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eenke mebyebOe Heece&

CUSTOMER RELATIONSHIP FORM

nceeje Oese / Our Mission


``os v ee yeQ k e DeHeves eenkeeW kees - yeng c et u e Je es ef J eeer e mes J eeSB ,
meHe kees - mekeejelceke keee& JeeleeJejCe Deewj Gvveefle SJeb GHeueeqyOeeeW kes DeJemej,
MesejOeejkeeW kees - Glke= efJeeere ueeYe, meceepe kees - DeeefLe&ke efJekeeme - GHeueyOe kejeSiee~,,
Dena Bank will provide its Customers - premier financial services of great value,
Staff - positive work environment and opportunity for growth & achievement,
Shareholders - superior financial returns, Community - economic growth

Trusted Family Bank

efee eenke / Dear Customer,


osvee yeQke ceW DeeHekee mJeeiele nw / Welcome to Dena Bank.

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

Latest Income tax / wealth tax order with address

JewOe Heeses HeWMeve Hegefmlekee

HeeseseeHe kes meeLe He$e Meer<e& Hej efveeeskelee kee He$e

Valid photo Pension Book

Letter from employer on letter head along with photograph

mJeleb$elee mesveeveer kee JewOe Heeme

jeMeve kee[&/Ration Card

Valid Freedom fighters pass


[^eFefJebie ueeFmeWme/Driving License

esef[ kee[& kee efJeJejCe (Deeleve)/Credit card statement (Latest)

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 ~

In addition to the above, the following are also required :


PAN / GIR No. or Form No.60
Latest stamp size photograph (2 copies) and Customer Profile Form
Introduction from a customer of our Bank banking with us since the last six
months or introduction from your present banker.
For Proprietary / Partnership firms
Declaration of Proprietorship / Partnership.
Registration Certificate of firm (for Partnership firm).
Proof of address, latest stamp size photograph (2 copies) & Customer Profile
Form of the Proprietor/Partners.
Telephone bill in the name of the firm/partners, lease or rental agreement,
conveyance deed etc.
For Limited Companies
Certificate of incorporation.
Certificate of commencement of business (in case of public limited company).
Memorandum and Articles of Association duly certified by a Director /
company secretary as true and up-to-date.
Power of attorney granted to Managers / Officers or employees to transact
business on its behalf.
Latest stamp size photograph of the directors / authorized signatories
(2 copies) and Customer Profile Form.
Copy of the TAN
Copy of the telephone bill of the Company.
Duly certified Resolution passed by its Board of Directors as per the following
specimen :
RESOLVED that a Banking Account of the Company to be opened with DENA
BANK _________________ Branch and that the said Bank be and is hereby
authorized to honor all cheques, Bills of Exchange, Promissory Notes and
other orders accepted, endorsed or made on behalf of the Company by
__________________________________ and to act on any Instructions so
given relating to the account whether the account be in credit or overdrawn.
For Hindu Undivided Families
Declaration of HUF.
Latest stamp size photograph (2 copies) and Customer Profile Form of the
Karta and coparceners.
Telephone bill of the HUF.

For Clubs / Associations / Societies / Trusts etc.


Certified copies of constitution, bye-laws, trust deed, etc.

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.

eje Keesues ieS Keeles : (veece)


nmlee#ej :
eje eeefOeke=le : (veece)

kesJeue yeQke kes eeesieeLe& (DeeF&yeerDeej kees[)


eenke Heneeve

nmlee#ej :___________________ mLeeeer Keelee mebKee ____________


Keelee mebKee

efoveebke ____________ kees eenke/Heefjeekelee& kees Yespee ieee OeveJeeo He$e

Keeles kee ekeej

eenke mebyebOe Heece&

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&)

Hewve/peer DeeF& Deej mebKee *

efuebie
(Heg./m$eer)

je^erelee

eLece Oeejke mes mecyevOe

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

Deve (ke=Heee efJeefveefo& kejW)

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 :

mebj#eke kes nmlee#ej

Jeefj veeieefjke kes ceeceues ceW : Deeeg


meHe kes ceeceues ceW
mesJee ceW

(ke=Heee Deeeg kee eceeCeHe$e emlegle kejW)


mesJeeefveJe=e eefo mesJee ceW nes lees YeefJe<e efveefOe mebKee
mesJeeefveJe=e meHe mesJee efJeso kee He$e emlegle kejW
* DeefMeef#ele Deewj DevOes JeeqkeleeeW kes ceeceues ceW Yeeie XII He= meb.3 ceW mee#eer kee Helee Deewj Gmekee nmlee#ej eeHle efkeee peeS.
Yeeie - II DeeJesoke kee mJeHe (eeuet KeeleeW kes efueS)
mLeeHevee keer efleefLe (Hecee&X/kecHeefveeeW kes ceeceues ceW)
(efove/ceen/Je<e&)
mJeeefcelJe
Yeeieeroejer
ee. efue. kecHeveer
efue. kecHeveer
keueye/mebmLee/meesmeeeer
efnvot DeefJeYeeefpele HeefjJeej
efJeosMeer kecHeveer
HebpeerkejCe mebKee Deewj jepe kee veece (Deej Dees meer) :
efueefces[ kecHeveer kes ceeceues ceW eefo Jen Mesej yeepeej ceW meteerye nw.
neB
veneR
keee Yeeieeroejer Hece& Hebpeerke=le nQ
neB
veneR
HebpeerkejCe keer efleefLe
(eeuet Keeles kes ceeceues ceW ke=Heee Fmekes meeLe mebueive mebyebefOele DevegyevOe kees YejW)

Yeeie - III [eke es<eCe kee Helee


eLece Oeejke
Heuew veb.:

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)

Account opened by : (Name)


Sign :

For Bank use only (IBR Code)

Authorized by : (Name)
Customer ID
Sign :
Account No.

