NOMINATION FORM DA1
Nomination under Section 45ZA of the Banking Regulations Act 1449, and Rule 2(1) of the Banking Companies (Nomination) Rules 1985 in respect of bank
deposits.
I/We                                                                                                                                 nominate the following
person to whom in the event of my/our/minor’s death the amount of deposit, particulars where of are given below, may be returned by Indusind Bank Ltd.
             Branch.
            Details of Deposit                                                                  Nominee
  Nature of Deposit &      Additional                                                        Relationship with                  If nominee is a minor,
                                                    Name                 Address                                   Age
  Distinguishing No.      details, if any                                                     Depositor, if any                   his/her date of birth
Print Nominee Name#               #
                         Y   N        Depending upon the option selected here, nominee name will get printed / not printed on statements, passbook etc.
# 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’s death during the minority of the nominee.
                                                                                                        *Signature/Thumb impression of the depositor
                                                                                                     Place:
                                                                                                     Date:
Witness(es)
  Name                                                                             Name
  Signature ***                                                                    Signature ***
  Address                                                                          Address
  * Where deposit is made in the name of a minor, the nomination must be signed by a person lawfully entitled to act on behalf of the minor.
  ** Strike out if nominee is not a minor.
  *** Thumb impression(s) shall be attested by two witnesses.
                                                                ACKNOWLEDGMENT
We acknowledge your nomination in form DA1 relating to Account No.                                                                                    in the
name of                                                                    held with us.
Ref. No.:                                                       Date of Registration
Manager
                                                                                                                                      Stamp / Seal