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KARASSERY SERVICE CO-OPERATIVE BANK LTD.

ISO 9001:2008 Certified
Head Office, Mukkam P.O., Kozhikode - 673 602
Phone : 0495 - 2298588, 2293100. Fax: 0495 - 2294445. E-mail:karacobank@sify.com
BRANCH : KARASSERY. PHONE : 0495 2298568

ACCOUNT OPENING FORM FOR INDIVIDUALS

(Please fill the form in BLOCK LETTERS only)

Office Use only

Customer ID A/c Type No. Date

To
The Manager,

.....................................Branch.
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Dear Sir,

Please open a SB/CA/TD/RD/...................................... Account with your Branch in my/our name. I / We

agree to abide by the rules and regulations which have been read/explained to me/us. I/We hereby tender
Rs. ............................. (Rupees ..................................................................................................only) for the same.

I. APPLICANT’S DETAILS
Applicant No. 1
Name in full : ....................................................................................................................................... Sex: M/F
S/o., D/o., W/o. ....................................................... Age............ DOB.............................
House Name : .............................................................................................................
Place.............................................................Post..........................................................
Dist................................................ State..................................Pincode........................
Address for Communication : .....................................................................................
Place.............................................................................Post....................................................................
Tel (R) ................................... (O) ..................................Mob.............................................
Fax....................................... E-mail ID ..............................................................................
PAN/GIR.No.......................................... (If not available attach form 60/61) Membership No .................................
Category : General/Staff/Sr. Citizen/Minor. Religion: Hindu/Muslim/Christian/Others..........................................

Caste: SC/ST/OBC/General/Others .......................................................................................................................

Education : Undergraduate/Graduate/Post Graduate/Doctorate/Professional/Others ...............................................

Occupation : Salaried/Business/Doctor/Engineer/Lawyer/Retired/Student/Farmer/Others..........................................

Residence : Owned/Rented Marital Status : Single/Married Number of Children: ............................................

Name of Spouse : ..................................................... Occupation of Spouse:.......................................................

Family Income (Annual ): Below Rs. 1.50L / Between Rs. 1.50L & Rs. 2.50L/2.50L & 3.60L/3.60L & 5.00L/above 5L

Vehicles owned : 2 wheeler / 4 wheeler / Others Main Banker : ..........................................

Preferred investment : Company Deposits/Mutual Funds/Shares/Bank Deposits/Property/Gold/Others
Loans availed in the last 3 years : Car/Housing/Mortgage/Business/Agricultural/Gold Loan/Others
Applicant No. 2
Name in full : ....................................................................................................................................... Sex: M/F
S/o., D/o., W/o. ....................................................... Age............ DOB.............................
Address : ..........................................Place.......................................Post.........................
.......................... Dist...................................State...............................Pincode.....................
Address for Communication : .....................................................................................
Place.............................................................................Post....................................................................

Tel (R) ................................... (O) ..................................Mob.............................................

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Fax......................................................... E-mail ID ............................................................................................

PAN/GIR.No.......................................... (If not available attach form 60/61) Membership No ......................................
Category : General/Staff/Sr. Citizen/Minor. Religion: Hindu/Muslim/Christian/Others............................................
Caste: SC/ST/OBC/General/Others .........................................................................................................................
Education : Undergraduate/Graduate/Post Graduate/Doctorate/Professional/Others .................................................
Occupation : Salaried/Business/Doctor/Engineer/Lawyer/Retired/Student/Farmer/Others.............................................
Residence : Owned/Rented Marital Status : Single/Married Number of Children: ..................................................

Name of Spouse : ................................................... Occupation of Spouse:...........................................................

Family Income (Annual ): Below Rs. 1.50L/Between Rs. 1.50L & Rs. 2.50L/2.50L & 3.60L/3.60L & 5.00L/above 5L
Vehicles owned : Two wheeler / Four wheeler/Other Main Banker : ........................................
Preferred investment : Company Deposits/Mutual Funds/Shares/Bank Deposits/Property/Gold/Other
Loans availed in the last 3 years : Car/Housing/Mortgage/Business/Agricultural/Gold Loan/Others
II. ACCOUNT OPERATION INSTRUCTIONS : Single/ Either or Survivor/ Former or Survivor/ Any one
of us or any of the survivor of the last survivor/ Jointly/ Jointly all of us or Jointly the survivors or the last survivor.

III. REQUEST FOR ISSUE OF CHEQUE BOOK : I/We request you to issue a Cheque Book containing .......... leaves.

IV. PAYMENT DETAILS : Cash Rs. .............................. Transfer from A/C. No. .........................................

Cheque/DD No. ......................... drawn on .......................Bank .......................Branch ................................

V. FOR TERM DEPOSITS:

Amount : ............................. Period: ............ Days/Months/Years Rate of Interest ................................%

Payment of Interest : Monthly/Quaterly/Halfyearly/Yearly by transfer to my/our account No.............................or

pay by Pay order fvg............................ Bank ......................... Branch ..........................A/C. No.......................

Address .................................................................................................................................................

(Address of the branch where you require the payment to be sent)

VI. NOMINATION : I/We nominate the following person to whom in the event of my/our/minors death, is
entitled to receive the amount in the account.

Name ............................................................. Address............................................................................

............................................................... Relationship with the depositor (if any) .......................................

(if nominee is a minor) age........................ Date of Birth ............................................................................

as the nominee is a minor on this date, I/we appoint Mr./Ms. .........................................................................

Age.......................... Address................................................................................... to receive the amount

the account on behalf of the nominee in the event of my/our/minors death during minority of the nominee.
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VII. INTRODUCTION : The Ist and IInd applicants are known to me and I confirm the identity, occupation and
address of the applicants.
Name .........................................................................................................................................................
Member/Account No. ........................................... Signature ...................................................................

Verified by ..........................................
VIII. APPLICATION FOR CHANNEL FACILITIES.
I/We hereby apply for an ATM Card (Local/Insta/Others) [ ] Internet Banking [ ] E-mail Alert
[ ] Mobile Alert [ ] Mobile Banking [ ] Tele Banking
Please note: ATM facility is available for operating Instruction : single, E or S and any one or survivor only
IX. DECLARATION : I/We hereby declare that the particulars given above are true and correct. I/We have
read and understood the Terms and Conditions and agree to the Terms and Conditions governing the opening
of an account with Karassery Service Co-operative Bank Ltd. No. D-2628 and those related to various services
including ATM services. I/We am/are bound by the said Terms and Conditions.

I/We authorise the Bank to debit my/our account for service charges as may be applicable from time to time.
I/We confirm that I/We am/are residents of India.

(1) ................................................................................ (2) .............................................................................................

Name & Signature Name & Signature

(Ist applicant) (2nd applicant)

Specimen Signature Specimen Signature

FOR OFFICE USE:

1. Data entry made by ....................................... 1. Signature verified : Yes / No

2. Signature & Photo scanned and 2. Form duly filed : Yes / No
saved by ....................................................... 3. Account No .................. opened on ................

Clerk Officer

DOCUMENTS (PHOTOCOPIES) ATTACHED ALONG WITH THE FORM

1. Identity Proof : a) Passport b) Banker’s Verification c) PAN Card d) Driving Licence e) Voters ID Card

f) Govt. ID Card
2. Proof of Address : (a) Ration Card (b)Driving Licence (c) Voter’s ID (d) Latest Telephone Bill
KSCB/GN38/0

(e) Electricity Bill (f) Copy of LIC Policy or latest premium receipt (g) Bank Pass Book etc.

Authorised Officer