Account Opening Form PnUSz vÓUS® £iÁ® · 2020. 8. 8. · Instruction for filling Account Opening Form / PnUSz vÓUS® £iÁzøu {µ¨¦ÁuØPõÚ AÔÄøµPÒ Please write your

For Individuals

DCB Bank Limited

Account Opening Form

PnUSz vÓUS® £iÁ®

Instruction for filling Account Opening Form / PnUSz vÓUS® £iÁzøu {µ¨¦ÁuØPõÚ AÔÄøµPÒ

Please write your NAME as it appears in all your support documentsu¯Äö\´x E[PÒ GÀ»õ BuµÄ BÁn[PÎ¾® EÒÍøu¨ ÷£õ»÷Á E[PÒ ö£¯øµ GÊuÄ®.

Hint boxes give tips and highlight important points across the form£iÁ® ÊÁx©õP SÔ¨¦U Pmh[PÒ ¦ÒÎPÎß UQ¯zxÁ® £ØÔ¯ SÔ¨¦PÒ ©ØÖ® ]Ó¨¦UPøÍ PõmkQßÓÚ.

Please fill the form preferably in ‘BLACK’ ink onlyu¯Äö\´x £iÁzøu P¸¨¦ ø© öPõsk ©mk÷© §ºzv ö\´Áx Â¸®£z uUPx.

Please countersign in full for any overwriting / alterationu¯Äö\´x HuõÁx v¸zu®/ ©õØÓ® ö\úõÀ AuÚ¸÷P øPö¯õ¨£ªhÄ®.

ABC

Specify the addresses along with City, State and PIN CodePÁ›ø¯ |Pµ®, ©õ{»®, ¤ß÷Põk Ehß SÔ¨¤hÄ®.

Please tick the appropriate boxesu¯Äö\´x ö£õ¸zu©õÚ PmhzvÀ ÷uºÄUSÔ°hÄ®.

Please use in CAPITAL LETTERS onlyu¯Äö\´x ö£›¯ GÊzxUPøÍ ©mk÷© £¯ß£kzuÄ®.

ALL PHOTOCOPIES of documents to be SELF-ATTESTED by the applicantBÁn[PÎß GÀ»õ ÷£õm÷hõPõ¨¤PÎ¾® Âsn¨£uõµº øPö¯õ¨£ªh ÷Ásk®.

Description of Document Can be obtained for / RÌUPshÁØÖUPõP ö£ÓU Ti¯ BÁn ÂÍUP®

Address / PÁ›Identity / Aøh¯õÍ®

Indicative List of Documents that can be provided to open a Bank Account

Passport / PhÄa ^mk

Voter's Identity Card / ÁõUPõÍº Aøh¯õÍ Amøh

Driving License / KmkÚº E›©®

Proof of Possession of Aadhaar Number / Buõº Gs øÁzv¸¨£uØPõÚ Buõµ®

£¯ß£õmk ¤ÀPÒ & ªß\õµ®, öuõø»÷£], Si}º ¤À, ø£¨m ÷Pì, ÷£õìm÷£´k ö©õø£À (2 ©õu[PÐUS® £øÇ¯uõP ÇUPU Thõx), ö\õzx AÀ»x ©õ|Pµõm] Á› µ^xPÒ, K´Åv¯® AÀ»x K´Äö£ØÓÁºPÐUS Aµ\õ[P xøÓPÒ AÀ»x ¤Gì³ ÁÇ[S® Sk®£ K´Åv¯ ÁÇ[S® EzuµÄPÒ , ©õ{»/ ©zv¯ Aµ_, \mh¨§ºÁ AÀ»x JÊ[SøÓ Bøn¯[PÒ, ö£õxzxøÓ {ÖÁÚ[PÒ, AmhÁøn¨£kzu¨£mh ÁºzuP Á[QPÒ, {v {ÖÁÚ[PÒ ©ØÖ® £mi¯¼mh {ÖÁÚ[PÒ ÁÇ[S® FÈ¯¸UPõÚ Ãmk JxURmkU Piu® ©ØÖ® Ax÷£õßÓ {ÖÁÚ[PÎß A¾Á»P Ÿv¯õÚ Ãmk JxURmkhß Ti¯ ÁõhøP ©ØÖ® Jzv J¨£¢u®. (Azxhß ÁõiUøP¯õÍº C¢u BÁn[PøÍ \©º¨¤¨£xhß 3 ©õu Põ»zvØSÒÍõÚ uØ÷£õøu¯ ¦v¯ PÁ›²hß A¾Á»P Ÿv¯õÚ ö\À¾£i¯õS® BÁnzøuU Psi¨£õP \©º¨¤UP ÷Ásk®)

Utility bills – Electricity, Telephone, Water Bill, Piped Gas, Postpaid Mobile (not more than 2 months old), Property or Municipal Tax receipts, Pension or Family Pension Payment Orders issued to retired employees by Govt. Departments or PSU, Letter of allotment of accommodation from employer issued by State / Central Govt, Statutory or Regulatory bodies, Public Sector Undertakings, Scheduled Commercial Banks, Financial Institutions and Listed companies and Leave and Licence agreements with such employers allotting official accommodation.(Provided that customer must submit Official Valid Document with updated current address within a period of 3 months of submitting these documents)

Passport / PhÄa ^mk

Voter's Identity Card / ÁõUPõÍº Aøh¯õÍ Amøh

Driving License / KmkÚº E›©®

Proof of Possession of Aadhaar Number / Buõº Gs øÁzv¸¨£uØPõÚ Buõµ®

Job Card issued by NREGA duly signed by Officer of the State Government©õ{» Aµ_ AvPõ›PÒ øÓ¯õP øPö¯õ¨£ªmh GßBºDâH ÁÇ[P ÷Áø» Amøh

Please Note / u¯Äö\´x PÁÛUPÄ®:

1. Customer must sign the Account Opening Form (AOF) in the presence of Bank officials.1. ÁõiUøP¯õÍº Psi¨£õP Á[Q AvPõ›PÎß ßÛø»°À PnUSz vÓUS® £iÁzvÀ (HKGL¨) øPö¯õ¨£® Ch÷Ásk®.

Letter issued by National Population Register containing details of name and addressö£¯º ©ØÖ® PÁ› ÂÁµ[PøÍU öPõsh ÷u]¯ ©UPÒöuõøP £v÷Ák ÁÇ[Q¯ Piu®

PAN Card / £õß Põºk

Á[QU PnUSz vÓUP öPõkUPU Ti¯ BÁn[PÎß GkzxU Põmk¨ £mi¯À

Job Card issued by NREGA duly signed by Officer of the State Government©õ{» Aµ_ AvPõ›PÒ øÓ¯õP øPö¯õ¨£ªmh GßBºDâH ÁÇ[P ÷Áø» Amøh

Letter issued by National Population Register containing details of name and addressö£¯º ©ØÖ® PÁ› ÂÁµ[PøÍU öPõsh ÷u]¯ ©UPÒöuõøP £v÷Ák ÁÇ[Q¯ Piu®

Rupay Platinum - Scheme Code List / ¹÷£ ¤ÍõmiÚ® & vmh ö|ÔøÓ £mi¯À

SB106 DCB Bank Staff Savings Account Yes i]¤ Á[Q FÈ¯º ÷\ª¨¦U PnUS B®

SB114 DCB Basic Savings Bank Deposit Account No i]¤ Ai¨£øh ÷\ª¨¦ Á[Q øÁ¨¦U PnUS CÀø»

SB113 DCB Free Style Savings Account Yes i]¤ L¨Ÿ ìöh°À ÷\ª¨¦U PnUS B®

SB104 DCB Benefit Savings Account Yes i]¤ £¯ß ÷\ª¨¦U PnUS B®

SB115 DCB Privilege HNI Savings Account Yes i]¤ ¤›ÂÀ÷»ä GaGßI ÷\ª¨¦U PnUS B®

SB103 DCB Family Savings Account Yes i]¤ Sk®£ ÷\ª¨¦U PnUS B®

SB102 DCB Shubh-Labh Savings Account Yes i]¤ _¨&»õ¨ ÷\ª¨¦U PnUS B®

Codes Scheme Description Rupay Platinumö|ÔøÓPÒ vmh ÂÍUP® ¹÷£ ¤ÍõmiÚ®

SB109 DCB Max Savings Account Yes i]¤ ÷©Uì ÷\ª¨¦U PnUS B®

SB111 SB Classic Yes Gì¤ UÍõ]U B®

SB105 Gold Mortgages - Savings Account Yes u[P Ah©õÚ[PÒ & ÷\ª¨¦U PnUS B®

SB110 DCB Junior Saver Account Yes i]¤ áüÛ¯º ÷\ª¨¦U PnUS B®

SB118 DCB Corporate Payroll Account (Plus) Yes i]¤ Põº£÷µm ÷£÷µõÀ AUPÄßm (¤Íì) B®

SB121 DCB Kisan Mitra Savings Account No i]¤ Qéõß ªzµõ ÷\ª¨¦U PnUS CÀø»

SB125 DCB CashBack Saving Account Yes i]¤ ÷Pè÷£U ÷\ª¨¦U PnUS B®

SB119 DCB Student Savings Account Yes i]¤ ©õnÁº ÷\ª¨¦U PnUS B®

SB122 DCB Golden Savings Account Yes i]¤ ÷PõÀhß ÷\ª¨¦U PnUS B®

SB124 DCB Elite Savings Account Yes i]¤ Gø»m ÷\ª¨¦U PnUS B®

SB133 PMJDY Account No ¤G®÷áiJ´ PnUS CÀø»

SB138 DCB Saahas Savings Account Yes i]¤ \õíì ÷\ª¨¦U PnUS B®

SB132 DCB Basic Savings Bank Deposit Account (Small) No i]¤ ÷£]U ÷\ª¨¦ Á[Q øÁ¨¦U PnUS (ì©õÀ) CÀø»

Codes Scheme Description Rupay Platinumö|ÔøÓPÒ vmh ÂÍUP® ¹÷£ ¤ÍõmiÚ®

SB117 DCB Corporate Payroll Account (Basic) Yes i]¤ Põº£÷µm ÷£÷µõÀ AUPÄßm (÷£]U) B®

3

Bank Use only (*Fields are Mandatory)

Á[Q¨ £¯ß£õmiØS ©mk® (*Pmhõ¯¨ £Sv)

Customer ID:

ÁõiUøP¯õÍº Ii

Account No.:

PnUS Gs:

Application No.: INDÂsn¨£ Gs: IGßi

SOL Code:GìKGÀ ÷Põm

Relationship Form / EÓÄ £iÁ®

“I / We hereby apply for a relationship with your Bank under which I / we wish to open an account.”|õß/ |õ[PÒ Cuß ‰»® E[PÒ Á[Q°ß EÓÄUPõP Âsn¨¤UQ÷Óõ®, Auß ‰»® |õß/ |õ[PÒ J¸ PnUSz vÓUP Â¸®¦Q÷Óõ®.

Funding:{v²uÂ

Txn. / ID No.:£›ÁºzuøÚ / Ii Gs YYYYMMDD

Date:÷uv YYYMMDD

Value Date:©v¨¦ ÷uv Y

* Occupation Code:*öuõÈÀ ÷Põm

Applicant 1:Âsn¨£uõµº 1

Joint Applicant 1:Tmk Âsn¨£uõµº 1

Joint Applicant 2:Tmk Âsn¨£uõµº 2

*Segment Code*ö\Uö©ßm ÷Põm

RM / CSE / RO / CBE (Code):BºG®/ ]GìD/ BºK/ ]¤D (÷Põm)

Branch:QøÍ

Date:÷uv YYYYMMDD

Please specify the occupation code as mentioned by customer in the form. u¯Äö\´x £iÁzvÀ ÁõiUøP¯õÍº SÔ¨¤mh£i öuõÈÀ ÷Põøh SÔ¨¤hÄ®.

Employee Code:FÈ¯º ÷Põm

Savings / ÷\ª¨¦

Fixed DepositEliteGø»m

Others (please specify including Personal Current A/c.)

©ØÓøÁ (u¯Äö\´x ö£º\ÚÀ Pµßm AUPÄßm Em£h GxöÁÚ SÔ¨¤hÄ®)

ClassicUÍõ]U

Shauryaö\Íº¯õ

Corporate Payroll (Basic)Põº£÷µm ÷£÷µõÀ (÷£]U)

Shubh-Labh_¨&»õ¨

Corporate Payroll (Plus)Põº£÷µm ÷£÷µõÀ (¤Íì)

Suraksha Fixed Deposit_µUåõ {µ¢uµ øÁ¨¦

Saahas\õíì

Cash Back÷Pè ÷£U

BSBDA¤Gì¤iH

Privilege¤›ÂÀ÷»ä

Personal Details: Primary Applicant / uÛ|£º ÂÁµ[PÒ: ußø© Âsn¨£uõµº (* Fields are Mandatory / Pmhõ¯¨ £Sv)

*Account Type:

KYC Number:

(First Name / uÀ ö£¯º) (Middle Name / |k¨ ö£¯º) (Last Name / Pøh]¨ ö£¯º)

*Date of Birth:YYYYMMDD

*Nationality: Indian Other (pl. specify)

*Short Name: Maximum 19 characters.

This namewould appear on the Debit CardAvP£m\® 19 GÊzxUPÒ. C¢u¨ ö£¯º öh¤m PõºiÀ Aa]h¨£k®.

*Status: Minor Sr. Citizen Pensioner Staff, if yes, Employee No.Other General

Maximum 32 characters.AvP£m\® 32 GÊzxUPÒ

*Name:

Existing Customer ID: (If applicable)

Mr. Mrs. Ms. Dr. Prof. Capt. Others

*Gender: Male Female Third Gender

Marital Status: Single Married

*Country of Birth: *Place of Birth: Please fill FATCA

Declaration Form if you are U.S.A. or other country citizen / resident}[PÒ ².Gì.H AÀ»x ÷ÁÖ

|õmk Si©Pß / Á]¨£ÁµõP Ç¢uõÀ

u¯Äö\´x GL¨Hi]H AÔÂ¨ø£ {µ¨£Ä®.

*Citizenship: *Residence for Tax Purposes:

U.S. Person: Yes No

Religion: Hindu Muslim Christian Sikh Buddhist Jain Parsi Others

*Mother’s Full Name:

*Father / Spouse Full Name:

*Mother’s Maiden Name:

*Permanent Account Number (PAN): Form 60If PAN is not

available please fill in Form 60

£iÁ® QøhUPõÂmhõÀ

u¯Äö\´x £iÁ® 60&I {µ¨£Ä®Passport Number:

YYYMMDDExpiry Date:

Y

Driving Licence:YYYMMDD

Expiry Date:Y

Aøh¯õÍ®/ PÁ› Buõµ©õP

PhÄa ^mk AÀ»x KmkÚº

E›©® ÁÇ[P¨£mhõÀ

÷uøÁ.

Required if Passport or

Driving licence provide as Identity /

Address proof

*Residential Status: Resident Individual Non Resident Indian Foreign National Person of Indian Origin

Passport

NREGA Job Card:

Others: (any document notified by the central government) / ©ØÓøÁ: (©zv¯ Aµ\õ[P® SÔ¨¤k® HuõÁx J¸ BÁn®)

Identification Number:

*Proof of Address: Driving Licence UID (Aadhaar)

NREGA Job Card Others

Simplified Measures Account Document Type CodeGÎuõUP¨£mh |hÁiUøPPÒ PnUS BÁn ÁøP ÷Põm

Voter Identity Card:

Your unique identification number / E[PÒ J¨£ØÓ Aøh¯õÍ Gs*Aadhaar Number:

Põºiß ÁøP ©ØÖ® Põ÷\õø»

¦zuP® ÁÇ[SÁx vmhzøu¨ ö£õÖzux

Type of card & cheque book

issuance would be based upon

the product.