P. A. No. :

Letter of thanks sent to customer / introducer on ________________

Account Type

Customer Relationship Form


To,
The Branch Manager
Dena Bank

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

PAN / GIR NO.#

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

Name of Parent / Natural Guardian :

Date of Birth of Minor :


Address of
parent /
guardian :
Relationship with minor

Pensioner

Father

Mother

By Court Order (enclose copy)

Others (Pl specify)

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

IN CASE OF SENIOR CITIZEN : AGE


(Please submit proof of age)
In
Retired
In case of Staff
If in service PF No.
Service
Retired staff to submit letter of severance
# In case of illiterate and Blind persons obtain address of witness and signature in section XII (Page No.3)

Section-II CONSTITUTION OF APPLICANT (FOR CURRENT ACCOUNTS)


Date of establishment (in case of Firms / Companies)
dd/mm/yyyy
Proprietorship
Partnership
Pvt Ltd Co.
Ltd. Co
Trust
Club / Association / Society
HUF
Foreign Co.
Others (specify)
Reg No and name of state (ROC) :
In case of Ltd Co whether listed in stock exchange
Yes
No
Whether partnership firm is registered
Yes
No
Date of registration
(In case of current accounts please fill in the relevant annexure attached herewith)
Section-III MAILING ADDRESS
1st
Flat No.
HOLDER
Area / Street :
City :

Apptt / Co op. soc. :


Land Mark :
Pin :

State :

Ph (O)
Mobile

Ph (R)
Fax

Email :
2nd
HOLDER

Flat No.

Apptt / Co op. soc. :


Land Mark :

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

Yeeie - IV Keesues peeves Jeeues Keeles kee efJekeuHe


Keeles kee ekeej
Keelee mebKee (kesJeue yeQke kes eeesie kes efueS)
jeefMe
q eeuet
yeele
veeyeeefueie yeele eespevee
DeuHe yeele eespevee
Jesleve Keeles (keeHee&xjs)
efceeeoer pecee (ceeefmeke ee efleceener
yeepe meefnle)
osvee eer[ce pecee eespevee
mece=ef pecee jmeero
Jeefj veeieefjke efce.pe. jmeero/mece=ef pecee jmeero
mesJeer efHekeme Keelee
ceeefmeke efkeMle keer jkece
DeeJeleea pecee $
HetBpeeriele DeefYeueeYe pecee
DeesJej [^eHe megefJeOee
vekeoer GOeej megefJeOee
Deve (ke=Heee efJeefveefo& kejW)
$ ke=Heee cesjs/nceejs yeele yeQke Keelee mebKee _____________________ ceW veeceW [eues (DeeJeleea pecee Keelees kes efueS mLeeeer DevegosMe)
veneR
* ceQ osvee peerJeve yeele yeQke Keelee kes lenle .1.00 ueeKe kee peerJeve yeercee eeHle kejvee eentBiee
neB
(menceefle men eeefOekeej Heece& mebueive nw)

