APPLICATION for Issuance of LTFD/FD/Recurring Deposit

To Date:- …………………….
Branch Manager
Branch:-……………………… Place:-……………………

Sub:- Application for issue of Term Deposit / Recurring Deposit

Sir,
Please issue a LTFD/FD Receipt for Rs………………………………………………… For …………… Days/Months/ Years as per
particulars written below:
First Name :-…………………………………………............................... Second Name:-…………………………………………………….
Third Name :-………………………………………….............................. Fourth Name:- …………………………………………………….

Mode of Operation:-
A):- Self only B):- Jointly C):- Either or Survivor
D):- Any One or Survivor E):- Former or Survivor
Moreover, I authorize yourself to debit my saving A/c ………………………………………………. for credit transaction of the LTFD.

Nomination:- (Form DA-1)

I/We …………………………………………………………………………………………………………………………………………………………………………………..
nominate the following person to whom in the event of my /our/ minor’s death, the amount of the deposit in the
account opened with this AOF may be returned by the bank.
Name Address Relationship Age/Date of Birth If nominee is a minor,
his date of Birth

As the nominee is a minor on this date, I /We appoint ……………………………………………………………………………………………………..

……………………………………………………………………………………………………………………………………………………… to receive the amount
of the deposit on behalf of the nominee in the event of any/our/minor’s death during the minority of the nominee.
In Case depositor is illiterate, then two witnesses are required for nomination:-
Witness1- ………………………………………………………. Witness 2:- ………………………………………………………………
Address:-……………………………………………………….. Address:- …………………………………………………………………
……………………………………………………………………….. …………………………………………………………………………
……………………………………………………………………….. ……………………………………………………………………….
Thanking you

Signature / Thumb impression

For Office Use:

Account Number allotted: - ………………………………. Authorized Signatory:-………………………………………………