FINANCIAL INCLUSION ACCOUNT OPENING CUM OVERDRAFT APPLICATION FOR INDIVIDUALS
REF. NO. -
                                                          CIF No. :-
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 Name of the Branch                                                                                    Branch code
 Village/Town                                                                                                   District
 Sub District/Block Name                                                                                        State
 Village code/Town code                                                                                  Name Village/Town
 (As per census 2011)                                                                                   (As per census 2011)
 Full Name                                                                                                                   Date :
 Father Name                                                                                                            Mother Name
 Spouse Name                                                                                                           Marital Status                       Married                     Unmarried
 Gender                                                        Male                                Female               Date of Birth
 Mobile No.                                                                                                             Pan No.
 Aadhaar Card No.                                                                                                        Nationality                   INDIAN
 Occupation/ Profession                                                                                                  Religion
 Annual Income                                                                                                           Caste
               Address :
                                        FORM 60 [See third provision to of Rule 114 B]
1. Full Name & Address of the declarant. ___________________________________________________________
2. Particular of transaction___ Account Type…(Saving)
3. Amount and the transaction Rs. _____               A/c No.
                                                                                      NOMINATON
               DEPOSIT                                                                                                                        NOMINEE
                    A/C No.                                       Name                              Address                                  Relationship Date of Birth
                                                                Witnesses                                 [If Candidate Illiterate ]
               First Witnesses                                                                                    Second Witnesses
 Name _______________________________________                                                          Name ________________________________________
 Signature ____________________________________                                                        Signature _____________________________________
 Address _____________________________________                                                          Address ______________________________________
  Declaration :                                                                                                                            Signature/LTI/RTI of Applicant)
I also understand that I am eligible for an Overdraft after satisfactory operation of my account after 6 months of opening my account with a Limit up to      10,000/- (Rupees Ten Thousand only) for
meeting my emergency/family needs subject to the condition that only one member from the household will be eligible for overdraft facility I shall abide by the terms and conditions stipulated by the Bank in
this regard.
Place :- _________________
                                                                              For I NDIAN BANK
Date. :- _________________                                                    (Authorised Official)
                                                                              SS No. _________________
                                                                                                                                           Signature/LTI/RTI of Applicant)