Internet BankingDCB – On The Go (Mobile Banking)Online Banking:

*Card: Debit Card required Yes No Rupay Platinum (Optional)

*PnUS ÁøP

NormalC¯À£õÚøÁ

Simplified (for low risk customers)GÎuõUP¨£mhøÁ (SøÓ¢u A£õ¯ ÁõiUøP¯õÍºPÐUPõP)

Smallì©õÀ

OTP based KYCKi¤ Ai¨£øh°»õÚø ÷PJ´]

÷PJ´] Gs HØPÚ÷Á²ÒÍ ÁõiUøP¯õÍº Ii: (ö£õ¸¢vÚõÀ)

*ö£¯º v¸. v¸©v S©õ› hõ. ÷£µõ. ÷P¨. ©ØÓøÁ

*_¸UP¨ ö£¯º

*{ø» Á¯xUS ÁµõuÁº ‰zu Si©UPÒ K´Äö£ØÓÁº ÷ÁÖ ö£õxÁõÚøÁ FÈ¯º, B® GÛÀ, FÈ¯º Gs

*¤Ó¢u ÷uv *£õ¼Ú® Bs ö£s ‰ßÓõ® £õ¼Ú®

*÷u]¯® C¢v¯º ©ØÓøÁ (u¯Äö\´x SÔ¨¤hÄ®) v¸©n {ø» uÛ|£º v¸©n©õÚÁº

*¤Ó¢u |õk *¤Ó¢u Ch®

*Si²›ø© *Á›ö\¾zx® ÷|õ[PÐUPõÚ Ãk

².Gì. |£º B® CÀø»

Category:

¤›Ä

General

ö£õxÁõÚx

MBC

G®¤]

OBC

K¤]

SC

Gì]

ST

Gìi

Others

©ØÓøÁ

©u® C¢x ì½® QÔìuÁº ÛQ¯º ö£Ízuº \©nº £õºê ©ØÓøÁ

*uõ°ß Ê¨ö£¯º

*u¢øu / ©øÚÂ°ß Ê¨ ö£¯º

*uõ°ß PßÛ¨ ö£¯º

*Si°¸¨¦ {ø»

*Põºk: öh¤m Põºk ÷uøÁ

Bßø»ß ÷£[Q[

*{µ¢uµ PnUS Gs (£õß)

*Buõº Gs

PhÄ^mk Gs

KmkÚº E›©®:

ÁõUPõÍº Aøh¯õÍ Amøh

GßBºDâH ÷Áø» Amøh

*PÁ›UPõÚ Buõµ®

Á]US® uÛ|£º C¢v¯õÂÀ Á]UPõuÁº öÁÎ|õmiÚº C¢v¯ Á®\õÁÈ°Úº

B® CÀø» ¹÷£ ¤ÍõmiÚ® (Â¸¨£ Ai¨£øh°»õÚx)Please refer page no. 2 for eligible scheme code / uSv¯õÚ

vmh ÷Põøh AÔ¯ u¯Äö\´x £UP® Gs 2&I £õºUPÄ®

i]¤ & Bß u ÷Põ (ö©õø£À ÷£[Q[) Cßhºö|m ÷£[Q[

£iÁ® 60

Põ»õÁv ÷uv

Põ»õÁv ÷uv

Aøh¯õÍ Gs

PhÄa ^mk KmkÚº E›©® ²Ii (Buõº)

Voter Identity Card

ÁõUPõÍº Aøh¯õÍ Amøh GßBºDâH ÷Áø» Amøh ©ØÓøÁ

{µ¢uµ øÁ¨¦

4

Customer Profile / ÁõiUøP¯õÍ›ß Áµ»õÖ

*Occupation:

Gross Annual Income (`): 3 Lakhs - < 5 LakhsLess than 50K

5 Lakhs - < 10 Lakhs

50K - < 1.5 Lakhs

10 Lakhs - < 50 Lakhs

1.5 Lakhs - < 3 Lakhs

50 Lakhs and above

Residence: Self Owned Family Owned Rented Company Lease

Existing Credit Facility: House Loan Vehicle Loan Consumer Loan Education Loan Business Loan Credit Card

Education: Graduate Post Graduate Professional Others

Two WheelerVehicle: Four Wheeler Both None

uSv Áõ´¢u PnUSPÐUPõÚ

£vÄ.

All alerts will besend to thepreferred

Mobile Numberand E-mail ID.

Mobile Numberwill be used forSMS Bankingregistration for

eligibleaccounts.

GÀ»õ SÖgö\´vPÐ

® ÷uºÄ ö\´²® øP÷£]

Gs ©ØÖ® ªßÚg\À

PÁ›US AÝ¨£¨£k®. øP÷£] Gs GìG®Gì

÷£[Q[&US £¯ß£kzu¨£k

®.

Address proofof mailingaddress ismandatory.Otherwise,

default addresspicked would be Current Address

Ag\»Ý¨¦® PÁ›UPõÚ PÁ›

Buõµ® Pmhõ¯©õÚx. ©ØÓ£i, ÷uºÄ

ö\´¯¨£k® PÁ› uØ÷£õøu¯

PÁ›¯õP ÇUS®

Mailing Address: Office Permanent (You must tick mark one option)Current Address

*Landmark:

Extn.: Fax: (with STD Code)

State: Telephone: (with STD Code)

Office Address:

City: PIN:

*Preferred Email Id:

Permanent Address:

City: PIN:

*Landmark:

Same as Current Address


*Preferred Mobile No.:Telephone: (with STD Code)

State: Country:

Communication Address:

City: PIN:

*Landmark:

uPÁÀ öuõhº¦ PÁ›

|Pµ® ¤ß

©õ{»® |õk

öuõø»÷£]: (Gìii ÷Põm Ehß) *÷uºÄ ö\´²® øP÷£] Gs

*÷uºÄ ö\´²® ªßÚg\º PÁ›

{µ¢uµ PÁ›: |h¨¦ PÁ› ÷£õßÓ÷u

|Pµ® ¤ß

©õ{»®

A¾Á»P PÁ›

|Pµ® ¤ß

©õ{»®

öuõø» |PÀ: (Gìii ÷Põm Ehß)

Ag\»Ý¨¦® PÁ› uØ÷£õøu¯ PÁ› A¾Á»P® {µ¢uµ® (}[PÒ Psi¨£õP J¸ Áõ´¨ø£ ÷uºÄ ö\´¯ ÷Ásk®)

*öuõÈÀ

PÀÂ CÍ[Pø» xPø» öuõÈÀ {¦nº ©ØÓøÁ

©õzu Á¸h Á¸Áõ´ (¹.) 50 B°µzvØS® SøÓÄ 50 B°µ® & 1.5 »m\zvØS SøÓÄ 1.5 »m\® & 3 »m\zvØS SøÓÄ 3 »m\® & 5 »m\zvØS SøÓÄ

5 »m\® & <10 »m\zvØS SøÓÄ 10 »m\® & < 50 »m\zvØS SøÓÄ 50 »m\® ©ØÖ® AuØS AvP®

ö\õ¢u©õÚx Sk®£zvØS ö\õ¢u©õÚx ÁõhøP {ÖÁÚ SzuøPSi°¸¨¦

HØPÚ÷Á²ÒÍ Phß Á\v: Ãmk Phß ÁõPÚU Phß ~Pº÷Áõº Phß PÀÂU Phß öuõÈØPhß Qöµim Põºk

ÁõPÚ® l Ã»º L÷£õº Ã»º Cµsk® GxÄªÀø»

}mi¨¦

Joint Applicant 1 / Tmk Âsn¨£® 1 (* Fields are Mandatory / Pmhõ¯¨ £Sv )

##(Guardian to fill a Minor Declaration Form separately) If applicable, please attach age proof * Fields are Mandatory##

(£õxPõÁ»º uÛ¯õP Á¯xUS ÁµõuÁº AÔÂ¨¦¨ £iÁzøu {µ¨£ ÷Ásk®) ö£õ¸¢vÚõÀ u¯Äö\´x Á¯xUPõÚ Buõµzøu CønUPÄ®. * Pmhõ¯¨ £Sv

Relationship with Primary Applicant:ußø© Âsn¨£uõµ¸hÚõÚ EÓÄ

*{»USÔ±k

*{»USÔ±k

*{»USÔ±k

öuõø»÷£]: (Gìii ÷Põm Ehß)


Please fill FATCA




*Account Type:*PnUS ÁøP



Smallì©õÀ


KYC Number:



*Name:





*Date of Birth:YYYYMMDD*¤Ó¢u ÷uv

*Gender: Male Female Third Gender*£õ¼Ú® Bs ö£s ‰ßÓõ® £õ¼Ú®

*Nationality: Indian Other (pl. specify)*÷u]¯® C¢v¯º ©ØÓøÁ (u¯Äö\´x SÔ¨¤hÄ®)

Marital Status: Single Marriedv¸©n {ø» uÛ|£º v¸©n©õÚÁº

*Country of Birth: *Place of Birth:*¤Ó¢u |õk *¤Ó¢u Ch®

*Citizenship:*Si²›ø©

*Residence for Tax Purposes:*Á›ö\¾zx® ÷|õ[PÐUPõÚ Ãk

U.S. Person: Yes No








*Mother’s Maiden Name:*uõ°ß PßÛ¨ ö£¯º

*Residential Status: Resident Individual Non Resident Indian Foreign National Person of Indian Origin*Si°¸¨¦ {ø» Á]US® uÛ|£º C¢v¯õÂÀ Á]UPõuÁº öÁÎ|õmiÚº C¢v¯ Á®\õÁÈ°Úº

5

YYYMMDD Y

YYYMMDD Y

Maximum 19 characters.This namewould appear on the Debit CardAvP£m\® 19 GÊzxUPÒ. C¢u¨ ö£¯º öh¤m PõºiÀ Aa]h¨£k®.

If PAN is not available please fill in Form 60


u¯Äö\´x £iÁ® 60&I {µ¨£Ä®

Aøh¯õÍ®/ PÁ› Buõµ©õP

PhÄa ^mk AÀ»x KmkÚº

E›©® ÁÇ[P¨£mhõÀ

÷uøÁ.



Address proof


Your unique identification number / E[PÒ J¨£ØÓ Aøh¯õÍ Gs

Põºiß ÁøP ©ØÖ® Põ÷\õø»

¦zuP® ÁÇ[SÁx vmhzøu¨ ö£õÖzux



the product.

*Short Name:*_¸UP¨ ö£¯º

*Status: Minor Sr. Citizen Pensioner Staff, if yes, Employee No.Other General*{ø» Á¯xUS ÁµõuÁº ‰zu Si©UPÒ K´Äö£ØÓÁº ÷ÁÖ ö£õxÁõÚøÁ FÈ¯º, B® GÛÀ, FÈ¯º Gs

Category:

¤›Ä

General

ö£õxÁõÚx

MBC

G®¤]

OBC

K¤]

SC

Gì]

ST

Gìi

Others

©ØÓøÁ

*Permanent Account Number (PAN):*{µ¢uµ PnUS Gs (£õß)

*Aadhaar Number:*Buõº Gs

Passport Number:PhÄ^mk Gs

Driving Licence:KmkÚº E›©®:

Voter Identity Card:ÁõUPõÍº Aøh¯õÍ Amøh

NREGA Job Card:GßBºDâH ÷Áø» Amøh

*Card: Debit Card required Yes No

*Põºk: öh¤m Põºk ÷uøÁ B® CÀø»Rupay Platinum (Optional)¹÷£ ¤ÍõmiÚ® (Â¸¨£ Ai¨£øh°»õÚx)

Please refer page no. 2 for eligible scheme code / uSv¯õÚ vmh ÷Põøh AÔ¯ u¯Äö\´x £UP® Gs 2&I £õºUPÄ®

Internet BankingDCB – On The Go (Mobile Banking)Online Banking:Bßø»ß ÷£[Q[ i]¤ & Bß u ÷Põ (ö©õø£À ÷£[Q[) Cßhºö|m ÷£[Q[

Form 60£iÁ® 60

Expiry Date:

Expiry Date:

Põ»õÁv ÷uv

Põ»õÁv ÷uv

Identification Number:Aøh¯õÍ Gs

Passport*Proof of Address: Driving Licence UID (Aadhaar)


Simplified Measures Account Document Type CodeGÎuõUP¨£mh |hÁiUøPPÒ PnUS BÁn ÁøP ÷Põm*PÁ›UPõÚ Buõµ® PhÄa ^mk KmkÚº E›©® ²Ii (Buõº)

Voter Identity Card



Permanent Address:

City: PIN:

*Landmark:




State: Country:


City: PIN:

*Landmark:


|Pµ® ¤ß

©õ{»® |õk




|Pµ® ¤ß

©õ{»®

*{»USÔ±k

*{»USÔ±k


Joint Applicant 2 / Tmk Âsn¨£® 2 (* Fields are Mandatory / Pmhõ¯¨ £Sv )

Relationship with Primary Applicant:ußø© Âsn¨£uõµ¸hÚõÚ EÓÄ

Please fill FATCA




*Account Type:*PnUS ÁøP



Smallì©õÀ


KYC Number:



*Name:





*Date of Birth:YYYYMMDD*¤Ó¢u ÷uv

*Gender: Male Female Third Gender*£õ¼Ú® Bs ö£s ‰ßÓõ® £õ¼Ú®

*Nationality: Indian Other (pl. specify)*÷u]¯® C¢v¯º ©ØÓøÁ (u¯Äö\´x SÔ¨¤hÄ®)

Marital Status: Single Marriedv¸©n {ø» uÛ|£º v¸©n©õÚÁº

*Country of Birth: *Place of Birth:*¤Ó¢u |õk *¤Ó¢u Ch®

*Citizenship:*Si²›ø©

*Residence for Tax Purposes:*Á›ö\¾zx® ÷|õ[PÐUPõÚ Ãk

U.S. Person: Yes No








*Mother’s Maiden Name:*uõ°ß PßÛ¨ ö£¯º

*Residential Status: Resident Individual Non Resident Indian Foreign National Person of Indian Origin*Si°¸¨¦ {ø» Á]US® uÛ|£º C¢v¯õÂÀ Á]UPõuÁº öÁÎ|õmiÚº C¢v¯ Á®\õÁÈ°Úº

Category:

¤›Ä

General

ö£õxÁõÚx

MBC

G®¤]

OBC

K¤]

SC

Gì]

ST

Gìi

Others

©ØÓøÁ

6

Mode of Operation / C¯US® Âu®

Self_¯©õP

Jointly TmhõP

Either or Survivor¯õµõÁx J¸Áº AÀ»x E°º ÁõÌ£Áº

Former or Survivor¢øu¯Áº AÀ»x E°º ÁõÌ£Áº

Guardian£õxPõÁ»º

Anyone or Survivor¯õµõÁx J¸Áº AÀ»x E°º ÁõÌ£Áº

Services / ÷\øÁPÒ

SMS Banking & Alert Facility: / GìG®Gì ÷£[Q[ ©ØÖ® A»ºm Á\v:Alerts facility enables you to receive alerts on your Email and / or Mobile regarding large debit, large credits, Standing Instruction failure, balance below Account Quarterly Balance and balance update. New alerts may be added from time to time. / A»ºmì Á\v }[PÒ E[PÒ ªßÚg\À ©ØÖ® / AÀ»x ö©õø£¼À ö£›¯ £ØÖ, ö£›¯ ÁµÄPÒ, {ø» AÔÄÖzuÀ ö\¯¼Ç¨¦, Põ»õsk Ç¨¦US® SøÓÁõÚ Ç¨¦ ©ØÖ® Ç¨¤ß ¦v¯ uPÁÀPøÍ ö£Óa ö\´QÓx. AÆÁ¨÷£õx ¦v¯ A»ºmPÒ ÷\ºUP¨£h»õ®.