DeJeefOe
ueeiet veneR
ueeiet veneR
ueeiet veneR
ueeiet veneR
ueeiet veneR

ueeiet veneR

ueeiet veneR
ueeiet veneR

Yeeie - V Keelee Keesueves kes efueS Yegieleeve kee yeewje


eeuet/yeele yeQke Keelee mebKee __________________ ceW veeces [eueW.
vekeoer
eske (mJeeb DeHeves veece Hej) mebKee
Hej Deenefjle
yeQke
MeeKee
Yeeie - VI Keelee Heefjeeueve kes efueS DeefOeosMe
oesvees ceW mes keesF& Ske ee GejpeerJeer
HetJe&Jelee&a ee GejpeerJeer
keesF& Ske ee GejpeerJeer
Skeue
meYeer eje mebegkele He mes
mJeeceer
keesF& Ske Yeeieeroej/veemeer/efveosMeke
kelee& eje (efnvot DeefJeYeeefpele HeefjJeej)
mebegkele He mes keesF& oes
mebkeuHe kes Devegmeej
eeefOekeej He$e kes Devegmeej
Deve (efJeefveefo& kejW)
neB
veneR
eske yegke eeefnS
neB
veneR
yeng Menjer eske eeefnS
cesjs yeele Keeles ceW Heee&Hle pecee Mes<e nesves keer efmLeefle ceW, ceQ yeQke kees eeefOeke=le kejlee ntB efke Jen/cesjs mesJeerefHekeme pecee Keeles keer etefveW Ieekej cesjs yeele Keeles mes efveefOeeeW kee DevlejCe
kejkes cesjs eskeeW keer efvekeemeer/DeenjCe keer Devegceefle oW ~
ceQ eske/eskeeW keer JeeHemeer keer efmLeefle ceW, cesjs/nceejs eeuet/yeele yeQke/vekeo GOeej/DeesJej[^eHe Keeles ceW .15000/- leke keer lelkeeue $eCe megefJeOee eeHle kejvee eentBiee ~ ceQ/nce Jeeve oslee
ntB/osles nQ efke mebyebefOele DeJeefOe kes efueS ueeiet yeepe meefnle DemJeerke=le eske/eskeeW kes efueS DeHesef#ele efveefOeeeB lelkeeue GHeueyOe kejeTBiee ~
neB
veneR
Yeeie - VII DeHesef#ele veeceebkeve (Jeeqkeleiele Keeles/mJeeefcelJeHetCe& Hecee&X kes efueS ueeiet)
eefo neB, lees ke=Heee mebueive veeceebkeve Heece& YejW :
Yeeie - VIII meeJeefOe peceejeefMeeeW kes efueS (er.[er):DeeHe yeepe kee Yegieleeve efkeme ekeej efkeee peevee Hemebo kejWies ?
yeQkeme& eske peejer kejW
vekeo (kesJeue mJeerkeee& jkece)
Keelee mebKee __________________________________ ceW pecee kejW
___ kes efueS cetue Oeve Deewj
____ kes efueS kesJeue
HeefjHekeJelee Hej
yeQkeme& eske peejer kejW
Keelee mebKee ____________ ceW
yeepe kee veJeerkejCe kejW
cetueOeve kee veJeerkejCe
pecee kejW
ceQ/nce yeQke kees eeefOeke=le kejlee ntB/kejles nQ efke Jen cesjs/nceejs eje peyeleke DeveLee ve metefele efkeee peeS, Gheefele yeepe meefnle Gkele pecee jeefMe kee HeefjHekeJelee efleefLe kees eeefuele
yeepe oj Hej Ske Je<e& kes efueS mJeecesJe veJeerkejCe kej os ~
ceQ/nce DeeHe kees osvee eer[ce pecee eespevee kes lenle ueeiet nesves Jeeueer Melee&X SJeb efveyebOeveeW kes DeOeerve cegPes/nceW ee GejpeerJeer kees cetue jkece kes 90% leke keer DeesJej[^eHe megefJeOee eoeve
kejves kes efueS eeefOeke=le kejlee ntB/kejles nQ~
er.[er.Sme. : eesle Hej kej keewleer (kesJeue er.[er. Keeles kes efueS)
eesle Hej keewleer ceW t kes efueS emlegle efkeS ieS omleeJespe
Heece& 15 peer SJeb 15 Se
kej ceW t kee eceeCeHe$e
ceQ/nce Jeeve oslee ntB/osles nQ efke eleske Je<e& 31 ceF& mes Henues en Heece& emlegle keieeB/kejWies ~ Heece& emlegle ve kejves keer efmLeefle ceW yeQke efveeceevegmeej eesle Hej kej keer keewleer kej mekelee nw ~

3rd
HOLDER

Flat No.

Apptt / Co op. soc. :


Land Mark :

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

Capital Gain Deposit


Overdraft Facility
Cash Credit Facility
Others (Pl specify)
# Please debit my/our account No. _____________________ (Standing instruction for RD account)
I would like to avail of life insurance upto Rs.1 lac under your Dena Jeevan SB A/c
Yes
(cosent cum authorization form attached)
PAYMENT DETAILS FOR OPENING OF ACCOUNT
Section-V
Cash
Debit C/A No / SB A/c No.
Cheque (self) No.
Drawn on

Period
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Not Applicable

Not Applicable
Not Applicable

No

Bank

Branch

MANDATE FOR ACCOUNT OPERATION


Section-VI
Either or survivor
Former or survivor
Anyone or survivor
Single
Jointly by all
Proprietor
Any one partner / Trustee / Director
By Karta (HUF)
Any two jointly
As per resolution
As per Letter of Authority
Others (specify)
Yes
No
CHEQUE BOOK REQUIRED
Yes
No
MULTI CITY CHEQUE REQUIRED
In case of insufficient balance in my Savings Account, I authorize the Bank to clear my cheque / allow withdrawal by transferring funds to
my Savings account by breaking units of my Savifix deposit account.
I would like to avail of Instant Credit Facility upto Rs.15000/- in my/our CA/ SB/ CC/ OD account. In the event of return of cheque/s, I / We
undertake to immediately provide the funds against the dishonored cheque/s along with the applicable interest for the respective period.
NOMINATION REQUIRED (Applicable for personal accounts/ Prop firms)
Section-VII
If yes : Please complete the nomination form enclosed.

