POST OFFICE SAVINGS BANK sata sx ACCOUNT OPENING/PURCHASE OF NSC APPLICATION FORM FOR INDIVIDUALS "=" For Office Use Post Office Date. SOLID, LL [ren AccountRegisiration ali I L T CIFID2Y] I I I [SFoay [ [ For Applicant(s) “1. lWWe request you to oper/issue accountcertificate in my/our name (please tick v the emply box) = [Savings Account [TD AC2 Years r_ Citizen Savings Schem A/C Basic Savings Account TO AC 3 Years PFF AIC RD Account. TD AIC 5 Years NSC Vilith issue TD AIC 1 Year Monthly income AIC NSC IXth issue KVP-14 ‘Sukanya Samridahi AC "2. Operating instruction (please tick v the emply box) Singie/Seit Either or Survivor (Joint-B) | Jointly (Joint-Ay [ Through literate agent “3. Full Name of applicant in CAPITAL Letters (Leave a space between words) Mr/Mrs./Ms./Others First Name Middle Name Last Name Gender (M/F) 7 “4. Full Name of father/husband/Mother, in CAPITAL Letters (leave @ space between words) McJMrs/Ms./Others First Name Middle Name Last Name Gender (M/F) 7 5 | *5. Residental Address. First Applicant 2 Applicant 3” Applicant Fiat No/Bidg. name StreetRoad/Locality/vilage [TehsiliPost Office City and District ‘State Pin Code TTel./Mobile No. (optional) Email (optional), aa "6. Applicant Date of Birth (dd/mmiyy) _PAN (if not available, attach Form 60/61) __CIF ID (If already exists) 7 a] 2 3 *7. Please choose from the following (Tick v any one) Minor Lunatic | BlindiPhysically Pensioner | BPL | Beneficiary of throug Through | Handicappedililterate any welfare Guardian | Guardian | through agent Scheme ‘Sanchayaka Others °8. In case of minor/Lunatic Account, please fill the following = Name of Guardian Residential Address Relationship with minor *9. In case of othe: than Minor/Lunatic, please fill the following = ‘Name of Sanchayika/Government Welfare Scheme | PPO/BPLRegistrétion/Enroliment No. (0. Details about AADHAR = UIDAI Aadhar Number UIDATRadhar Number of Guardian (In case of minor/unatic account)*11.Details of know your customer (KYC) documents submitted :- : | “Photo 1D ‘Address Proot_ 7 fa ‘Applicant ‘Applicant ze ¥ cil z ¥ Type of Document Documen No. 1 Valid up to (if any) "42. Details of First deposit Mode of deposit] (Tick » any one) | Amount Rs. (figures). aie (WOKS) enaciornanincnens listhaabcsenarbes [Cash Cheque/DD ‘Cheque/O0 No Date of Issue. Name of Bank/Post Office Transfer Transfer Account No. CID Name of BankPost Office SBMO_ Postal Orders "13, Amount of Monthly installment (In case of RD Account Rs. (In figures)... (words)... : “14: n case of GeriicatesIKVP “Please Issue certfcales/KVP as detaied belo [Banominaten ({ No.of CariicatesiKVP [Detail of Coifeates KVP issued (o be erlored by Post Ofies) [100 Not for 500 Not for KVP. 1000 _ "15. In case services of SAS/PPFIMPKYBY Agent are taken Tie are using the services of SASTPPFINPKBY Agent (name)... ‘Authority No... Valid up to... Received Passbook/Getiicats on behal of depositor Signature of Agent with date... : “46. Standing instructions Please credit my monthly/Quarteriy/Yearly interest into following account (in case of MIS/SCSS/TD accounts) ‘Savings Accounts No. Standing at. 5 Please debit my following account for credit of my RD installment monihiyinall yearyiyearly = ‘Savings Account No. a ~--Standing at “17. Nomination \We nominate the person(s) named below under Section 4 of the Government Savings Bank Act, 1873 (5 of 1873) to be the sole recipient (s) of the amount standing at the credit of the account in the event of my/our death. Name & address of | Date of Birth ‘Share of | Name & address of person who may receive the nominee (s) (In case of nomination | said amount during the minority of the nominee (s) minor) Signature of witness in case depositor to make nomination. Name & address of witness.. mendetory Fields to be filled by customer.+218 Other Information Moathly income (Rs.) (Tick v any one) [Re-S000 | s00r- 10000] 10001-70000 | 20007-50000 | S0007-T Tae ‘Above Tae 7 ‘Occupation (Tick » anyone) Sarared Setemployed | Business —] Rewied | Student | Pensioner] Agncultore] Ommers: “Account Open mode (Tick v any one) Nomar TWitout Cheque Book | Wi cheque book L Wercorne Ki Documents attached (Tick » relevant colums) Age proof Photo 1D_ Address Proof ‘Sources of funds | Form 60 [Form 61] Form 15G | Form 15H Facilities required (Tick v relevant columns) Tatemet [Viewing nghis Apphicant (1) Applicant (2) Banking [Transaction ights | Applicant (1) Applicant (2) FppicaA GY plicant (3) I Tek 7 lever Box = — [ATM carn Debi Card Banking, ‘SMS Alens For ATM cum Debit Card (fil relevant line) ) Foalcant | Shorname Ware as would appear on the card (Capilal Levers) No. 7 2 3 [Mothers marden (ntial) name zal + For Mobile Banking/SMS Alerts For Statement Mobile No. EmailiD Signature or Thumb