Email Account Statement Utility Bills

Phone Banking Preferred Language Options: English Hindi Marathi Gujarati Tamil Telugu

Investment: Life Insurance Mutual Fund Wealth Management General InsurancePassbook

Please fill a separate Mobile

Banking Registration

Form for Joint Account Holder

Tmk PnUS øÁzv¸¨£Á¸US u¯Äö\´x

uÛ¯õÚ ö©õø£À

÷£[Q[ £vÄ £iÁzøu {µ¨£Ä®

Please Note: Authorised signatory/ies of the Firm / Company / Trust / Association / Society are eligible for free Mobile alert facility subject to compliance of terms and conditions as stipulated by the Bank from time to time. / u¯Äö\´x PÁÚzvÀöPõÒÍÄ®: Pøh / {ÖÁÚ® / AÓUPmhøÍ / \[P® / ö\õø\mi°ß A[RP›UP¨£mh øPö¯õ¨£uõµº / PÒ C»Á\ ö©õø£À A»ºm ö£Óz uSv ö£ØÓÁºPÒ BÁº. BÚõÀ AÆÁ¨÷£õx Á[Q {ºn°US® ÂvøÓPÒ ©ØÖ® {£¢uøÚPÐUS Cn[Q |h¨£uØS Em£mhx.

I / We don’t wish to receive any Bank related promotional calls, SMS alerts or emails.

I / We don’t wish to link my/our Aadhaar Number to this account. (Please Note: Any 1 Aadhaar Number is linked to 1 Account Number to receive subsidy on the account)

Initial Payment Details / öuõhUP £n® ö\¾zv¯ ÂÁµ[PÒ

Amount `: Debit to DCB Bank A/c No.:Amount in words:

Cheque Dated:YYYYMMDD

Payment By: Cash Deposited on: YYYYMMDD

Please note: Allcheques shouldbe CROSSED

and in favour of‘DCB Bank Limited’ A/c(Your Name)’u¯Äö\´x PÁÛUPÄ®:

GÀ»õ Põ÷\õø»PÎ¾®

Qµõì ö\´¯ ÷Ásk® ©ØÖ®

'i]¤ ÷£[U ¼ªöhm PnUS (E[PÒ ö£¯º)'

SÔ¨¤mk GkUP

÷Ásk®

Drawn on (Bank):

Others (Please Specify): ©ØÓøÁ: (u¯Äö\´x SÔ¨¤hÄ®)

£n® ö\¾zv¯xCash (To be deposited by the customer at teller counter only)

öµõUP® (PÄßh›À ©mk÷© ÁõiUøP¯õÍº ö\¾zu ÷Ásk®) öµõUP® ÷\º¨¤zu |õÒ

Cheque No.: Põ÷\õø» Gs Põ÷\õø» ÷uv GkUP¨£mhx (Á[Q)

öuõøP ¹. öuõøP ÁõºzøuPÎÀ i]¤ Á[QUPõP PÈzxU öPõÒÍÄ®: PnUS Gs

|õß / |õ[PÒ Á[Q öuõhº£õÚ £µ¨¦øµ AøÇ¨¦PÒ, SÖgö\´vPÒ AÀ»x ªßÚg\ÀPøÍ ö£Ó Â¸®£ÂÀø».

|õß / |õ[PÒ GÚx / G[PÍx Buõº Gsøn C¢u PnUShß CønUP Â¸®£ÂÀø». (u¯Äö\´x PÁÚzvÀ öPõÒÍÄ®: PnUQÀ ©õÛ¯® ö£Ó HuõÁx 1 Buõº Gs 1 PnUS GsoÀ CønUP¨£h ÷Ásk®)

ªßÚg\À PnUS AÔUøP £¯ß£õmk ¤ÀPÒ

÷£õß ÷£[Q[ ÷uºÄ ö\´²® ö©õÈ Áõ´¨¦PÒ B[Q»® C¢v ©µõzv Sáµõzv uªÌ öu¾[S

PhÄa ö\õÀ u½k B²Ò Põ¨¥k £µì£µ {v ö\ÀÁ {ºÁõP® ö£õx Põ¨¥k

YYYMMDD Y

YYYMMDD Y

Maximum 19 characters.This namewould appear on the Debit CardAvP£m\® 19 GÊzxUPÒ. C¢u¨ ö£¯º öh¤m PõºiÀ Aa]h¨£k®.

If PAN is not available please fill in Form 60


u¯Äö\´x £iÁ® 60&I {µ¨£Ä®



Address proofAøh¯õÍ®/

PÁ› Buõµ©õP PhÄa ^mk

AÀ»x KmkÚº E›©®

ÁÇ[P¨£mhõÀ ÷uøÁ.


Your unique identification number / E[PÒ J¨£ØÓ Aøh¯õÍ Gs



the product.Põºiß ÁøP

©ØÖ® Põ÷\õø» ¦zuP®

ÁÇ[SÁx vmhzøu¨ ö£õÖzux

*Short Name:*_¸UP¨ ö£¯º

*Status: Minor Sr. Citizen Pensioner Staff, if yes, Employee No.Other General*{ø» Á¯xUS ÁµõuÁº ‰zu Si©UPÒ K´Äö£ØÓÁº ÷ÁÖ ö£õxÁõÚøÁ FÈ¯º, B® GÛÀ, FÈ¯º Gs

*Permanent Account Number (PAN):*{µ¢uµ PnUS Gs (£õß)

*Aadhaar Number:*Buõº Gs

Passport Number:PhÄ^mk Gs

Driving Licence:KmkÚº E›©®:

Voter Identity Card:ÁõUPõÍº Aøh¯õÍ Amøh

NREGA Job Card:GßBºDâH ÷Áø» Amøh

*Card: Debit Card required Yes No

*Põºk: öh¤m Põºk ÷uøÁ B® CÀø»Rupay Platinum (Optional)¹÷£ ¤ÍõmiÚ® (Â¸¨£ Ai¨£øh°»õÚx)

Please refer page no. 2 for eligible scheme code / uSv¯õÚ vmh ÷Põøh AÔ¯ u¯Äö\´x £UP® Gs 2&I £õºUPÄ®

Internet BankingDCB – On The Go (Mobile Banking)Online Banking:Bßø»ß ÷£[Q[ i]¤ & Bß u ÷Põ (ö©õø£À ÷£[Q[) Cßhºö|m ÷£[Q[

Form 60£iÁ® 60

Expiry Date:

Expiry Date:

Põ»õÁv ÷uv

Põ»õÁv ÷uv

Identification Number:Aøh¯õÍ Gs

Passport*Proof of Address: Driving Licence UID (Aadhaar)


Simplified Measures Account Document Type CodeGÎuõUP¨£mh |hÁiUøPPÒ PnUS BÁn ÁøP ÷Põm*PÁ›UPõÚ Buõµ® PhÄa ^mk KmkÚº E›©® ²Ii (Buõº)

Voter Identity Card



Permanent Address:

City: PIN:

*Landmark:




State: Country:


City: PIN:

*Landmark:


|Pµ® ¤ß

©õ{»® |õk




|Pµ® ¤ß

©õ{»®

*{»USÔ±k

*{»USÔ±k


7

Tax Deduction at Source / BuõµzvÀ Á›U PÈÄ

If No, TDS Exemption Reference No.

TDS to be deducted if applicable: Yes No TDS Exemption submission date :YYYYMMDD

Enclose TDS Certificate for exemption. / Â»US¨ ö£Ó iiGì \õßÔuøÇ CønUPÄ®.

Form 15G / 15H, etc. to be

submitted at thebeginning of

every financialyear and whilemaking fresh

deposits duringthe year.

£iÁ® 15â / 15Ga

÷£õßÓÁØøÓ {v¯õsiß öuõhUPzvÀ ©ØÖ® A¢u

BsiÀ ¦vuõP øÁ¨¦PÒ

øÁUS®÷£õx® \©º¨¤UP ÷Ásk® .

Facility required: Yes No (please tick appropriate options)2-Way Sweep Deposit Details:

Please Note: Reverse Sweep to Fixed Deposit account shall happen only, if the balance in the account exceeds threshold limit and Sweep shall happen if the balance in the account goes below the threshold limit. All deposits will be under Re-investment scheme with Auto Renewal Facility, this facility may differ from product to product and from time to time. / ">åNøÒ A¡ì¹ ë>ài¡ u¯Äö\´x PÁÚzvÀ öPõÒÍÄ®: PnUQÀ EÒÍ Ç¨¦ Auß GÀø»ø¯ Ph¢uõÀ ©mk÷© L¤Uìm öh£õ]m&US ›Áºì ìÃ¨ |øhö£Ö®. PnUQÀ Ç¨¦ Auß Áµ®¦US® SøÓÁõP BÚõÀ ìÃ¨ |øhö£Ö®. GÀ»õ øÁ¨¦PÐ® ©Öu½mk vmhzvß RÇõP Bm÷hõ ›Û³ÁÀ Lö£]¼mi²hß ÇUS®. C¢u Á\v JÆöÁõ¸ vmhzvØS® ©ØÖ® AÆÁ¨÷£õx ©õÖ£k®.

Account Statement: Frequency of statement would be as per the product feature. / PnUS AÔUøP: vmhzvß ]Ó¨£®\zvß£i AÔUøP°ß Põ» CøhöÁÎ Aø©²®.

2&÷Á ìÃ¨ öh£õ]m ÂÁµ[PÒ: ÷uøÁ¨£k® Á\v: B® CÀø» (u¯Äö\´x ö£õ¸zu©õÚ Áõ´¨¦PÎÀ ÷uºÄUSÔ°hÄ®)

ö£õ¸¢vÚõÀ iiGì PÈUP¨£k® B® CÀø» iiGì Â»UøP \©º¨¤US® ÷uv

CÀø»ö¯ßÓõÀ, iiGì Â»US £õºøÁ Gs

Term Deposit Details / Põ» øÁ¨¦ ÂÁµ[PÒ (* Fields are Mandatory / )Pmhõ¯¨ £Sv

Transfer to DCB Bank A/c. No.:

Issue Demand Draft Payable at

Through NEFT

‰zu Si©UPÐUPõÚ

£¯ßPøÍ¨ ö£Ó ¤Ó¢u ÷uv (iK¤)

Buõµ® ÷uøÁ.

Date of Birth (DOB) proof required to

avail benefits for Senior Citizens.

Amount of Deposit Please issue Fixed Deposit in the name(s) of

by Cash / Debit to Account No.:

Amount `

(Rupees only)

uUPx.

6 ©õu[PÒ Põ»zvØS® SøÓÁõÚ

øÁ¨¦PÐUS GÎ¯ Ámi

Ãu® ©mk÷© öPõkUPz

ONLY Simple Interest

payable for deposits of less than 6 months

tenor

Type of Deposit

Interest Payout Frequency

*Maturity Instruction s(Tick any one) / vºa] AÔÄøµPÒ (HuõÁx JßøÓz ÷uºÄ ö\´¯Ä®)

Auto Renew Principal and Interest Auto Renew Principal and Pay Interest

Interest PaymentInstructions

Deposit Period Days Months Years (Minimum 7 days maximum 10 years)

Senior Citizen Yes No Interest Rate.

% per annum

Fixed Deposit (FD){µ¢uµ øÁ¨¦ (GLï)øÁ¨¤ß ÁøP

DCB Suraksha FDI]¤ _µUåõ GLï

Tax Saver FDÁ› ÷\ª¨¦ GLï

Ámi ö\¾zx® Põ»U öPk

Monthly Interest Payout (MIC)©õuõ¢vµ Ámi ÁÇ[SuÀ (G®I])

Simple Interest (for deposits less than 6 months)

GÎ¯ Ámi (6 ©õu[PÐUS® SøÓÁõÚ øÁ¨¦PÒ)

Half Yearly Interest Payout (only applicable for FD)

Aøµ¯õsk Ámi ÁÇ[SuÀ (GLï&US ©mk÷© ö£õ¸¢x®)

On Maturityvºa]°ß÷£õx

Quarterly Interest Payout (QIC)Põ»õsk Ámi ÁÇ[SuÀ (U³I])

øÁ¨¦ øÁUS® öuõøP u¯Äö\´x &ß ö£¯›À(PÒ) {µ¢uµ øÁ¨¦ ÁÇ[PÄ®

öµõUP©õP / PnUS GsoØS PÈzxU öPõÒÍÄ®:

öuõøP ¹.

©mk®)

øÁ¨¦ Põ»® |õmPÒ ©õu[PÒ BskPÒ (SøÓ¢ux 7 |õmPÒ AvP£m\® 10 BskPÒ)

‰zu Si©UPÒ BskUS ÁmiÃu®

Ámi ÁÇ[S® AÔÄøµPÒ

i]¤ Á[Q PnUS GsqUS AÝ¨£Ä®

Áøµ÷Áõø» ÁÇ[PÄ® £n® ÁÇ[PUPz uUP Ch®

GßDGLï

‰»©õP

uõÚõP ¦x¨¤US® uÀ ©ØÖ® Ámi uõÚõP ¦x¨¤US® uÀ ©ØÖ® Ámi ÁÇ[SuÀ

Repay Principal and InterestA\À ©ØÖ® Ámiø¯z v¸¨¤U öPõkUPÄ®

Non-callable FDAøÇUP i¯õuõ GLï

Please tick if you wish to receive hard copy of the Deposit Confirmation Advice (DCA) otherwise the DCA will be sent at your registered email ID with the Bank. / }[PÒ øÁ¨øÁ EÖv¨£kzx® AÔÄøµ°ß (i]H) PõQu ¤µvø¯ ö£Ó Â¸®¤ÚõÀ u¯Äö\´x ÷uºÄUSÔ°hÄ®. CÀ»õÂmhõÀ Á[Q°À }[PÒ £vÄ ö\ú ªßÚg\À PÁ›°À i]H AÝ¨£¨£k®.

Transfer to DCB Bank A/c. No.:

Issue Demand Draft Payable at

Through NEFT

*Payment Instructions(upon closure) / Ámi ÁÇ[SuÀ (‰k®÷£õx)

Mode of Operation JointlyFormer or SurvivorSelf

Guardian

Either or Survivor

By anyone or Survivor

C¯US® øÓ _¯® ¯õµõÁx J¸Áº AÀ»x E°º ÁõÌ£Áº ¢øu¯Áº AÀ»x E°º ÁõÌ£Áº TmhõP

£õxPõÁ»º ¯õµõÁx J¸Áº AÀ»x E°º ÁõÌ£Áº

i]¤ Á[Q PnUS GsqUS AÝ¨£Ä®

Áøµ÷Áõø» ÁÇ[PÄ®

GßDGLï

‰»©õP£n® ÁÇ[PUPz uUP Ch®

1. Mandatory to attach a cancelled cheque of the bank account mentioned below1. R÷Ç SÔ¨¤k® Á[QU PnUQß µzx ö\´¯¨£mh Põ÷\õø»ø¯ Cøn¨£x Pmhõ¯®. 2. Beneficiary Name (As per Beneficiary’s Bank record - should be same as applicant name):2. £¯ÚõÍ›ß ö£¯º (£¯ÚõÍ›ß Á[Q £v÷Ámiß£i & Âsn¨£uõµ›ß ö£¯øµ¨ ÷£õ»÷Á ÇUP ÷Ásk®):

Instructions for payment of interest & maturity proceeds through NEFTGßDGLï ‰»©õP Ámi ÁÇ[SuÀ ©ØÖ® vºa] ö\¯ÀøÓPÐUPõÚ AÔÄøµPÒ

This facility is not available

for fixed deposits with

maturity instruction as “Auto Renew Principal &

Pay Interest”C¢u Á\v,

“uõÚõP ¦x¨¤US® A\À ©ØÖ®

Ámi ÁÇ[Suø»

vºa] AÔÄøµ¯õP

öPõsh {µ¢uµ øÁ¨¦PÐUSU

QøhUPõx.

