PUNJAB NATIONAL BANK
ACCOUNT OPENING FORM (All BRANCHES)
FOR RESIDENT INDIVIDUALS (SINGLE/ JOINT) ACCOUNTS
The Manager,
Branch Office…………………………..
Dist. No…….……………………………
(FOR OFFICE USE ONLY)
Customer ID No:
(Sole/first A/c holder only)
Account No.
(16 digits)
1. I/we request you to open the following account. I/we agree to be bound by the bank’s rules in force from time to time. (Tick the relevant box on right side).
(To be filled in Block Letters)
(A) Savings Fund Account
(B) PNB Prudent Sweep SF
(Sweep In and Out Facility Required for………days)
(C) Current Account $
(D) PNB Smart Roamer
Current Account $
(Sweep In and Out Facility Required for………days)
(E) Overdraft/Cash Credit $
(F) PNB Spectrum FixedDeposit@
(G) Recurring Deposit
Monthly Instalment Rs………
No. of instalments……………
Interest rate ………….%
(H) Flexi-Recurring Deposit
Monthly Core amount Rs……………
No. of instalments………………
Interest rate ………….%
(I) Tax Saver FD@
(Separate declaration
annexed)
(J) Flexible Rate
Deposit@
(K) OTHERS (specify):
@Amount Rs………………….……………Period: Year………..Months………...Days…….……. Interest Rate: ………..…%
On maturity
Annually
Half Yearly
Quarterly
Monthly
Credit Interest to SF/CA/ CC/OD
Account No.________________
Interest payment frequency
(Pl. tick in the appropriate box)
Credit maturity proceeds to SF/CA/ CC/OD
Account No.__________________
TDS DETAILS
TDS, if applicable: Yes/No If no, exemption reference No.______________________
If Yes, Whether Form 15 G/H* submitted : YES NO
Instruction for Auto Renewal on maturity of deposit (Tick the relevant column)
Renew for Principal & Interest
Renew for Principal only
Period for which Auto renewal required:………
No. of times…………
2. Name of sole/first account holder (in block letters)
Mr./Ms.
First Name
Middle Name
Last Name
$ I /We am/are not availing any credit facility with any other Bank(s)/branch(es) of your Bank and I/We undertake to inform you, in writing, as soon as any credit facility is availed by me /us from any other Bank/branch of your Bank. OR I/We am/are availing credit facilities with other bank(s)/branch(es) of your bank, as per details given in the enclosed sheet
* Form 15G for General Category & Form 15 H for Senior Citizens
PNB 1084 A
3. Names of the joint account holders (If applicable) (in block letters)
i. Mr./Ms.
First Name
Middle Name
Last Name
ii. Mr./Ms.
First Name
Middle Name
Last Name
4. Mode of operation (tick whichever is applicable)
Self
Either or Survivor
Former or Survivor
Any one of us or Survivor(s)
Jointly
Any Other#
# Specify__________________________
5. Nomination required : YES NO If Yes, please fill form DA-1.
6. 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 ATM/DEBIT card.
Name of IstCardholder
Name of 2nd Card holder
Name of 3rd Card holder
7. Account numbers of the customer on which ATM-cum-Debit card services are required (in case the customer has more than one account with Bank)
Main Account No.
2nd Account No.
3rd Account No.
8.Nomination for ATM/DEBIT 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. Internet Banking : I/we may please be allowed Internet Banking as per the following details. I/we have read the terms and conditions
governing the use of Internet Banking.
i) Name of the account holder (s) authorized for using internet banking services :
a.________________________________________________________ b.__________________________________________________
ii) Account numbers on which internet banking services are required (in case the customer has more than one account with Bank)
Main Account No.
2nd Account No.
3rd Account No.
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
iv.
I wish to avail Locker facility
Y
N
v.
I wish to avail on-line Trading facility
Y
N
vi.
I wish to avail cheque book facility
Y
N
vii.
I wish to avail Credit Card facility
Y
N
viii.
Y
N
Date:………………………… Customer’s Signature/ : 1. _______________________________________
Thumb Impression
2. ___________________________________
Place:………………...………
3. ___________________________________
Cheque Book issued bearing No. From:__________________ to _______________
SIGNATURE OF AUTHORISED OFFICIAL
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. & Date)
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.)
Internet issued
(Mention User ID)
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 the 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 )
(ALL BRANCHES)
PUNJAB NATIONAL BANK
Branch Office……………………...
Dist. No…….……………………….
CUSTOMER MASTER FORM
(To be filled in separately by every individual)
(To be filled by bank)
1. Customer ID No.
(Tick the appropriate boxes, wherever required)
Photograph: Please
paste recent Passport
Size photograph.
1. Name of Account Holder (In block letters)
Mr./Ms.