Yes

No

Section-VIII FOR TERM DEPOSITS(TD) :


How do you want interest to be paid :
Credit to account No. : _____________________________
Issue Bankers Cheque
By Cash (permissible amount only)
ON MATURITY
Renew Principal &
Renew Principal
Issue Bankers
Credit to account No.
Interest for
only for
Cheque
I / we authorize the Bank to automatically renew the deposit with accrued interest for one year on the maturity date at the prevailing rate
of interest unless otherwise informed by me/us.
I / we authorize you to allow me/ us/ or survivor overdraft facility upto 90% of the principal amount subject to the terms and conditions
applicable under Dena Freedom Deposit Scheme.
TDS : DEDUCTION OF TAX AT SOURCE : (FOR TD ACCOUNTS ONLY)
Documents submitted for exemption of TDS
Form 15 (G) / 15 (H)
Tax exemption certificate
I / we undertake to submit this form before 31st May every year. In case of non-submission the Bank may deduct TDS as per rules.

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

megjef#ele pecee ueekej(GHeueyOelee keer Mele& Hej)


efyeue Hes (eeefvele kesveW Hej GHeueyOe)

kee[& Hej cegefle efkeee peeves Jeeuee veece * :


Deefleefjkele kee[eX kes efueS veece* :
Yeeie - XI
ceQ/nce Iees<eCee kejlee ntB/kejles nQ efke ceQves / nceves Deve yeQke / yeQkeeW ee DeeHekes yeQke keer Deve MeeKeeDeeW mes $eCe megefJeOeeSB veneR eeHle kej jKeer nQ / ee Gvekes Heeme cesje/nceeje eeuet Keelee veneR nw/cewb/nce en Jeeve oslee ntB/osles nQ efke pewmes
ner cesjs / nceejs eje efkemeer Deve yeQke / DeeHekes yeQke keer MeeKee mes efkemeer ekeej keer $eCe megefJeOee eeHle keer peeSieer, DeeHekees Gmekeer efueefKele metevee oer peeSieer ~
ceQves / nceves Deve yeQke / yeQkeeW / DeeHekes yeQke keer MeeKeeDeeW mes $eCe megefJeOee eeHle kej jKeer nw / GveceW eeuet Keeles Keesue jKes nQ ~
(ke=Heee Ssmeer megefJeOeeDeeW kes efJeJejCe Deueie mes mebueive kejW)

yeQke SJeb MeeKee kee veece

Keelee mebKee

megefJeOee kee mJeHe

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)

HeeseseeHe eneB efeHekeeSB,


msHeue ve kejW
DeeJesokeeW kees HeeseseeHe
kes Deej Heej nmlee#ej
kejves eeefnS
efeHekeeS ieS Heeses kes
keesves ceW MeeKee keer ieesue
cegnj ueieeSB

efoveebke

yeQke DeefOekeeefjeeW
keer GHeefmLeefle ceW
nmlee#ej

DeeJesoke/DeeJesokeeW kes nmlee#ej

Heeses

--------------------------------------

eLece DeeJesoke kes nmlee#ej


efnerve/DeefMeef#ele JeeqkeleeeW kes Keeles kes ceeceues ceW :
mee#eer kee veece Deewj Helee :
mLeeve :
Yeeie - XIII

Heeses

--------------------------------------

efleere DeeJesoke kes nmlee#ej

efleefLe :

--------------------------------------

le=leere DeeJesoke kes nmlee#ej

mee#eer kee nmlee#ej

Heefjee SJeb Heneeve


Heefjeekelee& kee veece :
osvee yeQke kee eenke nesves keer efleefLe :
Keelee mebKee
eenke Heneeve

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

DeefOekeejer kee nmlee#ej


3

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

SDV Locker (Subject to availability)


Bill Pay (available at select centers)

# Name to be printed on the card


Name for additional cards :
Section-XI
I/We declare that I/we do not have credit facilities / current account/s with other bank/s or other branches of your Bank. I/We undertake to inform you in writing as
soon as any credit facility is availed of by me/us from any other Bank / Branch of your Bank.
I/We have credit facility / Current accounts with other bank/s branches of your bank.
(Please attach details of such facilities separately)

Name of bank & branch

Account No.

Nature of Facility

Amount

Section-XII DECLARATION and UNDERTAKING


1. I / We confirm having received, read and understood the Account Rules and hereby agree to be governed by them for the accounts which I/We am/are opening with
Dena Bank along with amendments from time to time to various services except ATM card / telebanking / Mobile Banking / Bill Pay / Internet Banking. I/we have
read the terms and conditions governing the use of ATM/Debit card etc.
2. I / We, accept and agree to be bound by the said terms and conditions stated above including those which are limiting the Banks liability.
3. I / We, understand that the bank may at its absolute discretion amend or discontinue any of the services completely or partially without any notice to me/us. I/We
agree that the bank may debit my account for service charges as applicable from time to time.
4. I / We also declare that the authorizations and declarations given by me/us to the Bank herein are out of my/our free will with full knowledge and awareness.
5. I / We hereby declare that the information furnished above and also in the enclosed Customer Profile Form is true and correct to the best of my/our knowledge.
6. I / We authorize the Bank/their representatives to verify the details given in these forms for due diligence.
7. The Bank may on receipt of written application from Shri/Smt. ____________________________ the former/the latter/the first name, the second name etc of us
or Either or Survivor of us, Any one or Survivors of Survivor of us, the Bank may in its absolute discretion and subject to such terms and conditions as the Bank may
stipulate, (a) grant a loan/advance against the security of the term deposit receipt to be issued in our joint names or (b) make premature payment of the
proceeds of the deposit to the former / the latter/the first named of us/either the second or survivor of us etc. named of us/any one of us or survivor/s of us.
8. Applicable only for Alpa Bachat Yojana I/We authorize the branch not to permit further transactions if at any point of time during any financial year in all my/our
accounts the balance with the branch taken together exceeds Rupees Fifty thousand (Rs.50000/-) or total credits in the account/(s) taken together exceeds
Rupees One lakh (Rs.1,00,000/-) until the full KYC procedures is completed by me/us.
Place :

