United Bank of India

ADDITIONAL ACCOUNT OPENING FORM
New A/c No.:
FORM – DA1

……………………………Branch
Date: ……../……../…………..…
(DD / MM / YYYY)
(Applicable only if first Account has been opened on KYC Account Opening Form)
Name
1st Applicant: ……………………………………………………………………………………….
2nd Applicant: ……………………………………………………………………………………….
3rd Applicant: ……………………………………………………………………………………….
Address
1st Applicant: ……………………………………………………………………………………….
2nd Applicant: ……………………………………………………………………………………….
3rd Applicant: ……………………………………………………………………………………….
Account
Details
Customer No. KYC A/c No.
(Please tick () the type of Account
Savings Bank
Current Deposit Recurring Deposit
(Monthly Instalment) Rs
Rate of Interest ……………%
Type of New Account
Re-Investment Plan
Others (Specify)
Amount of Deposit Rs
Period of Deposit
DD……………MM……………
YY……………………………..
Deposit Details
Mode of Deposit – Cash/Cheque/DD
Cash Rs. __________________ (__________________________________________________ only)
Cheque/DD No. ______________ dt. __________________ drawn on ____________________
Bank ___________________________ Branch for Rs. _________________________________
Transfer from Savings/Current Account No. __________________________________________
Mandate for Account Operations
Single Jointly by All
Anyone or Survivor
Either or Survivor
Former or Survivor
Others
Schemes
(FD/RIP/RD/Others) Maturity Value Maturity Date Maturity Renewed/Closed
Details
Renewal Instructions
Deposit Renewal Instructions:
o I/We authorize the bank to automatically renew the matured term deposit with/ without accrued interest
for________ period at the prevailing rate of interest unless otherwise instructed by me/us.
o I/We authorize the bank to automatically convert the matured recurring deposit with/ without accrued interest
for________ period to FD/ RIP A/c at the prevailing rate of interest unless otherwise instructed by me/us.
Interest Payment Instructions: Monthly Quarterly
(Please fill in only if the interest is not to be renewed with the Principal)
(Tick () appropriate box)
P.O / D.D to the mailing address Transfer to SB/CA/CC/LN No:
Others (Please specify)
Payment Instructions on Maturity: (Please fill in only if the interest is not to be renewed with the Principal)
(Tick () appropriate box)
P.O / D.D to the mailing address o Transfer to SB/CA/CC/LN No.
Payment Instructions
Others (Please specify)
TDS o To be deducted PAN No__________________________________
Not to be deducted (Form 15H, etc to be submitted every financial year)
Nomination
required
Yes (Please execute the nomination form DA 1 printed overleaf)
No
Please do not indicate the nomination on the passbook / deposit receipt
Standing
Instruction
Please debit monthly instalment of RD A/c__________ from my/our SB/CA/CC account no__________
Agreement
I/We agree to be bound by the Bank’s rules and regulations governing _______________account from time to time.
I/We will maintain minimum balance in the account and in the event of fall in the minimum balance the Bank may realize the appropriate service charge.
Signature (s)
1st Applicant: …………………………………………………………
2nd Applicant: …………………………………………………………
3rd Applicant: ………………………………………………………… …………………………………….
Signature of the Bank Official

Nomination under Section 45 ZA of Banking Regulation Act, 1949 and Rule 2(1) of the Banking (Nomination Rules 1985 in respect of Bank deposits)
I / We _____________________________________________nominate the following person to whom in the event of my / our / minor’s death the amount of deposit in the above account, may be returned by United Bank of India____________________________Branch (Name and address of the branch / office in which deposit is held)
Particulars of Nominee
Name Address Relationship with Depositor, if any Age
If nominee is minor, his / her date of birth
As the nominee is a minor on this date, I / We appoint Shri / Smt /Km …….……………………………………….
……………………………………………….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 the depositor(s)
Name, Signature and addresses of witness: ……………………………………………………………………………
..………..…………………………………………………………………
..…………………………………………………………………………..
..…………………………………………………………………………..
Strike out if the nominee is not a minor
Thumb impression shall be witnessed by two witnesses. One witness in all other cases
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.