First Name
Middle Name
Last Name
2. Father/Husband’s
Name
3. Gender
Male
Female
4. Place of
Birth
5. Date of birth (DD/MM/YYYY)
6. Nationality
7. Religion
HINDU / MUSLIM / SIKH / CHRISTIAN / OTHERS
8. Category
GENERAL/ OBC / SC / ST
9. Status
Illiterate
Blind
Pardanashin
Phy.Hand.
OTHERS
10. Identification mark__________________________________________________________________
11. Address :
(a) Present Residence
Owned
Parental
Rental
Employer provided
Address
City (State)
PIN
Telephone No. (with STD Code)
E-mail
Mobile No.
(b)Permanent Residence
Owned
Parental
Rental
Employer provided
Address
City (State)
PIN
Office / Business Address
City (State)
PIN
Telephone No. (with STD Code)
12. 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
13. Whether staff member: YES NO If yes, PF account no._____________
14. Occupation :
Salaried-Govt./PSU sector
Salaried-others
Retired -Govt./PSU sector
Retired-Others
Student
Housewife
Self employed
Others - Not working
Medical
Legal
CA/CS
Business-Trading
Business-Industry/Mfg.
Agriculture
Other (specify)
PNB 1084 B
15. Marital status : Married Single
16. Educational qualification :
Up to SSC Graduate Post Graduate Other (specify)_______________
17. Total annual income (individual) ;
Up to Rs.50000
Rs. 50000 - Rs. 1.5lakh
Rs.1.5 lakh - Rs 5 lakh
Above Rs.5 lakh
18. Annual turnover (in case occupation is business) __________________________
Nature of business (Commodity type)________________________________________________
Whether documentary proof in support of item no. 17 & 18 provided : YES NO
If yes, type of Proof : Balance Sheet Income-tax Return
Sales Tax Return Excise Return Other (specify) _______________
19. Whether Income Tax Assessee? YES NO
IF Yes, furnish PAN/GIR NUMBER (If PAN/GIR No. is not applicable, submit Form No. 60/61)
PAN/GIR Number
20. Proof of identity :
Passport PAN Card Voter ID Card Govt. /Defence ID Card
Driving license Others (specify)_________________
21. Proof of address :
Electricity Bill Telephone Bill Passport Ration Card
Driving Licence Govt / Defence ID Card Others (Specify)__________________
22. Name of spouse (In block letters)
Mr./Ms.
First Name
Middle Name
Last Name
Telephone No. (with STD Code)
PIN CODE
E-mail
Mobile No.
Customer ID No. (if any)
Whether employed/self employed
Y
N
If yes, furnish office/Business address
Office/Business
Address
Telephone No. (with STD Code)
23. Whether dealing with any other bank, if yes, please give details
Facilities/services being availed
NAME OF THE BANK AND BRANCH
SF
CA
OD
TL
OTH
24. Whether already dealing with PNB, if yes, please give details
Nature of Account
Account No.
Branch Office
25. Loans availed: (tick whichever is applicable, if yes, mention name of financing institution/bank with amount)
Sl.No.
Type of Loan
YES
NO
NAME OF INSTITUTION
AMOUNT
1.
CAR LOAN
2.
CONSUMER LOAN
3.
HOUSING LOAN
4.
MORTGAGE LOAN
5.
EDUCATION LOAN
6.
ANY OTHER
7.
8.
9.
26. Assets (approximate value) Rs._________________
Details(*) :
Vehicle owned Car Two wheeler Others None
Life policy for Upto Rs 1 lac Upto Rs 2 lacs Upto Rs 5 lacs Above Rs 5 lacs
Pension policy Yes No If yes, give details______________
Medical Insurance Yes No If yes, give details______________
Other Assets :_________________________________________________________________________________
27. Investments (approximate value) Rs._________________
Details(*) & Shares/NSCs/PPF, other deposits etc) (tick appropriately)
(Stocks{
Nationalized Banks
Pvt. Banks
Foreign
Others
Company Deposits
Mutual Funds
Shares
Bank Deposits
Investments
Property
Gold
PPF
Others
Amount :
up to Rs 1 lac Upto Rs. 2 lac up to Rs 5 lac Above Rs 5 lac
28. 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.
29(*). Spouse’s qualification :
Up to SSC Graduate Post Graduate Others (Specify)_______________
30(*).Details about your family members :
Age Group Up to 10 yrs 11 to 20 yrs 21 to 45 yrs 46 to 60 yrs Above 60 yrs Total
No. of Males + + + + =
No. of Females + + + + =
31(*). Any relative settled abroad? Yes No If Yes, please mention their names and addresses.
Name
Address
1.
2.
3.
How many times have you been abroad in last three years?
Never
1 to 5 times
Above 5 times
(*) Optional
32. DECLARATION :
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.
Date__________________
Place__________________
SIGNATURE/THUMB IMPRESSION OF CUSTOMER
33. 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 above his / her account.
minor for any withdrawal/transactions made by me in
DATE _____________________
PLACE _____________________
. SIGNATURE/THUMB IMPRESSION OF GUARDIAN
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