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

-------------------------------------Signature of 1st APPLICANT

PHOTO

-------------------------------------Signature of 2nd APPLICANT

-------------------------------------Signature of 3rd APPLICANT

In case of Blind/Illiterate Persons accounts :


Name of the witness and address :
Place

Date :

Signature of witness

Section-XIII INTRODUCTION AND IDENTIFICATION


Name of the Introducer :
Customer of Dena Bank Since :
Account No.
Customer ID

In case of introduction from another Bank (applicable


Only for SB accounts), please verify with introducing Bank.

Name of the Bank and Branch :

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 :

Signature of the Introducer

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 eesHeeFue Heece&

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 :

efHelee/Heefle kee 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

18 Je<e& mes kece

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&

60 Je<e& mes DeefOeke

meb.

meb.

meb.

meb.

meb.

meb.

mveeleke

meb.
mveelekeesej

Heer.Se.[er

meb.

HetJe&mveeleke

mveeleke

mveelekeesej

Heer.Se.[er

JeeJemeeefeke

DeeJesoke keer esCeer

ele#e He mes Devepe&ke

efJekeueebie

yenje Deewj ietBiee

Heoe&veMeeR

FveceW mes keesF& veneR

jkele etHe

S + Hee@efpeefJe
Syeer + Hee@efpeefJe

S - efveiesefJe
Syeer - efveiesefJe

yeer + Hee@efpeefJe
Dees + Hee@efpeefJe

yeer - efveiesefJe
Dees - efveiesefJe

II

18 Je<e& mes kece

HetJe&mveeleke

18 mes 40 Je<e&

41 mes 60 Je<e&

60 Je<e& mes DeefOeke

JeeJemeeefeke

jespeieej kee efJeJejCe

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

efveeeskelee kee veece


Deewj Hetje Helee
sueerHeesve
III

F&-cesue

Deee kee efJeJejCe :

ceeefmeke Deee (eefo JesleveYeesieer nw)


5000 leke

5001 - 10,000

10,000 - 25,000

.50,000 mes DeefOeke

25,001 - 50,000

keejesyeej / JeJemeee / HesMes mes Devegceeefvele Jeeef<e&ke Deee

eefle Je<e&

Deve Deee, eefo keesF& nes

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&

$eCe Hej Kejeroe ieee

efkejees kee

kecHeveer eje GHeueyOe

JeeefMebie ceMeerve

nesce efLeSj

Deve

keejeW keer mebKee

keej efvecee&lee-kebHeveer cee@[ue


DeeefmleeeB (Deve)
V

oes Heefnee JeenveeW keer mebKee


keee keej efveeeskelee eje GHeueyOe kejeF& ieF& nw

DeeJeemeere YetKeC[

kecHetj

neB

JeeefCeeqpeke mecHeefe
ke=ef<e eesie Yetefce

efveJesMe kee efJeJejCe : DeefOeceevele: efveJesMe

DeefOeceevele: efveJesMe

Mesejes ceW efveJesMe keer jeefMe

yeQke ceW peceejeefMeeeb


mecHeefe
Jeefj veeieefjke eespevee
1 ueeKe mes

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 Profile Form

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 :

Martial Status : Married / Single


Telephone / Mobile No. :

Do not call

Preferred time of calling :


Spouse

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

Special Status if any


Blood Group

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.

No of years in service with present employer :


Employers
Name and full
address
Telephone :

e-mail :

III INCOME DETAILS :


MONTHLY INCOME (IF SALARIED)
Upto 5000

5001 - 10,000

10,000 - 25,000

25,001 - 50,000

Above Rs 50000

ESTIMATED ANNUAL INCOME FROM THE BUSINESS / PROFESSION / OCCUPATION

Rs.

p.a.

OTHER INCOME IF ANY

Rs.

p.a.

IV ASSET OWNED / POSSESED


Residence
Consumer durables
Vehicles owned

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

Cars Make / Model


Assets
(Others)

Company
provided
Others

Whether car is provided by employer


Computer

Housing Plot

Yes

Commercial property
Agricultural Land

V INVESTMENT DETAILS : PREFERRED INVESTMENT


Preferred investments

Bank deposits
Property
Senior citizens
scheme

Shares
PPF
RBI
Bonds

Company deposits
Insurance
Others (specify)

Would You like to avail our Demat Services

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

Amount of investment in shares

Below
1 lacs

Mutual funds
Gold
NSCs
Post office schemes
1 lac to 5
lac

Nil

No

peerJeve yeercee Heeefuemeer

VI

mJeeb Deewj HeefjJeej kes meomeeW kes efueS


peerJeve yeercee Heeefuemeer (yeerceeke=le jeefMe)
keee DeeHekeer HeWMeve Heeefuemeer nw ?