Bank Name: Branch Name:

Others (please specify)

Account Type: Savings Current

Overdraft

Account Number:

IFS Code:

|õß / |õ[PÒ ¤ßÁ¸® ÂvøÓPÒ ©ØÖ® {£¢uøÚPÐUS Pmk¨£kQ÷Óõ®: 1. AÝ¨£¨£k® £n® GÚx / G[PÍx ö\õ¢u A£õ¯® ©ØÖ® ö£õÖ¨¤À AÝ¨£¨£kQÓx GßÖ ¦›¢x öPõÒÍ¨£kQÓx ©ØÖ® £›ÁºzuøÚ, ÁÇ[SuÀ AÀ»x ö\´vø¯ ÁÇ[Põuux AÀ»x HuõÁx uÁÖUPõP, £›©õØÓ® AÀ»x AÝ¨¦ÁvÀ ¤øÇ AÀ»x AÆÁõÖ ÁÇ[SuÀ AÀ»x ö£Ó¨£k®÷£õx AÀ»x C»US Á[Q°ß ö\¯À AÀ»x Bº¤I (›\ºÆ ÷£[U BL¨ C¢v¯õ) BºiâGì / GßDGLï ]ìh® QøhUPõux AÀ»x ö£Ö® Á[Q / QøÍ°À AÀ»x |õß / |õ[PÒ AÎzu uÁÓõÚ uPÁÀ AÀ»x |õß / |õ[PÒ AÎzu uÁÓõÚ uPÁÀ Põµn©õP ö£Ö® Á[Q / QøÍ°ß£i uÁÓõÚ Phß Em¦Ó uPÁÀ öuõhº¦ Aø©¨¤ß ö\¯¼Ç¨¦ AÀ»x HuõÁx ö\¯À AÀ»x Pmk¨£õmkUS A¨£õ»õÚ {PÌÄ AÀ»x |£›ß ö£¯øµ øÓ¯õP Aøh¯õÍ® Põs£vÀ ö\¯¼Ç¨¦, HuõÁx PõµnzvØPõP ö\´vø¯ ¦›¢xöPõÒÐuÀ AÀ»x AuøÚ uÁÓõP ¦›¢xöPõÒÐuÀ Põµn©õP HØ£k® HuõÁx CÇ¨¦PÒ AÀ»x ÷\u[PÒ AÀ»x iÄPÐUS Á[QUS G¢u ö£õÖ¨¦® HØPõx. 2. BºiâGì / GßDGLï ÷Ásk÷PõÒ AÁØÖUPõÚ Bº¤I JÊ[SøÓPÒ ©ØÖ® ÁÈPõmkuÀPÐUS Em£mhøÁ Gß£øu |õß / |õ[PÒ ¦›¢xöPõÒQ÷Óõ®. 3. Phß £¯ßö£Ö£Á›ß PnUS Gs uPÁø» øÁz÷u ÁÇVP¨£k® ©ØÖ® £¯ß ö£Ö£Á›ß ö£¯º ÂÁµ[PÒ AuØS £¯ß£kzu¨£hõx Gß£øu |õß / |õ[PÒ J¨¦UöPõÒQ÷Óõ®.

Terms and conditions / ÂvøÓPÒ ©ØÖ® {£¢uøÚPÒ:

I/We abide by the following terms and conditions: 1. It is being understood that the remittance is to be sent at my/our own risk and responsibility and on the distinct understanding that no liability

whatsoever is to be attached to the Bank for any loss or damages arising or resulting from delay in transmission, delivery or non-delivery of the message or for any mistake, exchange or error in

transmission or delivery thereof or in deciphering the message for whatsoever cause or from its misinterpretation when received or the action of the destination Bank or due to RBI (Reserve Bank

of India) RTGS / NEFT system not being available or failure of internal communication system at the recipient bank/branch or incorrect information provided by me/us or any incorrect credit

accorded by the recipient bank/branch due to information provided by me/us or any act or event beyond control or from failure to properly identify the person’s name. 2. I/We understand that the

RTGS / NEFT request is subject to the RBI regulations and guidelines governing the same. 3. I / We agree that the credit will be effected solely on the beneficiary account number information and

beneficiary name particulars will not be used for the same.

Á[Q°ß ö£¯º QøÍ°ß ö£¯º

PnUS Gs PnUS ÁøP ÷\ª¨¦ |h¨¦

IGL¨Gì ÷Põm KÁºiµõL¨m ©ØÓøÁ (u¯Äö\´x SÔ¨¤hÄ®)

B® CÀø»

(¹£õ´

% ÁmiÃu®

Yes NoB® CÀø»

uÛ ©ØÖ®Tmk PnUS

øÁzv¸¨£ÁºPÐUS ÷uºÄ

ö\´¯z uUPx. i]¤ _µUåõ GLï&US

Pmhõ¯©õÚx

Preferable for Single & Joint

account holders.

Mandatory for DCB Suraksha

FD

Name of Father / Mother / Guardian Signature of Father / Mother / Guardian

Minor's NameÁ¯xUS

ÁµõuÁ›ß ö£¯º

Declaration where Applicant is Minor / Âsn¨£uõµº Á¯xUS ÁµõuÁµõP ÇUS®÷£õuõÚ AÔÂ¨¦

I hereby declare that I am the natural guardian / lawful guardian appointed by the Court order dated (copy enclosed) of YYYYMMDD

Master / Miss

I shall represent the said minor in operating the Bank Account till he / she attains majority. I agree to indemnify the Bank against any claims for any transactions made in the account(s). / ö\õÀ»¨£k® Á¯xUSÁµõuÁº Á¯xUS Á¸®Áøµ |õß AÁß / AÁÐUS ¤µv{v¯õP Ç¨÷£ß. C¢u PnUQÀ(PÒ) ö\´¯¨£k® HuõÁx £›ÁºzuøÚPÐUPõP ö\´¯¨£k® HuõÁx E›ø©÷PõµÀPÎ¼¸¢x Á[Q°ß CÇ¨¦PÐUS £õxPõ¨¦ AÎUP |õß J¨¦UöPõÒQ÷Óß.

I undertake and confirm that I shall avail various services of the Bank (wherever applicable) like Phone Banking, Mobile Banking, Internet Banking, Bill Pay only for the benefit of the minor and I shall abide by all terms and conditions governing the various services and shall intimate the Bank in writing immediately upon the Minor attaining majority. / |õß Á¯xUS ÁµõuÁ›ß £¯ÝUPõP ©mk÷© ÷£õß ÷£[Q[, ö©õø£À ÷£[Q[, Cßhºö|m ÷£[Q[, ¤À ÷£ ÷£õßÓ Á[Q°ß £À÷ÁÖ ÷\øÁPøÍ ö£Ö÷Áß (ö£õ¸¢x® Ch[PÎÀ) ©ØÖ® £À÷ÁÖ ÷\øÁPøÍ {ºÁQUS® GÀ»õ ÂvøÓPÒ ©ØÖ® {£¢uøÚPÐUS Pmk¨£k÷Áß ©ØÖ® Á¯xUSÁµõuÁº Á¯xUS Á¢u Ehß EhÚi¯õÚ |õß Á[QUS GÊzx¨§ºÁ©õP öu›Â¨÷£ß Gß£øu J¨¦UöPõÒQ÷Óß ©ØÖ® EÖv¨£kzxQ÷Óß.

*Customer id:

* Incase Father / Mother / Guardian is an existing customer

i÷Pi ußø© Âsn¨£uõµ›

ß ö£¯›À ©mk÷©

E¸ÁõUP¨£k®.

DKD can be created in the name of the

Primary Applicant only

DCB Diamond Khushiyali Deposit Details / i]¤ øh©sm Sæ¯õ¼ öh£õ]m ÂÁµ[PÒ

Monthly Instalment Amount©õuõ¢vµ uÁøn öuõøP `

Monthly Instalments tobe collected through

Debit to Account No.

on DD of every month

Maturity Instructions Transfer to DCB A/c No.:

Date of Birth (DOB) proof required to

avail benefits for Senior Citizens.

‰zu Si©UPÐUPõÚ

£¯ßPøÍ¨ ö£Ó ¤Ó¢u ÷uv (iKÂ)

Buõµ® ÷uøÁ.

Deposit Period Days Months Years (Deposit period is minimum 14 days and maximum 10 years)

Interest Rate . %Senior Citizen Yes No

Mode of Operation Self Either or SurvivorJointly

Others: (Please Specify)

Former or Survivor Guardian

øÁ¨¦ Põ»® |õmPÒ ©õu[PÒ BskPÒ (øÁ¨¦ Põ»® SøÓ¢ux 14 |õmPÒ ©ØÖ® AvP£m\® 10 BskPÒ)

‰zu Si©Pß B® CÀø» BskUS ÁmiÃu®

RÌUPsh ÁÈPÎÀ ÷\P›UP¨£h ÷Ási¯ ©õuõ¢vµ uÁøn

PnUS GsoÀ PÈUP ÷Ási¯x

÷uv°À JÆöÁõ¸ ©õu®

vºa] AÔÄøµPÒ i]¤ PnUS GsqUS AÝ¨¦uÀ:

ö\¯À£k® øÓ _¯® TmhõP ¯õµõÁx J¸Áº AÀ»x E°º ÁõÌ£Áº ¢øu¯Áº AÀ»x E°º ÁõÌ£Áº £õxPõÁ»º

©ØÓøÁ: (u¯Äö\´x SÔ¨¤hÄ®)

÷uv°mh }v©ßÓ EzuµÂß£i {¯ªUP¨£m |õß C¯ØøP¯õÚ £õxPõÁ»ß / \mh¨§ºÁ©õÚ £õxPõÁ»ß Gß£øu |õß Cuß ‰»® AÔÂUQ÷Óß.

S©õµß / S©õ›

(CønUP¨£mkÒÍ)

*ÁõiUøP¯õÍº Ii

*u¢øu / uõ´ / £õxPõÁ»º HØPÚ÷Á ÁõiUøP¯õÍµõP ÇUS®£m\zvÀ

u¢øu / uõ´ / £õxPõÁ»›ß ö£¯º u¢øu / uõ´ / £õxPõÁ»›ß øPö¯õ¨£®

Thumb impression isrequired to be

attested by2 witnesses. In

case of signature, no witness is

required.ö£¸ÂµÀ ÷µøPUS 2

\õm]PÒ \õßÖ ÁÇ[P ÷Ásk®. øPö¯õ¨£©õP

ÇUS®£m\zv, \õm]

÷uøÁ°Àø». Signature(s) / Thumb Impression(s) of depositor(s)

øÁ¨£õÍ›ß(PÒ) øPö¯õ¨£®(PÒ) / ö£¸ÂµÀ ÷µøP(PÒ)

Nominationunder Section45ZA of the

BankingRegulation Act, 1949

and Rule 2(1) ofthe Banking Companies (Nomination) Rules 1985 in

respect of bankdeposits.

Á[Q øÁ¨¦PøÍ¨ ö£õÖzu Áøµ,

Á[Q JÊ[SøÓa

\mh®1949&ß ¤›Ä 45CémH ©ØÖ® Á[Q {ÖÁÚ[PÒ

(Áõ›_{¯©Ú®) ÂvøÓPÒ1985&ß Âv 2(1)&ß RÇõP Áõ›_

{¯©Ú® ö\´¯¨£kQÓx.

YRelationship with Applicant, if any

YYYMMDDDate of Birth:YearsAge:

* As the nominee is a minor on this date, I / we appoint (Name & Address)

to receive the amount of the deposit / in the account on behalf of the nominee in the event of my /our death during the minority of the nominee.Áõ›_ Á¯xUS ÁµõuÁµõP ÇPS®÷£õx GÚUS / G[PÐUS CÓ¨¦ HØ£k®£m\zvÀ øÁ¨¦/ PnUQÀ EÒÍ öuõøPø¯ Áõ›_UPõP ö£Ó.

In case you have specified a nominee above, please indicate if you wish to make mention of the nominee name on the passbook, statement & DCA issued in respect of your account and / or the passbook issued to you}[PÒ ÷©ØPsh Áõ›ø\ SÔ¨¤k®£m\zvÀ, E[PÒ PnUS ©ØÖ® / AÀ»x E[PÐUS ÁÇ[P¨£k® PnUS¨ ¦zuPzøu¨ ö£õÖzuÁøµ E[PÒ PnUQØPõP i]H ÁÇ[S® PnUS¨ ¦zuP®, AÔUøP°À Áõ›]ß ö£¯øµ SÔ¨¤h ÷Ásk©õ Gß£øu u¯Äö\´x PõmhÄ®.

I / We do hereby declare that what is stated above is true to the best of my / our knowledge and belief.GÚx / G[PÍx AÔÄ ©ØÖ® |®¤UøPUS Em£mk ÷©÷» TÓ¨£mhøÁ Esø©¯õÚøÁ Gß£øu |õß / |õ[PÒ AÔÂUQ÷Óõ®.

Yes No

Âsn¨£uõµ¸hß EÓÄ, HuõÁx Ç¢uõÀ Á¯x BskPÒ ¤Ó¢u ÷uv

* C¢u ÷uv°À Áõ›_ Á¯xUSÁµõuÁµõP Ç¨£uõÀ, |õß / |õ[PÒ {¯ªUQ÷Óõ® (ö£¯º ©ØÖ® PÁ›)

B® CÀø»

Nomination Details (Form DA 1) / Áõ›_ {¯©Ú ÂÁµ[PÒ (£iÁ® iH 1)

Yes, I / we want to nominate the following person No, I / we do not want to nominate anyone

Address:

Nominee Name:

I / we nominate the following person to whom in the event of my / our / minor’s death the amount of the deposit / in the account may be returned by DCB Bank Limited / GÚUS / G[PÐUS / Á¯xUS ÁµõuÁ¸US CÓ¨¦ HØ£k®£m\zvÀ PnUQÀ / øÁ¨¤À EÒÍ öuõøPø¯ i]¤ ÷£[U ¼ªöhm öPõk¨£uØPõP |õß / |õ[PÒ ¤ßÁ¸® |£øµ {¯ªUQ÷Óõ®.

B®, |õß ¤ßÁ¸® |£øµ Áõ›\õP {¯ªUP Â¸®¦Q÷Óß. CÀø», |õß ¯õøµ²® Áõ›\õP {¯ªUP Â¸®£ÂÀø».

Áõ›]ß ö£¯º

PÁ›

8

9

*Strike out if nominee is not a minor. ** Where deposit is made / account is held in the name of the minor the nomination should be signed by a person lawfully entitled to act on behalf of the minor.

Witness(es) / \õm](PÒ):

Name:

Signature:

Address:

Place: Date:

ö£¯º

øPö¯õ¨£®

•PÁ›

Ch® ÷uv

Risk Classification for Primary Applicant / ußø© Âsn¨£uõµ¸UPõÚ A£õ¯ ÁøP¨£õk

* Kindly fill the following details: / u¯Äö\´x ¤ßÁ¸® ÂÁµ[PøÍ {µ¨£Ä®:

Basis of Categorisation: Politically Exposed Person Domiciled in Risk Country Trust Sleeping Partner

High Risk Profession Others (Please specify):

Information: Politically Exposed Person due to position / status as:

If Domiciled in Risk Country - Country Name:

Nature of Business / Occupation:

*Details of Customer’s Source of Funds & Estimated Net Worth: / {vUPõÚ ÁõiUøP¯õÍ›ß Buõµ® ©ØÖ® ©v¨¤h¨£mh {Pµ ©v¨¤ß ÂÁµ[PÒ:

Income from Employment Income from Business Income from Investments Inherited Funds

Others (Please specify):

Expected Annual Turnover (`): Upto ` 1 Lakh Upto ` 10 Lakhs Upto ` 50 Lakhs Upto ` 1 Crore

Upto ` 5 Crores Upto ` 10 Crores Upto ` 25 Crores More than ` 25 Crores

Risk Classification of Account (L / M / H):

¹. 1 »m\® Áøµ Gvº£õºUS® Á¸hõ¢vµ ÁµÄö\»Ä(¹.):

¹. 5 ÷Põi Áøµ

¹. 10 »m\® Áøµ

¹. 10 ÷Põi Áøµ

¹. 50 »m\® Áøµ


¹. 1 ÷Põi Áøµ

¹. 25 ÷PõiPÐUS® AvP®

ÁøP¨£kzxu¼ß Ai¨£øh Aµ]¯À ö\ÀÁõUS¨ ö£ØÓ |£º A£õ¯ |õmiÀ ÁõÌ£Áº AÓUPmhøÍ EÓ[S® £[Suõµº

E¯º A£õ¯ öuõÈÀ ©ØÓøÁ (u¯Äö\´x SÔ¨¤hÄ®):

uPÁÀPÒ

A£õ¯ |õmiÀ ÁõÌ¢uõÀ & |õmiß ö£¯º

öuõÈ¼ß ußø© / öuõÈÀ

¤ßÁ¸Áx£i £uÂ / {ø» Põµn©õP Aµ]¯À ö\ÀÁõUS¨ ö£ØÓ |£º

÷Áø» ‰»©õÚ Á¸Áõ´ öuõÈÀ ‰»©õÚ Á¸Áõ´ u½kPÒ ‰»©õÚ Á¸Áõ´ Sk®£zv¼¸¢x ö£ØÓ {vPÒ

©ØÓøÁ (u¯Äö\´x SÔ¨¤hÄ®)

PnUQß A£õ¯ ÁøP¨£õk (GÀ / G® / Ga)

Risk Classification for Joint Applicant 1 / Tmk Âsn¨£uõµº 1&UPõÚ A£õ¯ ÁøP¨£õk

Risk Classification for Joint Applicant 2 / Tmk Âsn¨£uõµº 2&UPõÚ A£õ¯ ÁøP¨£õk

*Áõ›_ Á¯xUSÁ¢uÁµõP Ç¢uõÀ Aizx ÂhÄ®. **øÁ¨¦ / PnUS Á¯xUSÁµõuÁ›ß ö£¯›À øÁzv¸US®÷£õx Á¯xUS ÁµõuÁ¸UPõÚ \mh¨§ºÁ E›ø© öPõsh J¸Áº Áõ›_ {¯©ÚzvÀ øPö¯õ¨£® Ch÷Ásk®.

