I.
CONSENT / REQUEST FOR SEEDING AADHAAR & PAN NUMBER IN ACCOUNT / CUSTOMER ID
II. CONSENT FOR LINKING AADHAAR NUMBER AND RECEIVING DIRECT BENEFITS INTO BANK
ACCOUNT (NPCI MAPPING)
The Branch Manager
Dhanlaxmi Bank Ltd. ____________________________________Branch Date:
I I am maintaining / would like to start and maintain a relationship with the Bank.
Account No (15 Digit)
Customer Name:
Customer ID: Individual/Authorized Signatory/Mandate Holder/Guarantor/Beneficial Owner
Mobile No (10 Digit)
PAN (If No PAN, Please submit Form 60)
CKYCR No: (If any)
a) I do not have mobile number b) I do not intend to disclose my mobile number
c) I have already registered a nominee for the above account.
d) I do not wish to make a NOMINATION for the above account*. (*Branch officials to obtain Form DA1 for registering Nomination facility)
2. Aadhaar No.:
- -
I hereby submit my Aadhaar number and voluntarily give my consent to
a) Use my Aadhaar Details to authenticate me from UIDAI
b) Use my mobile number mentioned above for sending SMS alerts to me.
c) Link the Aadhaar Number to all my existing/new/future accounts and to customer profile (Customer ID) with your Bank.
(Signature/Thumb Impression of customer)
II Options for receiving Direct Benefit Transfers (DBT) (Tick whichever is applicable)
a) I wish to seed my primary account number (shown above) with NPCI mapper to enable me to receive Direct Benefit Transfers including LPG
subsidy from Govt. of India in my account. I understand that if more than one Benefit transfer is due to me, I will receive all the Benefit
Transfers in this account. I here by declare that I have NOT so far seeded any of my accounts with other Bank(s) with NPCI Mapper.
*
b) I already have an account with _____________________________ Bank (Name of the Bank) having IIN number ________________ and
seeded with NPCI mapper for receving DBT from GOI. I request you to change my NPCI mapping (DBT Benefit account) to my account
with your Bank.
*
c) I already have an account with _______________________________ Bank (Name of the Bank) having IIN Number __________________
and seeded with NPCI Mapper for receiving DBT from GOI. I do not want to change my NPCI Mapping (DBT Benefit Account) from the
existing Bank.
d) I do not wish to seed my accounts from your Bank with NPCI Mapper. (I will not be getting DBT)
III. I have been explained about the nature of information that may be shared upon authentication. I have been given to understand that my
information submitted to the Bank herewith shall not be used for any purpose other than mentioned above, as per requirements of law.
IV. I here by declare that all the above information voluntarily furnished by me is true, correct and complete.
If consent sent through BC/BDO/VO
I hereby authorize the Banking Correspondent / Sarpanch / V.O /
(Signature/Thumb Impression of Customer) B.D.O ________________________________ to submit the
above consent letter to the Bank.
* IIN (Institution Identification Number) will be provided by Bank receiving the
consent application. (Signature/Thumb Impression of Customer)
For Branch Use only
We hereby confirm that
PAN has been verified online and confirm genuineness
For Aadhaar, e-KYC (Biometric / OTP) has been done and confirm the genuineness Signature of Branch Official with Seal