2 ueeKe mes kece

2 ueeKe mes
5 ueeKe leke

neB

veneR

5 ueeKe mes DeefOeke

10 ueeKe mes

neB

veneR

keee DeeHe nceejer iepees[ JeJemLee kes lenle peerJeve yeercee uesvee eenWies

efeefkelmee/mJeemLe yeercee

VII

keee DeeHeves efeefkelmee/mJeemLe yeercee kejJeeee nw


eefo neB, lees yeercee keer jeefMe

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

5 ueeKe mes DeefOeke

neB

veneR

neB

veneR

meeceeve peerJeve yeercee Hee@efuemeer (DeeefmleeeW kes efueS meeceeve yeercee)

VIII

keee DeeHe nceejer iepees[ JeJemLee kes lenle meeceeve peerJeve yeercee eeHle kejvee eenWies

$eCe

IX

efueee ieee $eCe

keej $eCe
DeeJeemeere $eCe

JeeHeej/Geesie
GHeYeeskelee Jemleg

yekeeee eefo keesF& nes,


(.
)
keee DeeHe yeQke mes efveke YeefJe<e ceW efkemeer lejn kee keesF& $eCe uesvee eenWies
eefo neB, lees ke=Heee efvecveefueefKele metevee oW
$eCe kee
efMe#ee
DeeJeeme
eeespeve
$eCe eeHle kejves kee
6 cenerves mes kece
eleeefMele mecee
X

Metve

DeefOeke
eefo neB, lees peejerkelee& kee veece Deewj yeerceeke=le jeefMe

Mesej $eCe
mJeCe& $eCe

Mewef#eke $eCe
Deve $eCe

keesF& Yeer $eCe


yekeeee veneR
neB

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

Heefle / Helveer kee efJeJejCe

veece :
XI

F&-cesue :

JeJemeee :

esef[ kee[& kee efJeJejCe

Jele&ceeve kee[& kes peejerkelee& kee veece :


keee DeeHe osvee esef[ kee[& uesvee eenWies

neB

kee[& mebKee :
veneR

neB

veneR

XII

Fvjves HengBe

XIII

efJeosMe ceW yemes ngS HeefjJeej kes meomeeW/mebyebefOeeeW kes efJeJejCe :-

ece mebKee

XIV

veece

eefo neB, lees -

Iej ceW

keeee&uee ceW

F&-cesue Heneeve meefnle Helee

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

oewjs kee Je<e&

eeespeve

Meewke Deewj Jeeqkeleiele efe kes #es$e

DeeHekees megveves kee

Yeejleere Meem$eere
efHeuceer ieerle

DeeHekees He{ves kee

keLee

Hee@He
iewj keLee

DeeHekees osKeves kee

efnvoer efHeuceW

Debespeer efHeuceW

DeeHekees efJeosMeeW ceW ee$ee kejves Hej


DeeHekees Yeejle ceW ee$ee kejves Hej
keueye meomelee kee efJeJejCe

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

Deve keesF& Yeer metevee, pees DeeHe eoeve kejvee eenW :

FveceW mes keesF& veneR

FveceW mes meYeer

DeeOeeeqlceke ekeeMeve

FveceW mes keesF& veneR


FveceW mes meYeer
FveceW mes keesF& veneR
FveceW mes meYeer
keesF& veneR
keesF& veneR
keesF& veneR

Kesue/veeke
keuee emlegefle
leerLe&ee$ee
leerLe&ee$ee
Deve
(efJeefveefo& kejW)

VI LIFE INSURANCE POLICY


Life Insurance Policy for self and
family members (Sum asured)
Do you have Pension Policy

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

VII MEDICAL / HEALTH INSURANCE


Do you have Medical/Health Insurance
If yes, amount of Insurance

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

VIII NON LIFE INSURANCE POLICY (General Insurance for Assets)


Would you like to avail non life insurance under our tie up arrangement

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

XI CREDIT CARD DETAILS


Name of issuer of present card:
Would you like to avail Dena Credit Card ?

Yes

No

Card No.:

XII INTERNET ACCESS

Yes

No

Limit
If yes please submit application form
If yes

At home

At office

XIII DETAILS OF FAMILY MEMBERS / RELATIVE SETTLED ABROAD:


Sr. No.

