years _______months as a ____________________ (e.g.) friend , relative, neighbour etc. and confirm his/ her occupation as a ____________________ and confirm address(s) as mentioned herein.
a. Introducer’s Name_____________________________ b. Introducer’s address: ______________________________________
Phone ________________________ Signature of the Introducer:___________________________________
Introducer’s Customer ID No.
Introducer’s Account No.
ii) (a). Proof of identity provided : YES NO If yes, give detail :
Passport PAN Card Voter ID Card Govt. /Defence ID Card
Driving license Certificate by Head of Village Council/VDB/as agreed by SLBC Others (specify)_________________
ii) (b). Proof of address provided : YES NO If yes, give detail :
Electricity Bill Telephone Bill Passport Ration Card
Driving Licence Govt / Defence ID Card Others (Specify) __________________
10. Request:
i) Please issue Pass Book: OR Statement of account:
(at my residence/Office /e-mail address (Any one))
ii.
I wish to avail Met-life insurance facility
Y
N
iii.
I wish to avail Medi-claim insurance facility
Y
N
iii.
I wish to avail cheque book facility
Y
N
iv.
Y
N
v.
Y
N
11. I/We request to provide me/us a General Credit Card for Rs 10,000/ (Rs Ten Thousand only) after one year
provided my/our account is conducted satisfactory during the period.
12. DECLARATION
I/We have opened the above deposit account with your bank with simplified KYC norms, since I/We intend to keep balances not exceeding Rs 50,000/ in all my/our accounts taken together with the Bank and that total credit summations in all the accounts taken together would not exceed Rs 1 Lakh in a year. I / We am / are aware, that if, at any point of time, the balance in all my/our accounts with the Bank taken together exceeds Rs 50,000/ or total credit in all the accounts exceeds Rs 1 Lakh in a year, the Bank shall be within its rights to stop further transactions in the accounts until full KYC norms are completed by me / us. I will also close all other accounts maintained with our Bank/other banks within 60 days of the opening of this account.
I have read (a) the Account Rules and hereby agree to be bound by the terms and conditions outlined in these rules which govern the account(s) which I am opening/will open with Punjab National Bank and (b) amendments to the rules made from time to time and those relating to various services availed by me. I understand that the bank may at its absolute discretion discontinue any of the services completely or partially without any notice to me. I have also been made aware of the charges applicable on various services provided by the Bank. I authorise the bank to debit my account for recovery of service charges/incidental charges as applicable from time to time. I hereby declare that the information furnished above is true and correct to the best of my knowledge.
I/We request you to grant me/us financial assistance by way of overdraft* (consumption) for Rs 1000/ (Rupees one thousand only) at ___% p.a. to be charged at monthly rests or at such rates including penal rates which are stipulated by the Bank and credit the proceeds to my/our No-Frill account with you. I/we understand that the review/renewal or the credit facility is at the sole discretion of the Bank.
* (Applicable for Branches working under North-East Zone)
Date:………………………… Customer’s Signature/ : 1. _______________________________________
Thumb Impression
2. ___________________________________
Place:………………...………
3. ___________________________________
13. DECLARATION IN CASE OF A MINOR ACCOUNT
I hereby declare that the date of birth of the minor is ____/____/_____ who is my (relationship) __________________ and I am his/her natural guardian/lawful guardian appointed vide 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 y me in his / her account.
above minor for any withdrawal/transactions made b
DATE _____________________
PLACE _____________________
. SIGNATURE/THUMB IMPRESSION OF GUARDIAN
Cheque Book issued bearing No. From:__________________ to _______________
SIGNATURE OF AUTHORISED OFFICIAL
FOR BRANCH USE
Risk Category : High risk Medium risk Low risk Negligible risk
SIGNATURE
GBPA/SPA/ PF NUMBER
DATE
1. Introducer’s signature verified by
2.Creation of customer master authorized
by
3.Account opening Authorized, copies of documents obtained verified, Customers name checked with the barred list and Risk category verified by
4. If no Introduction/Identity & address proof provided, then the Branch Manager verifies authenticity/genuineness and introduces.
Photograph: Please
paste recent Passport
Size photograph
Photograph: Please
paste recent Passport
Size photograph
PUNJAB NATIONAL BANK
Branch Office…………………………..
Dist. No…….……………….……………
Customer ID
Account No.
SPECIMEN SIGNATURES/THUMB IMPRESSIONS
3. NAMES OF THE ACCOUNT HOLDER(S) (IN BLOCK LETTERS)
i.
Mr.
Ms.
ii.
Mr.
Ms.
iii.
Mr.
Ms.
Mode of operation
Signature(s) verified by:
(With GBPA No.)
FOR BRANCH USE ONLY
SIGNATURE
GBPA/SPA/ PF NUMBER
DATE
1. Information entered in the system by
2. Entered Information Verified by
ATM-cum-Debit Card no.
Date of issue
Issued by (Signature with GBPA/SPA no.)
PUNJAB NATIONAL BANK
Branch Office………………………….
Dist. No…….……………………………
FORM DA-1: NOMINATION
Nomination under Section 45 ZA of Banking Regulation Act, 1949 and Rule 2(1) of the Banking Companies (Nomination) Rules 1985 in respect of Bank Deposits,
I/ We @ Name(s) ________________________________________________________________________________________________
R/o_____________________________________________________________________________________________________________
Nominate the following person to whom in the event of my/our/ minor’s death, the amount of deposit in the account may be returned by Punjab National Bank, B.O.______________
DEPOSIT
NOMINEE
Nature of Account
Account No.
Additional Details, if any
Name
Address
Relationship with depositor, if any
Age
If nominee is minor his/her Date of birth
* As the nominee is minor on this date, I/we appoint Mr/Ms_______________________________________________________
Age________ Address______________________________________________________________________________________
_________________________________________________________________________________________________________
to receive the amount of the deposit on behalf of the nominee in the event of my/our/minor’s death during the minority of the nominee.
Place:_________________________________
Date:__________________________________ @ Signature(s)/thumb impression(s) of depositors
@Where the deposit is made in the name of minor, the nomination is to be signed by natural/legal guardian of the minor to act on behalf of the minor.
*Strike out if nominee is not a minor
WITNESSES#
Name & Signature of first witnesses
Name & Signature of second witnesses
Name___________________________
Signature:________________________
Address:_________________________
Place:___________________________
Date:____________________________
Telephone No._____________________
Name___________________________
Signature:________________________
Address:_________________________
Place:___________________________
Date:____________________________
Telephone No._____________________
#Thumb impression(s) shall be attested by two witnesses, otherwise it shall be attested by one witness.
…………….……………………………………………………………………………………………………………………………………………
A C K N O W L E D G E M E N T
Received on ________________nomination form no. DA – 1 for making Nomination from (Name of deposit Holder(s)) ___________________________ in respect of (Type of Account.) _________________ Deposit Account No._______________________________________________.
Date_____________________.
For Punjab National Bank
(Authorised Official)
(GBPA NO )