Name:

Signature:

Address:

Place: Date:

ö£¯º

øPö¯õ¨£®

•PÁ›

Ch® ÷uv














¹. 5 ÷Põi Áøµ

¹. 10 »m\® Áøµ


¹. 50 »m\® Áøµ


¹. 1 ÷Põi Áøµ




uPÁÀPÒ




















¹. 5 ÷Põi Áøµ

¹. 10 »m\® Áøµ


¹. 50 »m\® Áøµ


¹. 1 ÷Põi Áøµ




uPÁÀPÒ







10

GÚx / G[PÍx PnUQ»õÚ Ç¨¦ ©ØÖ® / AÀ»x GÚx / G[PÍx PnUQ»õÚ ö©õzu ÁµÄPÒ C¢v¯ ›\ºÆ Á[Q {ºn°zu Áµ®¦PøÍ PhUS®÷£õx A¢u ÷|µzvÀ

ö£õ¸¢xÁx£i ÷PJ´] ÂvøÓPøÍ §ºzv ö\´¯ ÷Ásk® Gß£uØS |õß / |õ[PÒ J¨¦UöPõÒQ÷Óõ® ©ØÖ® Á[Q ÷ÁskÁx£i |õß / |õ[PÒ |h¢xöPõÒ÷Áõ® GßÖ

EÖv¨£kzxQ÷Óõ® , AÆÁõÖ ö\´¯z uÁÖ®£m\zvÀ 15 |õmPÒ AÔÂ¨¦U öPõkzx Á[Q PnUQß ö\¯À£õmøh {Özv øÁUP AÀ»x ‰h E›ø©öPõskÒÍx Gß£øu

|õß / |õ[PÒ AÔ÷Áõ® ©ØÖ® J¨¦UöPõÒQ÷Óõ®.

DCB Bank Limited / i]¤ ÷£[U ¼ªöhm

___________________________________

(Signature of the Customer / )ÁõiUøP¯õÍ›ß øPö¯õ¨£®

Letter From Customer – Opening of “NO FRILL” Accounts in “VALUE SAVINGS SCHEME” under relaxed KYC Norms

uÍºzu¨£mh ÷PJ´] ÂvøÓPÎß RÇõP ©v¨¦ ÷\ª¨¦z vmhzvÀ ÷|õ L¨›Àì PnUS vÓ¨£uØPõÚ ÁõiUøP¯õÍ›ß Piu®

____________________ Branch / QøÍ

Yours faithfully / u[PÒ Esø©²ÒÍ,

The Branch Manager / QøÍ ÷©»õÍº

I / We am / are aware and agree that if the balance in my / our account and / or the aggregate credits in my / our account exceed/s the limits specified by

Reserve Bank of India, I/we agree to be subjected to full KYC norms applicable at that point of time and affirm that I/we shall comply with the same as per

requirements of the Bank failing which, the Bank has the right to suspend the operations or close the account by giving a notice of 15 days.

Sir / Madam / I¯õ / A®©õ,

____________________ Branch / QøÍ

I am / We are aware of the risks that would arise due to receipt of customer deliverables at the corporate address by any unauthorised person and I / we shall not hold

the Bank responsible and liable for any loss or damage that I / we may suffer, due to the Bank recording and treating the corporate address of my / our company as my

/ our mailing address. / ÁõiUøP¯õÍ¸US öPõkUPU Ti¯ÁØøÓ Põº£÷µm PÁ›°À ÁÇ[S®÷£õx Ax A[RPõµ® ö£Óõu |£ºPÎh® QøhUS® A£õ¯® EÒÍx Gß£øu

|õß / |õ[PÒ AÔ÷Áõ® ©ØÖ® GÚx / G[PÍx Ag\À PÁ›¯õP GÚx / G[PÒ {ÖÁÚzøu Põº£÷µm PÁ›¯õP Á[Q £vÄ ö\´x |hzxÁuß Põµn©õP HØ£hU Ti¯ HuõÁx

CÇ¨¦ AÀ»x ÷\uzvØS Á[Qø¯ |õß / |õ[PÒ ö£õÖ¨÷£ØPa ö\´¯ ©õm÷hß.


Letter From Customer – Opening of Corporate Payroll Account with Mailing Address as Office Address

A¾Á»P PÁ›ø¯ Ag\À PÁ›¯õPU öPõsk Põº£÷µm ÷£÷µõÀ PnUS vÓ¨£uØPõÚ ÁõiUøP¯õÍ›ß Piu®.

___________________________________

The Branch Manager / QøÍ ÷©»õÍº

Sir / Madam / I¯õ / A®©õ,

Yours faithfully / u[PÒ Esø©²ÒÍ,

(Signature/s of the Customer/s / )ÁõiUøP¯õÍº / PÎß øPö¯õ¨£® / PÒ DCB Bank Limited / i]¤ ÷£[U ¼ªöhm

Declaration Regarding Signing in Vernacular Language / By Illiterate / Visually Challenged PersonÁmhõµ ö©õÈ°À øPö¯õ¨£ªkuÀ / PÀ»õuÁº / £õºøÁ SøÓ£õk EÒÍÁºPÒ øPö¯õ¨£ªkÁx öuõhº£õÚ AÔÂ¨¦

I, Mr./Ms._________________________________________________________________ (the Declarant - either Bank Official or customer of Bank) have read out and

explained the contents of this Account Opening Form of DCB Bank Limited (the Bank) to the Applicant(s) Mr. / Ms. ____________________________________________

in _____________________________ language and he / she / they have confirmed that he / she / they has / have understood the same and have agreed to abide by all

the terms and conditions of the said Account Opening Form. Pursuant to the same the aforesaid Applicant(s) is / are affixing his / her / their signature(s)/thumb

impression(s) as given herein below: _________________________________________________________________ / |õß v¸ / S©õ› (AÔÂ¨£õÍº & Á[Q AvPõ›

AÀ»x Á[Q°ß ÁõiUøP¯õÍº) i]¤ ÷£[U ¼ªöhm&ß (Á[Q) PnUSz vÓUS® £iÁzvÀ EÒÍÁØøÓ £izx Âsn¨£uõµº(PÒ) v¸ / S©õ›

____________________________________________ _____________________________&US ö©õÈ°À ÂÍUQ÷ß ©ØÖ® AÁº / AÁÒ PnUSz vÓUS® £iÁzvÀ EÒÍ

GÀ»õ ÂvøÓPÒ ©ØÖ® {£¢uøÚPøÍ ¦›¢xöPõshøu EÖv¨£kzv AÁØÖUS Cn[Q |hUP AÁº / AÁÒ J¨¦UöPõshõº. ÷©Øö\õßÚ Âsn¨£uõµº(PÒ) R÷Ç

øPö¯õ¨£® CkQÓõº / ö£¸ÂµÀ ÷µøÁ øÁUQÓõº:

___________ ___________ ___________ ___________Name and signatures of Applicants Name and signature of the Declarant / Âsn¨£uõµºPÎß ö£¯º ©ØÖ® øPö¯õ¨£[PÒ AÔÂ¨£Á›ß ö£¯º ©ØÖ® øPö¯õ¨£[PÒ

Date / :_____________ Place / :_____________÷uv Ch®

Declaration / AÔÂ¨¦

I / We declare, confirm, understand, accept, acknowledge and agree:

H) C¢u Âsn¨£¨ £iÁzvÀ (SÔ¨¤mh AÀ»x öPõkUP¨£mh GÀ»õ BÁn[PÒ) öPõkzxÒÍ GÀ»õ ÂÁµ[PÒ ©ØÖ® uPÁÀPÒ GÀ»õÂuzv¾® Esø©¯õÚøÁ, \›¯õÚøÁ, Êø©¯õÚøÁ ©ØÖ® ¦v¯øÁ ©ØÖ® |õß/ |õ[PÒ HuõÁx uPÁÀPøÍ ©øÓUPÂÀø». |õß / |õ[PÒ öPõkzu SÔ¨¤mh ÂÁµ[PÒ Á[Q {ÖÁÚ[PøÍ {ºÁQUS® ö\¯À£k® ÁÈPõmkuÀPÐUS ÷uøÁ¨£k£øÁ GßÖ |õß / |õ[PÒ ¦›¢xöPõÒQ÷Óõ®. Á[QUSz ÷uøÁ¨£hU Ti¯ ©ØÖ® ÷uøÁ¨£kÁx£i ÷©ØöPõsk HuõÁx uPÁÀPøÍ |õß/ |õ[PÒ J¨¦UöPõÒQ÷Óõ® ©ØÖ® HØÖU öPõÒQ÷Óõ®. ¤) Gß / G[PÒ «x vÁõ»õS® ö\¯ÀøÓ xÁUP¨£hÂÀø», |õß/ |õ[PÒ vÁõÀ BPÄ® CÀø». ]) Âsn¨£¨ £iÁ® ©ØÖ® ¤µ_µ[PøÍ |õß / |õ[PÒ £iz÷uõ® ©ØÖ® Á[Q°ß {v²uÂ AÀ»x ÷\øÁ AÀ»x vmh[PøÍ¨ ö£ÖÁuØPõÚ AøÚzx ÂvøÓPÒ ©ØÖ® {£¢uøÚPøÍ AÔ÷Áõ®. i) HuõÁx Põµn® TÓõ©À GÚx Âsn¨£zøu ©ÖUS® E›ø©ø¯ Á[Q uUP øÁzxU öPõÒQÓx. ¦øP¨£h[PÒ Em£h öPõkzu BÁn[PÒ ©ØÖ® Âsn¨£¨ £iÁzøu uUP øÁzxU öPõÒÐ® E›ø©ø¯ Á[Q uUP øÁzxU öPõÒQÓx ©ØÖ® AÁØøÓ GÚUS/ G[PÐUS v¸¨¤u uµõx Gß£øu |õß / |õ[PÒ ¦›¢xöPõÒQ÷Óõ®. D) GÚx Ãk / ÷Áø»°À HØ£k® ©õØÓ® öuõhº£õP Á[QUSz öu›ÂUP ©ØÖ® AÆÁ¨÷£õx Á[QUSz ÷uøÁ¨£hU Ti¯ ©ØÖ® ÷uøÁ¨£kÁx£i ÷©¾® uPÁÀPøÍ AÎUP. GL¨) PnUS Põº£÷µm \®£Íz vmhzvß RÇõP Ç¢uõÀ: G¢u “ÂvøÓPÒ ©ØÖ® {£¢uøÚPÎß RÇõP GÚx / G[PÒ {ÖÁÚ® ©ØÖ® FÈ¯ºPÐUS \®£Íz vmh® ÁÇ[P¨£kQÓx Gß£øu²® |õß/ |õ[PÒ £izx¨ ¦›¢xöPõs÷hõ®. ‰ßÖ ÷Áø» |õmPÐUSÒÍõP G¢uöÁõ¸ öuõøPø¯²® GÚx PnUQÀ ÁµÄ øÁUP GÚx/ G[PÍx u»õÎ AÎzu AÔÄøµø¯ {Özv øÁUS® E›ø© AÁ¸US EÒÍx ©ØÖ® |õß/ |õ[PÒ GÚx/ G[PÍxPnUQÀ Ax÷£õßÓ PÈÄPÐUPõP G¢u Âu ÂÁPõµ® AÀ»x Á[Qø¯ ö£õÖ¨÷£ØPa ö\´¯ ©õm÷hõ® Gß£øu |õß/ |õ[PÒ J¨¦UöPõÒQ÷Óõ®. GÚx / G[PÍx uØ÷£õøu¯ u»õÎ°h® GÚx / G[PÍx ÷Áø» {ßÓ Eh÷Ú Á[QUS (GÊzx¨§ºÁ©õP) öu›Â¨£x GÚx/ G[PÍx ö£õÖ¨¦ ©ØÖ® Auß ¤ÓS \®£Í PnUSz vmhzvß RÇõÚ GÀ»õ AÀ»x HuõÁx £¯ßPÒ GÚUS / G[PÐUS QøhUPõx Gß£øu |õß, |õ[PÒ ¦›¢xöPõÒQ÷Óõ®. GÚx / G[PÍx PnUøP ÁÇUP©õÚ ÷\ª¨¦ Á[QU PnUPõP ©õØÖ® E›ø©ø¯ Á[Q uUP øÁzxUöPõÒQÓx ©ØÖ® ÷©ØöPõsk Põº£÷µm \®£Í vmhzvß RÇõÚ PnUS GßÓ ÁøP¨£õmøh {Özx® E›ø©ø¯ Gß£øu |õß / |õ[PÒ ¦›¢xöPõÒQ÷Óõ®. AÆÁõ÷Ó, SøÓ¢u£m\ Ç¨¦z ÷uøÁ°À ©õØÓ® HØ£h»õ® ©ØÖ® ÁÇUP©õÚ ÷\ª¨¦ Á[QU PnUQß£i Pmhn[PÒ ÂvUP¨£h»õ®. â) |õß / |õ[PÒ ö\¯ÀøÓ ö\´¯¨£mh uPÁÀPÒ / uµÄPÒ / vmh[PøÍ ÷ÁÖ Á[QPÒ / {v {ÖÁÚ[PÒ / Phß ÁÇ[S÷Áõº / ÷©ØPsh£i £vÄ ö\ú £¯ß£kzx÷Áõ¸US öPõk¨£uØPõP Á[Qø¯ ö£õÖ¨÷£ØPa ö\´¯ ©õm÷hõ®. Ga) AÆÁ¨÷£õx £›¢xøµ¨£x£i Á[Q°hª¸¢x SÔ¨¤mh ö£õÖ¨¦z vmh[PÒ / ÷\øÁPÐUPõÚ ÷©ØöPõsk Âsn¨£[PøÍ |õß/ |õ[PÒ {µ¨£ ÷Ásk® ©ØÖ® Ax÷£õßÓ Âsn¨£[PÒ C¢u Âsn¨£zvß (©ØÖ® ©õÓõP) J¸[Qøn¢u £Sv¯õP P¸u¨£k® £›¢xøµzu£i Ax÷£õßÓ £iÁ[PÎÀ öÁÎ¨£kzu¨£hõÂmhõÀ, C[÷P {ºn°UP¨£mh uPÁÀPÒ ©ØÖ® SÔ¨¤h¨£k® AÀ»x C[÷P öPõkUP¨£mh BÁn[PÒ GÀ»õÂuzv¾® Esø©¯õÚøÁ, \›¯õÚøÁ, Êø©¯õÚøÁ ©ØÖ® ¦v¯øÁ. I) uµÄ {ºÁõPzvØS EuÄ® ÁøP°À ÷©ØöPõsk AÎUP¨£k® ©ÝUPÐUS Âsn¨£¨ £iÁ Gs ©ØÖ® / Á[Q £›¢xøµUPU Ti¯ ÂÁµ[PøÍa ÷\ºUP ÷Ásk®.÷á) GÚUS/ G[PÐUS öh¤m ©ØÖ® HiG® Põºk ÁÇ[P Á[QUS |õß/ |õ[PÒ A[RPõµ©ÎUQ÷Óõ®. ÷P) AÆÁ¨÷£õx A©¼À EÒÍ ÂvøÓPÒ ©ØÖ® {£¢uøÚPÎß ‰»® öh¤m ©ØÖ® HiG® Põºk ÁÇ[SuÀ ©ØÖ® £¯ß£kzxuÀ {ºÁQUP¨£kQÓx ©ØÖ® AÁØÖUS Pmk¨£h |õß / |õ[PÒ J¨¦UöPõÒQ÷Óõ®. GÀ) AÆÁ¨÷£õx Á[Q öh¤m ©ØÖ® HiG® PõºkUPõÚ ÂvøÓPÒ ©ØÖ® {£¢uøÚPøÍz v¸zu»õ®. G®) öh¤m ©ØÖ® HiG® Põºøh £¯ß£kzxÁuØPõÚ PmhnzvØS Cøn¯õÚ öuõøPø¯ Á¸hõ¢vµ©õP GÚx/ G[PÒ PnUQ¼¸¢x PÈzxUöPõÒÍ |õß/ |õ[PÒ {£¢uøÚ°À»õ©À ©ØÖ® v¸®¤¨ ö£Ó i¯õ©À A[RPõµ©ÎUQ÷Óõ®. Gß) Tmk øÁ¨£õÍ›À(PÒ) ̄ õµõÁx J¸Áº AÀ»x JßÖUS ÷©Ø£mhÁº CÓUS®£m\zvÀ, C¯US® øÓ°ß£i uÁøn ÷uvUS ß£õP ÷ÁsiUöPõshõÀ ö\¯ÀøÓ°À E°º ÁõÌ£Á¸US(PÒ) £n® öPõkUP¨£h Tmk øÁ¨£õÍºPÍõÚ |õß / |õ[PÒ J¨¦UöPõÒQ÷Óõ®. ÷ÁsiUöPõÒÐ® ÷uv°À JÊ[SøÓ ÁÈPõmkuÀPÒ AÀ»x ¤]Gì¤I ö|ÔøÓPÎß ÂvPÒ AÀ»x Cµsiß AÝ©vUPz uUP£i Á[Q ushøÚ Pmhn[PøÍ ÂvUP»õ®. K) Á[Q°ß uÛ E›ø©°ß£i Á[Q°À PnUøPz öuõhµ»õ® ©ØÖ® Á[Q PnUS / PnUS øÁzv¸¨£Á›ß |hzøu°À Av¸¨v Aøh¢uõÀ, GÚUS / G[PÐUS J¸ ©õu AÔÂ¨¦ AÝ¨¤ PnUøP ‰h AÀ»x GÚUS / G[PÐUS AÎUS® HuõÁx ÷\øÁø¯ AÀ»x ÷\øÁ°À ÁÇ[P¨£k® \¾øPPøÍ {Özu AÀ»x Ax÷£õßÓ ÷\øÁPÐUS ö£õ¸¢x® Ãu[PÒ / Pmhn[PøÍ ÂvUP Á[QUS E›ø© EÒÍx. ¤) Á[Q uÚx uÛ²›ø©°À, GÚUS / G[PÐUS AÔÂ¨¦ AÝ¨£õ©À HuõÁx ÷\øÁPøÍ Êø©¯õP AÀ»x £Sv¯õP {Özu»õ®. U³) HuõÁx PõµnzvØPõP PnUSz vÓUS® öuõøPUPõÚ (HKH) Põ÷\õø» v¸®¤Á¢uõÀ, Á[Q GÚUS / G[PÐUS G¢uÂu Põµn® TÓõ©À PnUøP ‰h»õ®. Bº) A[RPõµ®ö£ØÓ øPö¯õ¨£uõµ›À(PÒ) ¯õµõÁx J¸Áº ©ØÖ® / E°ºÁõÌ£Áº AÀ»x G[PÎÀ E°ºÁõÌ£Áº AÎUS® GÊzx¨§ºÁ©õÚ Âsn¨£zøu¨ ö£ØÓx® Á[Q uÚx uÛ Â¸¨£zvß£i ©ØÖ® Ax÷£õßÓ ÂvøÓPÒ ©ØÖ® {£¢uøÚPÐUS Em£mk Tmk¨ ö£¯ºPÎÀ Phß / ß£n® / ¦x¨¤zuÀ / áõ«ß / öPõÀ»õmµø» AvP›zuø» ÁÇ[P»õ®.Gì) C¢v¯õÂÀ Á]US® uÛ|£µõP C¯UP¨£k® PnUQß ÁõiUøP¯õÍºPÐUS i]¤&Bß u ÷Põ Á\v ÁÇ[P¨£k®. i) C¢v¯õÂÀ Á]UPõuÁºPÎß PnUSPÐUS i]¤ ö©õø£À ÷£[Q[ ÁÇ[P¨£hõx. ²) ©ØÓ Âå¯[PÐUS Cøh÷¯, £À÷ÁÖ vmh ÂvPÎß RÇõP ÷\ª¨¦ Á[Q PnUQß ÁøPPÎß SøÓ¢u£m\

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I]¤ ÷£[U ¼ªöhm (“Á[Q�) uÚx Cøn¯uÍ® www.dcbbank.com&À {ºn°zxÒÍ GÚx / G[PÍx PnUQØS¨ ö£õ¸¢uU Ti¯ ÂvøÓPÒ ©ØÖ® {£¢uøÚPøÍ |õß / |õ[PÒ £izx¨ ¦›¢xöPõs÷hõ® ©ØÖ® Cuß ‰»® J¨¦UöPõÒQ÷Óõ®. C¢u EÓÄUS¨ ö£õ¸¢uU Ti¯ ÂvøÓPÒ ©ØÖ® {£¢uøÚPÎÀ ö\´¯¨£k® HuõÁx ©õØÓ[PÒ / ¦x¨¤zuÀPÒ Á[Q°ß Cøn¯uÍzvÀ ©mk÷© QøhUS® Gß£øu |õß / |õ[PÒ ¦›¢xöPõÒQ÷Óõ®. GÚx / G[PÒ AÔÄ ©ØÖ® |®¤UøPUS¨ ¦»¨£mhÁøµ C¢u¨ £iÁzvÀ öPõkzxÒÍ uPÁÀPÒ Esø©¯õÚøÁ ©ØÖ® \›¯õÚøÁ GßÖ |õß / |õ[PÒ Cuß ‰»® AÔÂUQ÷Óõ®. HiG® / öh¤m Põºk, ÷£õß ÷£[Q[, ö©õø£À ÷£[Q[ ÷\øÁPÒ, Cßhºö|m ÷£[Q[, ¤À ÷£ö©ßm ÷\øÁPøÍ ÁÇ[P |õß/ |õ[PÒ Cuß ‰»® A[RPõµ® AÎUQ÷Óõ®. ÁÇ[P¨£k® £À÷ÁÖ ÷\øÁPÐUS® ö£õ¸¢x® Pmhn[PøÍ |õß / |õ[PÒ AÔ÷Áõ®, Á[Q

uÚx Cøn¯uÍ® www.dcbbank.com &À {ºn°zxÒÍ£i ÷£õß ÷£[Q[, ö©õø£À ÷£[Q[ ÷\øÁPÒ, Cßhºö|m ÷£[Q[, ¤À ÷£ö©ßm ÷\øÁPøÍ £¯ß£kzxÁuØPõÚ “ÂvøÓPÒ ©ØÖ® {£¢uøÚPøÍ |õß / |õ[PÒ £izx¨ ¦›¢xöPõs÷hõ® ©ØÖ® Cuß ‰»® J¨¦UöPõÒQ÷Óõ® ©ØÖ® AÆÁ¨÷£õx ö£õ¸¢xÁx£i GÀ»õ ÂvøÓPÒ ©ØÖ® {£¢uøÚPøÍ |õß / |õ[PÒ ¤ß£ØÖ÷Áõ®. ÷©¾® AÆÁ¨÷£õx ö£õ¸¢xÁx£i HuõÁx ÷\øÁ / £À÷ÁÖ ÷\øPÐUS ö£õ¸¢x® HuõÁx Pmhn[PÐUPõP GÚx/ G[PÍx PnUQ¼¸¢x(PÒ) PÈzxUöPõÒÍ |õß/ |õ[PÒ Á[QUS A[RPõµ® AÎUQ÷Óõ®. vºa] AÔÄøµPÒ CÀ»õu£m\zvÀ, ö£õ¸¢x® ÂvøÓPÒ ©ØÖ® {£¢uøÚPÐhß ßÚuõÚ |h¨¤¼¸¢x Ámi Ãu[PÎÀ A÷u Põ»zvØS øÁ¨¦ uõÚõP ¦x¨¤UP¨£k®.

|õß/ |õ[PÒ RÌUPshÁØøÓ AÔÂUQ÷Óõ®, EÖv¨£kzxQ÷Óõ®, ¦›¢xöPõÒQ÷Óõ®, HØÖU öPõÒQ÷Óõ®, J¨¦U öPõÒQ÷Óõ®:

(a)That all the particulars and information given in this application form (and all documents referred or provided therewith) are true, correct, complete and up-to-date in all

respects and I / We have not withheld any information. I / We understand certain particulars given by me / us are required by the operational guidelines governing banking

companies. I / We agree and undertake to provide any further information as and when the Bank may require. (b) That I / we have had no insolvency proceedings initiated against

me / us nor I / we have ever been adjudicated insolvent. (c) That I / we have read the application form and brochures and am aware of all the terms and conditions of availing

finance or service or products from the Bank. (d) That the Bank reserves the right to reject any application without providing any reason and reference to me / us. I / We agree and

understand that the Bank reserves the right to retain the application forms, and the documents provided therewith, including photographs, and shall not return the same to me /

us. (e) To inform the Bank regarding change in my residence /employment and to provide any further information as and when the Bank may require from time to time. (f) That if

the Account is under corporate salary scheme: I / We have also read and understood “Terms and Conditions” under which Salary Scheme is offered to my / our organization

and employees. I / We agree that my / our employer has full right to reserve any instruction given by them to credit my account for any amount within a period of three working

days and I / we will not dispute or hold the Bank responsible for such debits in my / our account. I / We understand that it is my / our responsibility to inform (in writing) the Bank

immediately on termination of my / our employment with my / our current employer, whereupon I / we will cease to enjoy any or all benefits under Salary account scheme. I / We

understand that the Bank reserves the right to convert my / our account into a regular savings bank account and further ceasing to be categorised as a account under corporate

salary scheme. Accordingly there will be a change in minimum balance requirement and applicable charges per regular savings bank account. (g) That I / we shall not hold the

Bank liable and responsible for furnishing of the processed information / data / products thereof to other Banks / Financial Institutions / Credit Providers / Users registered as

above. (h) That I / we have to complete further application for specific liability products / services from the Bank as prescribed from time to time, and that such further

applications shall be regarded as an integral part of this application (and vice versa), and that unless otherwise disclosed in such further forms as prescribed, the particulars and

information set forth herein as well as the documents referred or provided herewith are true, correct, complete and up-to-date in all respects. (i) That such further applications

will require incorporation of the application form number, and / or such details as the Bank may prescribe, to facilitate data management. (j) That I / we authorize the Bank to

issue a Debit cum ATM Card to me / us. (k) That the issue and usage of the Debit cum ATM Card is governed by the terms and conditions as in force from time to time and I / we

agree to be bound by the same. (l) That the terms and conditions of Debit cum ATM Card are liable to be amended by the Bank from time to time. (m) That I / we unconditionally

and irrevocably authorize the Bank, to debit my / our Account annually with an amount equivalent to the fee and charges for use of the Debit cum ATM Card. (n) I/We, the joint

holder(s),agree that in case of death of any one or more of the joint depositor(s), the proceeds may be paid to the survivor(s), on request before due date as per the mode of

operation. The Bank can levy penal charges, if any, as may be permissible by either regulatory guidelines or provisions of BCSBI code or both, applicable as on the date of

request. (o) That continuation of the account with the Bank is at the sole discretion of the Bank and in case the Bank is dissatisfied with the conduct of the account / account

holder, the Bank has the right to close the account after giving me / us one month's notice or withdraw the concessions in to or any service granted to me / us or charge the

Bank's applicable rates/charges for such services. (p) That the Bank may at its absolute discretion, discontinue any of the services completely or partially without any notice to

me / us. (q) That in case of return of Account Opening Amount (AOA) cheque, for any reason whatsoever, the Bank would close the account without any reference to me / us. (r)

That on receipt of written application from any of the Authorised Signatory(ies) and / or survivor or survivors of us, the Bank at its sole discretion and subject to such terms and

conditions, grant a loan / advance / renew / enhance against the security / collateral issued in joint names. (s) That DCB – On The Go facility will be offered to customers whose

account is an individually operated resident account. (t) That DCB mobile Banking will not be available to Non Resident Accounts. (u) I / We hereby understand that among all

other things, minimum balance requirement for variants of savings bank account under various scheme codes would be applicable and is in line with such updated information

as available on the Bank's website www.dcbbank.com from time to time. (v) I / We agree that the non-callable deposit/s cannot be closed by me/us before expiry of the term of

such deposit/s. (w) I/We agree that the DCB Bank shall deduct applicable TDS (Tax Deducted at Source) as per the Income Tax Provisions.

I / We have read, understood and hereby agree to the terms and conditions as applicable to my / our account” set forth on DCB Bank Limited (“the Bank”) website at

www.dcbbank.com. I / We understand that access to any changes / updates in terms and conditions applicable to this relationship shall be available on the Bank's website

only. I / We do hereby declare that information furnished in this Form is true and correct to the best of my / our knowledge and belief. I / We hereby authorize issuance of ATM /

Debit Card and provision of Phone Banking, Mobile Banking Services, Internet Banking and Bill Payment Services. I / We am / are aware of charges applicable for various

services offered and I / we affirm, confirm and undertake that I / we have read and understood the “Terms and Conditions” for usage of the Phone Banking, Mobile Banking

Services, Internet Banking and Bill Payment Services of DCB Bank as set forth in the Bank's website www.dcbbank.com and I / We will adhere to all the terms and conditions as

applicable from time to time. I / We further authorize the Bank to debit my / our Account(s) towards any applicable charges for any / various service / services provided as

applicable from time to time. In the absence of maturity instructions, the deposit will be auto-renewed with the same tenure at the prevailing interest rates with the applicable

terms and conditions.

I / We understand and agree that the consent given for updation / registration / requests for free Mobile alert facility shall be valid till such time I / we withdraw the same in writing.

Unless specifically advised, the Bank will continue to send SMS alerts on the number requested by the authorised signatory/ies of the Firm / Company / Trust / Association /

Society. The Bank shall not be responsible and liable for any consequences which may arise owing to change in name/s, address, mobile number of individual, authorized

signatory/ies or partners or directors or trustees or members of the Firm / Company / Trust / Association / Society.

11

Signature of Primary Applicant

ußø© Âsn¨£uõµ›ß øPö¯õ¨£®

Signature of Joint Applicant 2Signature of Joint Applicant 1

The Bank is not able to offer any tax advice on CRS or FATCA or its impact on the applicant. I/we shall seek advice from professional tax advisor for any tax questions.Âsn¨£uõµº «x ]BºGì AÀ»x GL¨Hi] AÀ»x Auß uõUP® GÆÁõÖ ÇUS® Gß£øu Á[Q¯õÀ TÓ i¯õx. Á› £ØÔ¯ HuõÁx ÷PÒÂPÐUS |õß / |õ[PÒ öuõÈÀøÓ Á› B÷»õ\P›h® Á› B÷»õ\øÚ ö£Ó ÷Ásk®.