Name

Address with email ID

Occupation

XIV DETAILS OF FOREIGN COUNTRIES VISITED BY YOU DURING THE LAST THREE YEARS
Name of the Country

Year of visit

Purpose

XVI HOBBIES AND AREAS OF PERSONAL INTEREST


You listen to

Indian classical
Film songs

Western
Classical

You read

Fiction

Pop
Non Fiction

You watch

Hindi films

English films

You travel abroad on


You travel in India on
Club Membership Details

Work
Work
Lions Club

Family holidays
Family holidays
Rotary
International

Instrumental
Remix
Ghazals
Magazines
Professional publications
Regional films
Leisure trips
Leisure trips
Giants

Any other information that you would like to provide :

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)

eeuet Keeles kes efueS DevegyevOe


Jeeqkeleiele

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peceeMes<e nes ee Jen Deefle Deenefjle nes ~
efoveebke

nmlee#ej

mJeeefcelJe Hece&
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efoveebke

___________________

___________________

___________________

Yeeieeroej

Yeeieeroej

Yeeieeroej

mebegkele HeefjJeej/efnvot DeefJeYeeefpele HeefjJeej

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
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efceefele Hetbpeer kecHeefveeeB


nce Fmekes meeLe efvecveefueefKele omleeJespeeW kee efvejer#eCe kejves Deewj yeeo ceW GvnW JeeHeme kejves kes efueS Deesef<ele kej jns nwb :q efveieefcele kejves kee eceeCeHe$e
q keejesyeej eejcYe kejves kee eceeCeHe$e

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

veeme : mebIe meefceefle, keueye Deeefo :

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

ANNEXURE FOR CURRENT ACCOUNTS


INDIVIDUALS
I request and authorise you to honour all cheques, Bills of Exchange, Promissory Notes and others, drawn, accepted or made on the said account by me whether the account be
in credit or overdrawn
Date :

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

JOINT FAMILY / HUF


We request 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 behalf of the said Joint Family / HUF by ___________________________________ and to act on any instructions so given relating to the
account whether account be in credit or overdrawn in the event of any such notice, the account will be operated by both/all of us coparceners jointly.
As far as endorsement on cheques, Bills, Notes and other orders are concerned, they will be made by either/any of us on behalf of our said joint family / HUF.
Further whenever any change occurs in the HUF, 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 :

KARTA / AUTHORISED SIGNATORY

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

JOINT STOCK COMPANIES


We forward herewith for inspection and return
q
Certificate of Incorporation
q
Certificate of commencement of Business
We also forward
q
Certified copy of the Memorandum & Articles of Association
q
Certified copy of the Resolution for opening the account with Dena Bank
q
Specimen of the signature of the officials authorised to operate the subject account
q
Certified list of present directors of the company.
We undertake to advise the bank in writing of any change in the Articles of Association or in the Constitution of the Board of Directors of the Company or of any reconstruction of
the company.
A copy of the Resolution at the meeting of the Board of Directors of _________________________________________ (Ltd.) held on ________________________________.
RESOLVED that a Banking Account of the Company to be opened with DENA BANK and that the said Bank be and is hereby authorised to honour all cheques, Bills of Exchange,
Promissory Notes and other orders accepted, endorsed or made on behalf of the company by _____________________________________________ and to act on any
instructions so given relating to the account whether the account be in credit or overdrawn.
Date :

AUTHORISED SIGNATORY

TRUST, ASSOCIATION SOCIETY, CLUB ETC.


We forward herewith certified copies of
q
The Trust Deed / Constitution and Byelaws
q
Certificate of Registeration
q
Certified copy of the Resolution for opening the account with Dena Bank.
q
Specimen of the signatures of the officials authorised to operate the subject Account.
q
List of present Trustees / Office-bearers of the Managing Committee or Governing Body.
We undertake to advice the Bank in writing of any change in the constitution and Byelaws of _____________________________________ or in the composition of the
Trustees/Managing Committee / Governing body.

Date :

AUTHORISED SIGNATORY

Heece& mebKee 60
1.
2.
3.
4.
5.

6.

Iees<eCeekelee& kee Hetje veece :


uesve-osve kee efJeJejCe : veee ______________________________ Keelee mebKee _____________________________
uesve-osve keer jkece : Hees _____________________________
keee DeeHe kee kej efveOee&jCe efkeee ieee nw ?
eefo neB,
i.
lees Gme Jee[&/meke&ue/#es$e kee efJeJejCe peneB Deee keer Deefvlece efJeJejCeer oeej keer ieF& Leer ?
ii.
mLeeeer Keelee mebKee/meeceeve metekeebke mebKee ve nesves kee keejCe yeleeSB ?
kee@uece mebKee 1 ceW Heles kes meceLe&ve ceW emlegle efkeS peeves Jeeues omleeJespe * kee efJeJejCe

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

__________________________________________________________________________________________________________________________

(veece SJeb Helee)


efvecveefueefKele Jeeqkele kees veeefcele kejlee ntB/kejles nQ efpevekees cesjs/nceejs/veeyeeefueie keer ce=leg nes peeves keer efmLeefle ceW osvee yeQke ______________________ MeeKee eje Keeles ceW peceejeefMe, efpemekes efJeJejCe veeres
efoS ieS nQ, JeeHeme keer peeS.
pecee jeefMe keer eke=efle
eYesoer mebKee
Deefleefjkele efJeJejCe, eefo keesF& nes
veeefceleer kee veece Deewj Helee
peceekelee& mes mebyebOe,
eefo keesF& nes

Deeeg

eefo veeefceleer veeyeeefueie nes, lees Gmekeer


pevce efleefLe

@ 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 :

peceekelee& (peceekelee&DeeW) kes nmlee#ej/nmlee#ejeW/Debiets kee efveMeeve

Helee :

mee#eer (meeef#eeeW) kes nmlee#ej $

# 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)

____________________________ kees eeHle ngDee ~

ke=les osvee yeQke

pecee Keelee mebKee :


efoveebke :

eeefOeke=le nmlee#ejkelee&
7

FORM NO 60
1.
2.
3.
4.
5.