Impression Recent Photograph Applicant (1) or Gardian In case of Minor or Lunatic secount ‘Applicant (2) or Operating agent In case of Blind/Physically Handicappediiliterate Depositors operating through agent | Applicant (3)Deciarations (Tick a relevant bullet) © (Me hereby declare that We have clearly understood POSB Genera) Rules 1981 and Post Office Savings A¢count Rules 1981/ Post Office Recurring Deposit Rules 1981/ Post. Office Time Deposit Rules 1581/ Monthly income Account Rules 1987/ Senior Citizens Savings Scheme Rules, 2004 and Sukanya Samriddhi Account Rules 2014 (amended from time to time) governing the accounts under this scheme and to abide by such rules framed by the Central Government as may be applicable to the account from time to time. I/We Will not open more than one savings account in one post office. We will furnish on demand from the Post Office Saving Bank, particulars of all such accounts irrespective of the location of post office where these accounts are/were opened. * We also deciare that Vwe have not exceeded the prescribed maximum limit of investment for an individual While investing in various MIA/SCSS/SSA accounts in different post offices Note:-For the purpose of maximum limit in MIA, the depositor's share in the balance of a joint account shall be taken as one half or one third of such balance according as the account. held by two or three adults ‘© I/we shall adhere to the ceiling on deposits, taking the deposits in al the accounts opened by me/us together, as specified in rule 4 and amended from time to time. In case, at any time, any excess deposit is found, such excess deposit wil be ‘refunded to me/us after recovery of excess interest paid if any under the rules. © For any transaction occurred through my cheque-book/PassbooK/ATM cum Debit card/internelMobile Banking, I/We shall be fully responsible. * _twe am/are legal guardian of the minor/lunatic and copy of the orders of the competent courts attached For PPE © I hereby declare that Iwe have clearly understood the PPF Scheme Rules, 1968 governing the accounts under the said scheme, as amended from time to time (hereinafter referred to as the said rules) and shall abide by such nules framed by the Central Government as may be applicable to the account rom time totime,* hereby deciared that! am not maintaining any other Public Provident Fund Account. * Thereby declared that! am not maintaining any other Public Provident Fund Account except an accounton behalf of aminor. * also declare that shall adhere to the ceiling on deposits as provided for by Central Government from time to time, which is Rs. 1.50,000/- in a financial year at present, in my individual self account and accounts opened on behalf of minor(s) of whom | am a guardian, in case, at any time, the above said declaration is found untrue/faise, no interest shall be payable tome/ the subscriber on the amount of deposits found in excess of the prescribed limit. For NSC/KVP '* [Me hereby agree to abide by National Savings Certificates (Vill Issue) Rules, 1989 or (IX Issue) Rules 2011 or Kisan Vikas Patra Rules 2014 (amended from time to time). . ‘Authorization Me authorize Agent (name)... ..toreceive Passbook/Certificates on my/our behalf. signature/Thumb impression:- "Applicant 2" Applicant 3" Applicant Date:- Mandatory Fields to be entered into system by Post Office Operator. For Office Use only Certified that 1 have verfied the documents submitted with this application form and confirm that KYC norms are dully complied wit ‘Signature of BPM Signature of SPM Signature of Postmaster Date Stamp Please Cut from Here and paste in Register (Only for Literate Savings Account Customers)... Date of ‘Account Number | SINo. ‘Specimen Signature (to be filled by the applicant (s) Opening of Sera re ERceEEEEE EERE eee ere ‘Account‘OST OFFICE SAV: a NEWICHAN = (Know Your Customer) Fur: (to be sn? to CRC} Sionature ni Bhaloaraoh co) 1 epplicant ty Name am CIF 100. | Account No i Tir z | Apatisane(2) same: a @ k CIF ION. ‘Account No, - - Applicant (2) Name: @ | e110. ; ' ‘Account No, | 2 of new account and only relevant Information in case of Change in KYG 7 Jieeai Landman | ow 2 County | . Tot ea) EMsii9 | nereby submit photo copy of the following documents (self-attested) for the aroof of = Preol of ident (doe. type & ne.) “Atlas i yp tay | chy solemnly dectare thatthe information provided above Wilh reaped Tomy SGGOUAT Ts up to dale and FORE "— o Siguatura/Thun'b Impression:- 1 Applicant 2" Applicant 3 Applicant Petes a pans oec tng For Office Use only Seated that | have verted tne documents submitted with this application form and confiem that KYC norms are fully com, seh a Siywsacare of 2M Signature of SPM. Signature of Postmaster Dat. Date Scamp: