ABHYUDAYA CO-OP. BANK LTD.

(Multi - State Scheduled Bank)

Head Office : K.K. Tower, Off G. D. Ambekar Marg, Parel Village, Mumbai - 400 012.

(Names in capital letters)

(Mr./Mrs./Ms)

(Mr./Mrs./Ms)

(Mr./Mrs./Ms)

Address

/ Recurring Deposit (INSTALLMENT) :

Debit to A/c No. _____________ Branch ___________

Branch (MID INT. at Discounted Rate)

The Account will be operated by / Deposit Amount will be Payable to :
All

Whether Maturity Notice is to be sent?

Yes

No

Copies of Documents enclosed _____________________________________________________________

*In case the deposit is in the name of Minor with Guardian
D D MM Y Y Y Y

I/ We undertake to furnish Term Deposit Receipt with instructions for renewal or disbursement of the principal
amount of the deposit and interest due thereon upon maturity of the deposit . In the absence of any instructions on
the due date, I/We authorize the Bank to renew the deposit automatically for a similar term at the interest rate
prevailing at the time of renewal in order to safeguard loss of interest.
I, being the Term Deposit holder and a Senior Citizen availing the benefit of additional interest rates undertake to
furnish Term Deposit Receipt duly signed by me on or before due date for further renewal. In the absence of any
instructions on or before due date, Bank is authorized to renew the deposit automatically for a similar term at the
interest rate applicable to General Public.
Where deposit is withdrawn before date of maturity, the rate of interest applicable would be 1 % less than the rate
applicable for the period the deposit has actually remained with the Bank as ruling on the date of deposit. In case
of Joint A/c, all the joint account holders have to give discharge for getting withdrawal Before Maturity.

Related to Mr./Mrs. ____________________________________________ (Director of your Bank)

as ________________________ (Relation)

Yours faithfully.
1.
Place

2.

Date

3.

(#Signature (s) / Thumb Impression (s) of the Depositor/s)

P
*Nomination under section 45 ZA read with section 56 of the Banking Regulation Act 1949, and rule 2(1)
of the Co-operative Banks (Nomination) Rules,1985, in respect of the Bank deposits.
I/We 1)______________________________________, 2)_________________________________________,
3)___________________________________________, nominate the following person to whom the balance
in the account may be paid by ______________________ Branch of Abhyudaya Co-op. Bank Ltd., in the
event of my/ our/minor's death.

whose

D D MM Y Y Y Y

(#Signature (s) / Thumb Impression (s) of the Depositor/s)

*Witness : If Depositor (s) is / are giving Thumb Impression.

Verification

Verification

the ______________________ day of ______________

the ______________________ day of ______________

Instructions : Documents which can be produced in support

of the address are :
(a) Ration Card
(b) Passport
(c) Driving Licence
(d) Identity card issued by any Institution
(e) Copy of the electricity bill or telephone bill showing
residential address.
(f) Any document or communication issued by any
authority of the Central Government, State Government or
local bodies showing residential address.
(g) Any other documentary evidence in support of the
address given in the declaration.

Instructions : Documents which can be produced in support

of the address are :
(a) Ration Card
(b) Passport
(c) Driving Licence
(d) Identity card issued by any Institution
(e) Copy of the electricity bill or telephone bill showing
residential address.
(f) Any document or communication issued by any
authority of the Central Government, State Government or
local bodies showing residential address.
(g) Any other documentary evidence in support of the
address given in the declaration.

191 / 100000 / Form / S.E. / 05-2014