6.

Full Name of Declarant : _________________________________________________________________


Particulars of transactions : New ________________________ Account No. ________________________
Amount of Transaction : Rs. ___________________________
Are you assessed to Tax ?
If yes,
i.
Details of ward / Circle / Range where the last return of income was filed ?
ii.
Reasons for not having Permanent Account No / General Index No. ?
Details of document* being produced in support of the address in Column No.1.

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 :

NOMINATION (Nomination form DA-1) (Refer Section VII on Page No.2)


Nomination under Sec 45 ZA of the Banking Regulation Act, 1949 and rule 2 (I) of the Banking Companies
(Nomination) Rules, 1985 in respect of bank deposit.
I/We ___________________________________________________________________________________________________________________________
(Name & Address)
nominate the following person to whom in the event of my/our/minors death the amount of deposit in the account, particulars whereof are given below,
may be paid by Dena bank. _____________________________________ Branch
Nature of Deposit

Distinguishing No.

Additional details, if any

Relationship with
Depositor, if any

Age

If nominee is minor,
Date of Birth

Name & Address of Nominee

@ 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 :

Signature(s)/thumb impression of Depositor(s)#

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

Deposit Account No.

Date :

________________________________________________________________
AUTHORISED SIGNATORY

eenke mebyebOe Heece& SJeb eenke eesHeeFue Heece&


meHe kes efueS efoMeeefveoxMe
1.

eenke mecyevOe Heece& meYeer ekeej keer peceejeefMeeeW kes meeLe meeLe iewj-efveefOe DeeOeeefjle meerceeDeeW meefnle GOeej Keeles kes efueS Yeer Fmlesceeue efkeee peeSiee ~

2.

meYeer meteveeSB kesJeue mHe De#ejeW ceW Yejer peeveer neWieer ~

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 & CUSTOMER PROFILE FORM


GUIDELINES FOR THE STAFF
1.

CUSTOMER RELATIONSHIP FORM is to be used for all types of Deposits as well as Borrowal accounts including non-fund
based limits.

2.

All the information to be filled in Capital Letters Only.

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.

Wherever thumb impression is taken, the same should be properly witnessed.

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.

nmlee#ej kee[& / Signature Card


Keelee mebKee

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)

oesveeW ceW mes keesF& Ske ee GejpeerJeer q HetJe&Jeleea ee GejpeerJeer


keesF& Ske ee GejpeerJeer
q Skeue
q Either
q Anyone
or survivor
Former or survivor
or survivor
Single
meYeer eje mebegkele He mes
mJeeceer
keesF& Ske Yeeieeroej / kelee& (efn.De.HeefjJeej) eje
q Jointly by all
q Proprietor
q Any one partner / By Karta (HUF)
mebegkele He mes keesF& oes
mebkeuHe kes Devegmeej
eeefOekeej He$e kes Devegmeej
Deve (efJeefveefo& kejW)
q Any two jointly
q As per resolution
q As
per Letter of Authority q Others (specify)
Keelee Oeejke kee Hetje veece / Full Name of Account Holder

vecetvee nmlee#ej (kesJeue keeueer meener kee eeesie kejW) / Specimen Signature (use BLACK INK only)

ke=Heee He=< GueefS P.T.O.

Helee : Heuew/cekeeve mebKee/Address : Flat/House No. ____________________________________


DeHee&cesC/kees.Dee@HejsefJe meesmeeeer/Aptt/Co Op Society ___________________________________
ieueer/Street _____________ Heneeve/Landmark ________________ Menj/City ______________
jepe/State ___________ efHeve kees[/Pincode ___________ F&-cesue/Email ___________________
sueerHeesve/Tel ___________ Hewkeme/Fax ___________ ceesyeeFue veb/Mobile No. : _________________
efoveebke/Date : ___________ veeefceefleeeW kes veece/Nominees Name ___________________________
Heeses
1)

PHOTO

eneB HeeseseeHe efeHekeeS@, msHeue


ve kejW
Photograph to be pasted
here and not stapled.

2)

DeeJesokeeW kees HeeseseeHe kes Deej


Heej nmlee#ej Yeer kejves eeefnS

Heeses

Heeses

PHOTO

PHOTO

eLece DeeJesoke/1st APPLICANT

----------------------------------------

------------------------------------------efleere DeeJesoke/2nd APPLICANT

----------------------------------------le=leere DeeJesoke/3rd APPLICANT

efoveebke :

meleeHevekelee& DeefOekeejer kes nmlee#ej

cegKleejveecee mebKee

Date :

Signature of verifying Officer

Power of Attorney No.

Applicants should also sign


across photographs
3)

efeHekeeS ieS Heeses kes keesves ceW


MeeKee keer ieesue cegnj ueieeSB
Branch Round stamp to be
affixed on the corner of the
pasted photo