I/We agree to submit a new form within 30 days if any information or certification on this form becomes incorrect.

÷uøÁU÷PØ£ EÒ|õmk JÊ[SøÓ¯õÍºPÒ / Á› Bøn¯ºPÒ, Á[Q öu›ÂUP, ]¤ii&US (÷|µi Á›PÐUPõÚ ©zv¯U SÊ) öu›ÂUP AÀ»x GÚx / G[PÍx PnUøP ‰h AÀ»x {Özv øÁUP |õß / |õ[PÒ J¨¦UöPõÒQ÷Óõ®.

I/We understand that the Bank is relying on this information for the purpose of determining the status of the applicant named above in compliance with FATCA (Foreign Account Tax Compliance Act) / CRS (Common Reporting Standards).÷©÷» ö£¯º SÔ¨¤h¨£mh Âsn¨£uõµ›ß {ø» GL¨Hi]H (öÁÎ|õmk PnUS Á› CnUPa \mh®) / ]BºGì&US (ö£õxÁõÚ öu›ÂUS® uµ[PÒ) CnUP©õÚuõ GßÖ wº©õÛUS® ÷|õUPzvØPõP Á[Q C¢u uPÁÀPøÍ |®¤²ÒÍx Gß£øu |õß / |õ[PÒ ¦›¢xöPõÒQ÷Óõ®.

C¢u¨ £iÁzvÀ EÒÍ HuõÁx uPÁÀPÒ AÀ»x \õßÖPÒ uÁÓõÚøÁ¯õP Ç¢uõÀ 30 |õmPÐUSÒ J¸ ¦v¯ £iÁzøu \©º¨¤UP ÷Ásk® Gß£øu |õß / |õ[PÒ J¨¦UöPõÒQ÷Óõ®.

I/We agree that as may be required by domestic regulators/tax authorities the Bank may also be required to report, reportable details to CBDT (Central Board of Direct Taxes) or close or suspend my / our account.

I/We confirm that, I/We will intimate / notify in writing to the Bank and update operating instructions and / or any other change(s) on Bank's record immediately in the event of any change in the operating instructions and/or any other change(s) with respect to the account/s held with the Bank.Á[Q°À øÁzv¸US® PnUS /PÎÀ C¯US® AÔÄøµPÎÀ HuõÁx ©õØÓ® ©ØÖ® / ÷ÁÖ ©õØÓ®(PÒ) HØ£mhõÀ AÀ»x C¯US® AÔÄøµPÒ ©ØÖ® AÁØøÓ ¦x¨¤UP / AÀ»x Á[Q°ß £v÷ÁmiÀ ö\´¯¨£k® HuõÁx ÷ÁÖ ©õØÓzøu(PÒ) |õß / |õ[PÒ Á[QUS GÊzx¨ §ºÁ©õP öu›Â¨÷£õ® / AÔÂ¨÷£õ®

GßøÚ / G[PøÍ ²IiHI°¼¸¢x A[RP›UP GÚx / G[PÍx Buõº ÂÁµ[PøÍ £¯ß£kzuÄ®.

I/We certify that I/we provide the information on this form and to the best of my/our knowledge and belief the certification is true, correct, and complete including the taxpayer identification number of the applicant.

§ Map it at NPCI (National Payments Corporation of India) to enable me/us to receive Direct Benefit Transfer (DBT) from Government of India in my/our above mentioned account. I/We understand that if more than one Benefit Transfer is due to me/us, I/we will receive all Benefit Transfers in this account.

|õß / |õ[PÒ ÷©÷» SÔ¨¤mh GÚx / G[PÍx Buõº / ²Ii Gsøn ußÛaø\¯õPa \©º¨¤UQ÷Óõ® ©ØÖ® RÌUPshÁØÖUS \®©vUQ÷Óõ®:

÷©÷» öPõkzxÒÍ GÚx / G[PÍx PnUShß GÚx / G[PÍx ö£¯›À C¢v¯ Aµ\õ[P®, ²IiHI ÁÇ[Q¯ GÚx/ G[PÍx Buõº / ²Ii Gsøn £v÷ÁØÓÄ®.

|õß / |õ[PÒ Á[QUS öPõkzxÒÍ GÚx / G[PÒ uPÁÀPøÍ ÷©÷» SÔ¨¤mh ÷|õUP[PÒ uÂµ ÷ÁÖ GuØPõPÄ® £¯ß£kzu¨£hõx AÀ»x \mhzvß ÷uøÁPÐU÷PØ£ £¯ß£kzu¨£k® Gß£øu |õß / |õ[PÒ ¦›¢xöPõÒQ÷Óõ®.

§ Seed my/our Aadhaar/UID Number issued by UIDAI, Government of India in my/our name with my/our aforesaid account.

÷©÷» SÔ¨¤mh GÚx / G[PÍx PnUQÀ C¢v¯ Aµ\õ[Pzvhª¸¢x ÷|µi £¯øÚ¨ ö£Óa ö\´¯ (i¤i) Gß¤]I&°À (C¢v¯ ÷u]¯ ÁÇ[SuÀ PÇP®) AuøÚ £vÄ ö\´¯Ä®. JßÖUS ÷©Ø£mh £¯ßPÒ GÚUS / G[PÐUS AÝ¨£¨£h ÷Ási°¸¢uõÀ GÀ»õ £¯ßPøÍ²® C¢uU PnUQÀ ö£Ö÷Áß Gß£øu |õß / |õ[PÒ ¦›¢xöPõÒQ÷Óõ®.

i]¤ _µUåõ {µ¢uµ øÁ¨¦ C¢v¯õÂÀ Á]US® 18 Á¯x uÀ 54 Á¯x Áøµ¯õÚ uÛ|£ºPÐUS ©mk÷© QøhUS®. ußø© Âsn¨£uõµ›ß ö£¯›À GÀ»õ i]¤ _µUåõ {µ¢uµ øÁ¨¦PÎ¾® Av£m\©õP ¹. 50 »m\® B²Ò Põ¨¥mk¨ £õxPõ¨¦U QøhUS®. PnUS øÁzv¸¨£Áº 55 Á¯øu Aøh¢ux® Põ¨¥mk¨ £õxPõ¨¦ iÄUS Á¸®. Põ¨¥mk¨ £õxPõ¨¦ ußø© PnUS øÁzv¸¨£Á¸US ©mk÷© QøhUS®. ßÚuõP GkzxU öPõshõÀ, Põ¨¥k¨ £õxPõ¨¦ iÄUS Á¸®. £Sv¯õP GkzxU öPõshõÀ, Põ¨¥mk¨ £õxPõ¨¦ £Sv¯õP Gkzu AÍÂØS SøÓ²®. i]¤ _µUåõ {µ¢uµ øÁ¨¦ vÓUP £õß, Áõ›_ {¯©Ú®, ªßÚg\À PÁ›ø¯ öPõkUP ÷Ásk®. Â£zx AÀ»õu GÀ»õ CÓ¨¦PÐUS® 45 |õmPÒ Põzv¸US® Põ»® ö£õ¸¢x®. £õxPõ¨¦z öuõh[Q¯ ÷uv°¼¸¢x J¸ Bsk Põ»zvØS uØöPõø» Â»US¨ ö£õ¸¢x®. C¢u i]¤ _µUåõ {µ¢uµ øÁ¨¦ «uõÚ Põ¨¥mk¨ £õxPõ¨¦ Bvz¯ ¤º»õ \ß ø»L¨ Cßè³µßì P®ö£Û ¼ªöhm ('Põ¨¥mk {ÖÁÚ®') ‰»©õP öPõkUP¨£kQÓx. uPÆ» öu›ÂUP¨£hõÂmhõÀ, Cx C¢u Âsn¨£¨ £iÁzvÀ SÔ¨¤h¨£mkÒÍ øÁ¨¦ Põ»zvØS ö\À¾£i¯õS®. i]¤ _µUåõ {µ¢uµ øÁ¨ø£ (HuõÁx Ç¢uõÀ) ¦x¨¤US®÷£õx ©ØÖ® AUPõ»zvÀ ÁÇ[P¨£k® Põ¨¥mk¨ £õxPõ¨£õÚx Á[Q/ Põ¨¥mk {ÖÁÚzvß uÛ Â÷ÁPzvß£i ÁÇ[P¨£k®.

C¢u¨ £iÁzvÀ |õß / |õ[PÒ öPõkUS® uPÁÀPÒ GÚx / G[PÍx AÔÄUS® |®¤UøPUS® ¦»¨£mh ÁøP°À Esø©¯õÚøÁ, \›¯õÚøÁ, Âsn¨£uõµ›ß Á›aö\¾zx® Aøh¯õÍ Gs Em£h Êø©¯õÚøÁ GßÖ |õß / |õ[PÒ \õßÓÎUQ÷Óõ®.

GÚx uÛ¨£mh E[PÒ ÁõiUøP¯õÍøµ AÔ¢xöPõÒÐ[PÒ (÷PJ´]) uPÁÀPÒ ©zv¯ ÷PJ´] (]÷PJ´]) £v÷Ák AÀ»x ÷ÁÖ HuõÁx AvPõµÒÍ Bøn¯zxhß £Qº¢xöPõÒÍ¨£h»õ® Gß£uØS |õß J¨¦UöPõÒQ÷Óß. Á[Q / ]÷PJ´] £v÷Ák / Aµ\õ[P® / C¢v¯ ›\ºÆ Á[Q AÀ»x HuõÁx Bøn¯® GÚx £vÄ ö\ú ö©õø£À Gs/ ªßÚg\À PÁ›°À. GìG®Gì / ªßÚg\À AÝ¨£ |õß Cuß ‰»® \®©u® öu›ÂUQ÷Óß.

§ Use my/our mobile number mentioned in my/our account for sending SMS alerts to me/us

Aadhaar Consent / Buõº \®©u®:

I agree that my personal Know Your Customer (KYC) information may be shared with Central KYC (CKYC) registry or any other competent authority. I hereby give consent to receive information from the Bank / CKYC registry / the Government / Reserve Bank of India or any authority through SMS / email on my registered mobile number / email address. I also agree that non receipt of any such SMS / email shall not make the Bank liable for any nature of loss or damage.

(i) I/we hereby confirm that I/we do not hold BSBD account in any other bank.

DCB Suraksha Fixed Deposit / i]¤ _µUåõ {µ¢uµ øÁ¨¦:

(ii) I/we undertake to close the existing savings bank account in the Bank, if any, within 30 days of opening BSBD account.

GÚUS / G[PÐUS SÖgö\´vPÒ AÝ¨£ GÚx / G[PÒ PnUQÀ SÔ¨¤mkÒÍ GÚx / G[PÒ ö©õø£À Gsøn¨ £¯ß£kzuÄ®.

Á[Q°À HØPÚ÷Á øÁzxÒÍ ÷\ª¨¦U Á[QU PnUS HuõÁx Ç¢uõÀ ¤Gì¤i PnUS vÓ¢u 30 |õmPÐUSÒ AuøÚ ‰iÂh |õß / |õ[PÒ J¨¦UöPõÒQ÷Óõ®.

(iii) I/we am/are aware that I/we will not be eligible to open any other savings bank account in the Bank. C¢u Á[Q°À ÷ÁÖ G¢u ÷\ª¨¦ Á[QU PnUøP²® vÓUP GÚUS / G[PÐUS uSv CÀø» Gß£øu |õß / |õ[PÒ AÔ¢v¸UQ÷Óõ®.

Customer ID Merger: I/We understand and agree that all my/our Accounts will now be consolidated under a single DCB Bank Customer ID after merging the multiple Customer IDs. Post such merging, only one Customer ID will remain active. I/We, am/are aware that DCB Bank Personal Internet Banking or DCB Bank Business Internet Banking, if availed, will now be accessible only under the retained Customer ID and all the Accounts will be consolidated to this Customer ID. I/We am/are aware that Tax Deducted at Source (TDS) on interest earned on DCB Bank Fixed Deposit Account(s) under erstwhile Customer IDs will also stand consolidated and TDS shall now be applicable on the basis of the unique Customer ID in accordance with the provisions of the Income Tax Act, 1961 and the Bank will furnish one TDS Certificate for all my/our Accounts.

|õß / |õ[PÒ Á[Q°ß ÷PJ´] öPõÒøP ©ØÖ® / AÀ»x Á[Q°À øÁzxÒÍ GÚx / G[PÒ PnUQØPõÚ C¯US® AÔÄøµPÎß£i ¦v¯ / ¦x¨¤US® ÷PJ´] BÁn[PøÍ ÁÇ[P |õß / |õ[PÒ Cuß ‰»® J¨¦UöPõÒQ÷Óõ® ©ØÖ® Á[QUS AvPõµ® ÁÇ[SQ÷Óõ®.

ÁõiUøP¯õÍº Ii Cøn¨¦: £À÷ÁÖ ÁõiUøP¯õÍº IiPøÍ Cønzu ¤ÓS GÚx / G[PÍx GÀ»õ PnUSPÐ® C¨÷£õx JØøÓ i]¤ Á[Q ÁõiUøP¯õÍº Ii¯õP J¸[QønUP¨£k® Gß£øu |õß / |õ[PÒ ¦›¢xöPõÒQ÷Óõ®. Ax÷£õßÓ Cøn¨¦US¨ ¤ßÚº, J÷µ J¸ ÁõiUøP¯õÍº Ii ©mk÷© ö\¯À£k®. i]¤ ö£º\ÚÀ Cßhºö|m ÷£[Q[ AÀ»x i]¤ ÷£[U ¤]öÚì Cßhºö|m ÷£[Q[ ö£Ó¨£mhõÀ, AøÁ uUP øÁUP¨£mh JØøÓ ÁõiUøP¯õÍº Ii ‰»©õP ©mk÷© AqP¨£k® ©ØÖ® GÀ»õ PnUSPÐ® C¢u ÁõiUøP¯õÍº Ii°À J¸[QønUP¨£k® Gß£øu |õß / |õ[PÒ AÔ÷Áõ®. ¢øu¯ ÁõiUøP¯õÍº Ii°ß RÇõP i]¤ ÷£[U L¤Uìm öh£õ]m AUPÄßm(ì)&À \®£õvzu Ámi «uõÚ BuõµzvÀ PÈUP¨£k® Á›²® (iiGì) J¸[QønUP¨£k® ©ØÖ® Á¸©õÚ Á›a \mh®,1961&ß ÂvøÓPÎß£i C¨÷£õx iiGì J¨£ØÓ ÁõiUøP¯õÍº Iiø¯ Ai¨£øh¯õPU öPõsk iiGì ö£õ¸¢x® ©ØÖ® GÚx / G[PÍx GÀ»õ PnUSPÐUS® Á[Q iiGì \õßÔuÌ ÁÇ[S® Gß£øu|õß / |õ[PÒ AÔ¢v¸UQ÷Óõ®.

Gß£øu |õß / |õ[PÒ EÖv¨ £kzxQ÷Óõ®.

I/We hereby agree and authorize Bank to mark freeze to my account if I/We fail to submit the updated / refresh KYC documents as per Bank's KYC policy and/or operating instructions for my / our account periodically to the Bank.

I/We have voluntarily submitted my/our Aadhaar/UID Number mentioned above and consent to:

A[RP›UP \®©u®: ÷©÷» ö\õßÚ Buõº Gs øÁzv¸US® |õß / |õ[PÒ, A[RPõµzvØPõP ²IiHI&°¼¸¢x GÚx / G[PÍx Buõº Gs, ö£¯º, ÂµÀ ÷µøP / P¸ÂÈ ÷µøPø¯ Á[Q ö£Ó |õß/ |õ[PÒ Cuß ‰»® GÚx/ G[PÍx \®©uzøu ÁÇ[SQ÷Óõ®. GÚx / G[Íx Aøh¯õÍ uPÁÀPÒ i÷©õQµõ¤U A[RPõµ® / ©v¨¤kuÀ / D&÷PJ´] ÷|õUPzvØPõP ©mk÷© £¯ß£kzu¨£k® GßÖ Á[Q GÚUS / G[PÐUS öu›Âzux ©ØÖ® GÚx / G[PÍx £÷¯õö©m›Uì ÷\ªUP¨£hõx / £Qµ¨£hõx ©ØÖ® A[RP›US® ÷|õUPzvØPõP ©mk÷© ]IiB›h® (©zv¯ Aøh¯õÍ uµÄPÒ øÁ¨£P®) \©º¨¤UP¨£k® GßÖ® öu›Âzux.

