IEG Co-operative Urban Bank, ____________Branch

ACCOUNT OPENING FORM FOR INDIVIDUALS

FOR OFFICE USE ACCOUNT NO. DATE :

Current Account Please open account(s) as per details given below (type of accounts required ticked) Savings Bank Savings Bank without cheque book with cheque book Term Deposit facility
facility

Recurring Deposit Period in Months Monthly deposit Rs

Special Term Deposit Period in Months Amount Rs

Period in Months Amount Rs M/Q

Periodicity of interest payment

Name of in Block Letters of the persons A B C Photographs of the persons :

IDENTIFY CARD SIZE OR PASSPORT SIZE PHOTO IDENTIFY CARD SIZE OR PASSPORT SIZE PHOTO IDENTIFY CARD SIZE OR PASSPORT SIZE PHOTO

Signature/thumb impression of all the applicants A B C

Date of birth

Please also sign across the photographs above Verifying officials signature Mode of operation in case of joint account Minimum Balance : Rs Nomination required or not Occupation: Details of other accounts maintained Branch Account Type Account No. Since Designation E or S Increased to : L or S From F or S

Nomination form enclosed/ not enclosed

Residence address

Pay Account for interest

Pay Account for redemption

Nationality

CONTINUED.

Present address

Permanent address

Telephone No. (R) Telephone No. (O) email :

Telephone No. (R) Telephone No. (O) email :

I/We agree to abide by the BANKS RULES relating to the conduct of the Current/Savings Bank/Recurring Deposit/Term Deposit/Special Term Deposit account(s). The information furnished above is true and correct to the best of my/our knowledge. I/We authorise the Bank to verify the details given herein through any third party as necessary. Yours faithfully, Signature/thumb impression (of all the applicants) A B C Details of introduction Name of the Introducer Address of the introducer: Telephone No(s) email : Details of the accounts of the introducer with the Bank Branch Account Type Account No. Since Branch Manger Open the account (s)

I know the applicant personally for a period of occupation(s) and addresses as above.

months/years and confirm his/her/their

Signature of the Introducer

FOR OFFICE USE Names of the account holder(s) Account Number Account opened by (name of staff) signature Particulars of additional identification obtained Introducer is : Constituent of the Bank (yes/no) Customer/account No. Person known to the Bank (yes/no) Details Staff member (details, name, designation, etc.) Introducer did not call on the Bank but confirmed the face of introduction to : Name Designation Signature DA Form I received and entered in the Nomination Register (yes/no) Letter of thanks sent to applicants on Acknowledgement received on Letter of thanks sent to introducer on Acknowledgement received on Incomplete formalities, if any Followed-up and completed on Cheque book issued (yes/no) Signature of the officials authorising account opening account Designation of the above official Verified Branch Manager Account transferred to Branch On Signature of officer Account closed on Signature of officer Date

FORM DA 1 Nomination under section 45Z of the Banking Regulation act 1949 and Rule 2(1) of the Banking Companies (Nomination) Rules, 1985 in respect of bank deposits. I/We, (Name of in Block Letters and address of all the persons holding the deposits ) Name Address A B C Nominate the following person to whom in the event of my/our/minors death the amount of the deposit, particulars whereof are given below, may be returned by State Bank of India,______________________________Branch, _________________. Nature of deposit Distinguishing Account No. Additional details, if any

Name

DETAILS OF THE NOMINEE(S) Relationship Address with deposits(s) Age if any

If nominee is minor, his date of birth

As the nominee is a minor on this date, I/We appoint Shri/Smt/Kum: Name Address to receive the amount of the deposit on behalf of the nominee, in the event of my/our/minor(deposit holder)s death during minority of the nominee. Date Place Signature/thumb impression of all the persons holding the deposit* @ * Names, signatures and addresses of two witnesses, in case of thumb impression: Name Address Signature @ 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.

State Bank of India, ____________Branch

ACKNOWLEDGEMENT

DATE:

Name(s) and Address(es) of depositors : Dear Sir/Madam, We acknowledge receipt of nomination made by you in favaour of Shri/Smt/Kum aged years in respect of your SB/CA/TDR/STDR/RD Account Number on Form DA 1 dated the . Yours faithfully, BRANCH MANAGER