öPõkUP¨£mh AøÚzx ÂÁµ[PÐ® \›¯õÚøÁ Gß£øu |õß / |õ[PÒ EÖv¨£kzxQ÷Óõ® ©ØÖ® Á[Q°ß ÂvøÓPÒ ©ØÖ® {£¢uøÚPøÍ |õß / |õ[PÒ J¨¦UöPõÒQ÷Óõ®. £» ÁõiUøP¯õÍº Ii&PÒ HuõÁx Ç¢uõÀ J¸[QønUP¨£mh ¤ßÚº J¨£ØÓ ÁõiUøP¯õÍº Ii ‰»©õP GÚx / G[PÍx PnUSPøÍ AqP»õ® Gß£øu²® |õß / |õ[PÒ ¦›¢xöPõÒQ÷Óõ®.

I/We have been given to understand that my/our information submitted to the Bank herewith shall not be used for any purpose other than mentioned above, or as per requirements of law.

DCB Suraksha Fixed Deposit is available only for resident Indian individuals aged between 18 to 54 years. Maximum life insurance cover available is `50 lakh across all DCB Suraksha Fixed Deposits in the name of the primary applicant. Insurance cover shall cease on account holder attaining the age of 55 years. The insurance cover will be available only to the primary account holder. In case of premature withdrawal, insurance cover shall cease to exist. In case of partial withdrawal, insurance cover shall reduce to the extent of partial withdrawal. It is required to provide PAN, nomination and email ID to open DCB Suraksha Fixed Deposit. Waiting period of 45 days shall apply for all non-accidental deaths. Suicide exclusion shall apply for a period of one year from the coverage start date. Insurance cover on this DCB Suraksha Fixed Deposit is provided by Aditya Birla Sun Life Insurance Company limited ('Insurance Provider'), which is valid for the deposit period mentioned in this application form, unless communicated otherwise. Insurance cover provided on and during the renewal of the DCB Suraksha Fixed Deposit (if any) is at the sole discretion of the Bank / Insurance Provider.

DCB Basic Savings Bank Deposit Account (BSBDA) / i]¤ Ai¨£øh ÷\ª¨¦ Á[Q øÁ¨¦U PnUS (¤Gì¤iH):

I/We confirm that all the details provided are correct and I/We agree to the terms and conditions of the Bank. I/We also understand that all my/our accounts can be accessed from the unique Customer ID post consolidation of multiple Customer ID's if any.

§ Use my/our Aadhaar details to authenticate me/us from UIDAI.

§ Consent for Authentication: I/We, the holder of the above stated Aadhaar number, hereby give my/our consent to the Bank to obtain my/our Aadhaar number, Name and Fingerprint/Iris for authentication with UIDAI. The Bank has informed me/us that my/our identity information would only be used for demographic authentication / validation / e- KYC purpose and also informed that my/our biometrics will not be stored / shared and will be submitted to CIDR (Central Identities Data Repository) only for the purpose of authentication.

|õß / |õ[PÒ ÷ÁÖ G¢u Á[Q°¾® ¤Gì¤i PnUS øÁUPÂÀø» Gß£øu |õß / |õ[PÒ EÖv¨£kzxQ÷Óõ®.

12

Risk Classification for Joint Applicant 1 / g§`wº$ AmdoXH$ Ho$ {bE OmopI_ dJuH$aU 1

Tmk Âsn¨£uõµº1&ß øPö¯õ¨£® Tmk Âsn¨£uõµº2&ß øPö¯õ¨£®

13

Customer Information & Due Diligence (CIDD) Form - For Primary ApplicantÁõiUøP¯õÍº uPÁÀ ©ØÖ® ÷£õx©õÚ PÁÚ® ö\¾zxuÀ (]Iii) £iÁ® & ußø© Âsn¨£uõµ¸US

Information Type / uPÁÀ ÁøP Details / ÂÁµ[PÒ

Countries where business associates located (for Businessmen, only) / öuõÈÀ Tmk {ÖÁÚ[PÒ EÒÍ |õkPÒ (öuõÈ»v£ºPÐUS ©mk®)

Source of Funds for Credits in the Account

Other (please specify)

Investments

Savings Sale of PropertySalary

Inheritance

Business Proceeds

Professional fee

Wire Transfers Expected Yes

Yes

Into the Account No

No

Value `

Yes No Approximate Value `

Value `From the Account

Foreign Inward Remittances Expected

Country where the Individual / Entity based

Nature of business / Line of activity (in detail)

Expected number of transactions in a month Up to 20 21 to 50 More than 50

Signature of Primary Applicant

Financial Status (Net Worth) More than `10 lakhs upto `25 lakhsUpto `10 lakhs

More than `50 lakhs upto `2 croresMore than `25 lakhs upto `50 lakhs

More than `2 crores

uÛ|£º / {ÖÁÚ® EÒÍ |õk

öuõÈ¼ß ußø© / ö\¯À£õmk Á›ø\ (ÂÁµ©õP)

J¸ ©õuzvÀ ö\´ÁuõP Gvº£õºUP¨£k® £›ÁºzuøÚPÎß GsoUøP 20 Áøµ 21 uÀ 50 50&US® AvP®

{v {ø» ({Pµ ©v¨¦) ¹. 10 »m\® Áøµ ¹. 10 »m\zvØS® AvP® uÀ ¹. 25 »m\® Áøµ

¹. 25 »m\zvØS AvP® uÀ ¹. 50 »m\® Áøµ ¹. 50 »m\zvØS® AvP® uÀ ¹. 2 ÷Põi Áøµ

¹. 2 ÷PõiUS® AvP®

PnUQÀ ÁµÄ øÁUP¨£kÁuØPõÚ {vPÎß Buõµ® ÷\ª¨¦ \®£Í® öuõÈÀ ö\¯ÀøÓPÒ ö\õzøu ÂØ£øÚ ö\úÀ

u½kPÒ


ö£Ø÷Óõ›h® ö£ÖuÀ öuõÈÀøÓU Pmhn®

Gvº£õºUP¨£k® Á¯º iµõßìL£ºì PnUQÝÒ B® CÀø» ©v¨¦ ¹.

PnUQ¼¸¢x B® CÀø» ©v¨¦ ¹.

Gvº£õºUP¨£k® öÁÎ|õmi¼¸¢x AÝ¨£¨£kuÀ B® CÀø»

ußø© Âsn¨£uõµ›ß øPö¯õ¨£®

÷uõµõ¯©õÚ ©v¨¦ ¹.

Customer Information & Due Diligence (CIDD) Form - For Joint Applicant 1ÁõiUøP¯õÍº uPÁÀ ©ØÖ® ÷£õx©õÚ PÁÚ® ö\¾zxuÀ (]Iii) £iÁ® & Tmk Âsn¨£uõµº 1&UPõP





Investments


Inheritance

Business Proceeds

Professional fee


Yes

Into the Account No

No

Value `







Signature of Joint Applicant 1



More than `2 crores








u½kPÒ






Tmk Âsn¨£uõµº 1&ß øPö¯õ¨£®


For Bank Use Only / Á[Q £¯ß£õmiØS ©mk®Any of the Signatories / Beneficial Owners of the entity a Political / Public Figure or related to a Political / Public Figure Yes No

if yes, please give position

Does it seem that the initial Deposit and/or the declared transaction profile is in line with the status/occupation declared? Yes No

_______________________________________________ Employee signature

I Confirm that I have carried out proper Due Diligence and KYC verification. I am satisfied with the profile of the prospective Customer. / |õß ÷£õx©õÚ PÁÚ® ö\¾zv ÷PJ´] \›£õºuø» ö\´÷uß Gß£øu |õß EÖv ö\´Q÷Óß. ÁõiUøP¯õÍº BPÄÒÍ |£›ß Áµ»õÖ GÚUS {øÓøÁ AÎ¨£uõP EÒÍx.

Details of Staff sourcing the account / PnUøP E¸ÁõUQ¯ FÈ¯›ß ÂÁµ[PÒ

Employee Name:

Employee Designation:

Date: YYYYMMDDBranch:

If yes, please describe / _________________________________B® GÛÀ, u¯Äö\´x ÂÁ›UPÄ®

Are there any other concerns for higher AML risks? / AvP HG®GÀ A£õ¯[PÐUPõÚ ÷ÁÖ HuõÁx PÁø»PÒ ÇUQßÓÚÁõ?

Yes No

HRMS Number:

¯õµõÁx øPö¯õ¨£uõµºPÒ / Aµ]¯À / ¤µ£» |£›ß {ÖÁÚzvß £¯ßö£Ö® E›ø©¯õÍºPÒ AÀ»x Aµ]¯À / ¤µ£» |£¸US EÓÂÚº B® CÀø»

B® GÛÀ, u¯Äö\´x £uÂø¯U SÔ¨¤hÄ®

öuõhUP øÁ¨¦ ©ØÖ® / AÀ»x AÔÂUP¨£mh £›ÁºzuøÚ Áµ»õÖ AÔÂUP¨£mh £uÂ / öuõÈ¾hß Jzx¨ ÷£õÁuõP ÷uõßÖQÓuõ? B®

B®

CÀø»

CÀø»

FÈ¯›ß ö£¯º

GaBºG®Gì Gs

FÈ¯›ß £uÂ

÷uv QøÍ FÈ¯›ß øPö¯õ¨£®

14

Customer Information & Due Diligence (CIDD) Form - For Joint Applicant 2ÁõiUøP¯õÍº uPÁÀ ©ØÖ® ÷£õx©õÚ PÁÚ® ö\¾zxuÀ (]Iii) £iÁ® & Tmk Âsn¨£uõµº 2&UPõP





Investments


Inheritance

Business Proceeds

Professional fee


Yes

Into the Account No

No

Value `







Signature of Joint Applicant 2



More than `2 crores








u½kPÒ






Tmk Âsn¨£uõµº 2&ß øPö¯õ¨£®


Signatures and Photographs / øPö¯õ¨£[PÒ ©ØÖ® ¦øP¨£h[PÒ

Approved by BM / BSOM (Name, signature with HRMS Number) with seal*Incase of Thumb Impression, “Sign in BM/BSOM presence”

Please affixa recent

photograph.u¯Äö\´x J¸ Asø©UPõ» ¦øP¨£hzøu

JmhÄ®

u¯Äö\´x “PÖ¨¦ ø© öPõsk

PmhzvØSÒ øPö¯õ¨£ªhÄ®. “øPö¯õ¨£® GÀ»õ Põ÷\õø» AÝ©v ©ØÖ® Á[Q²hÚõÚ

HuõÁx GvºPõ» uPÁÀ

öuõhº¦UPõÚuõP P¸u¨£k®“.

Please signin “Black Ink”within the box.

“Signatureshall be

consideredfor all Cheque

clearancesand any futurecommunicationwith the Bank”

Please do notforget to collect

yourAcknowledgment

slipu¯Äö\´x E[PÍx J¨¦øP ^møh ö£Ó

©ÓUPõwº.

15

YYYYMMDDDate:Thumb Impression / ö£¸ÂµÀ ÷µøP Signature / øPö¯õ¨£®Please affix a recent

photograph

u¯Äö\´x J¸ Asø©UPõ»

¦øP¨£hzøu JmhÄ®

Sign across the photo

¦øP¨£hzvß SÖU÷P

øPö¯õ¨£ªhÄ®

Primary Applicant / ußø© Âsn¨£uõµº

÷uv

ö£¸ÂµÀ ÷µøP, “¤G® / ¤GìKG® ßÛø»°À øPö¯õ¨£ªmhõÀ“ zvøµ²hß ¤G® / ¤GìKG® (GaBºG®Gì Gsqhß ö£¯º, øPö¯õ¨£®) A[RPõµ®.


photograph






Joint Applicant 1 / Tmk Âsn¨£uõµº 1

÷uv


photograph






Joint Applicant 2 / Tmk Âsn¨£uõµº 2

÷uv

16

Confirmation / EÖv¨£kzxuÀ “I confirm having met the Applicant/s in person.” / |õß Âsn¨£uõµøµ ÷|›À \¢vzuøu EÖv¨£kzxQ÷Óß.

I confirm having met Mr. / Ms. __________________________________________________________________________________________________________, in person at

c DCB Bank Limited, ____________________________________ Branch, c Current Residential Address, c Permanent Address, c Office Address (anyone address

as mentioned in the application form) and hereby confirm the identity and address as provided in this account opening form and also confirm having verified the copy

of the documents (as applicable) against originals as produced by the applicant/s.

|õß v¸ / S©õ› __________________________________________________________________________________________________________ &I c i]¤ ÷£[U

¼ªöhm, ____________________________________ QøÍ°À ÷|›À \¢vzuøu EÖv¨£kzxQ÷Óß. c uØ÷£õøu¯ Ãmk PÁ›, c {µ¢uµ PÁ›,C¢u PnUSz vÓUS®

£iÁzvÀ öPõkzu£i c A¾Á»P PÁ› (Âsn¨£¨ £iÁzvÀ SÔ¨¤mh HuõÁx PÁ›) ©ØÖ® Cuß ‰»® Aøh¯õÍ® ©ØÖ® PÁ›ø¯ EÖv¨£kzxQ÷Óß ©ØÖ®

Âsn¨£uõµº / PÒ öPõkzu£i A\À BÁn[PøÍ øÁzx BÁn[PÎß ¤µvPøÍ (ö£õ¸¢xÁx£i) \›£õºzuøu EÖv¨£kzxQ÷Óß.

I also confirm that the form has been signed by the applicant is in my presence. I have also verified the Tel. No. _________________________________ by calling the no.

mentioned in this account opening form.

GÚx ßÛø»°À Âsn¨£uõµº £iÁzvÀ øPö¯õ¨£ªmhõº Gß£øu²® |õß EÖv ö\´Q÷Óß. PnUSz vÓUS® £iÁzvÀ SÔ¨¤mkÒÍ öuõø»÷£] Gs

_________________________________ &À AøÇzx |õß A¢u Gsøn²® \›£õºz÷uß.

For OfficeUse Only

A¾Á»P¨ £¯ß£õmiØS

©mk®

Acknowledgement / J¨¦øPPlease provide this number for future reference

Nomination Form Received: Yes No

Date: YYYYMMDDSignature of Bank Official

Branch:Employee code:

1st Applicant’s Name:

Joint Applicant 1:

Joint Applicant 2:

Name of the Bank Official:

Name of the Nominee:

DCB Bank Limited M026 / Jan 20 / 2.8481-Ver 1.1-March 2014

DCB Customer Care

■ Call: 1800 123 53631800 209 5363

Email: [email protected]

Web: www.dcbbank.com

Please call DCB Customer Care to enquire about your account application status


Name of Bank Official: Mr. Mrs. Ms.

Employee No.:

YYYYMMDDDate:

Signature of Bank Official

Á[Q AvPõ›°ß ö£¯º v¸ v¸©v S©õ› ÷uv

FÈ¯›ß GsÁ[Q AvPõ›°ß øPö¯õ¨£®

Áõ›_ {¯©Ú £iÁ® ö£Ó¨£mhx B® CÀø»

u¯Äö\´x GvºPõ» £õºøÁUPõP C¢u GsønU öPõkUPÄ®

1Áx Âsn¨£uõµ›ß ö£¯º

Tmk Âsn¨£uõµº 1

Tmk Âsn¨£uõµº 2

Áõ›]ß ö£¯º

Á[Q AvPõ›°ß ö£¯º

FÈ¯›ß ÷Põm ÷uv QøÍ

Á[Q AvPõ›°ß øPö¯õ¨£®

E[PÒ PnUS Âsn¨£ {ø» £ØÔ Â\õ›UP u¯Äö\´x i]¤ ÁõiUøP¯õÍº ÷\øÁø¯ AøÇUPÄ®