QkeZ la0@Form No.

-10
cpr cSad [kkrk [kksyus dk QkeZ
SAVINGS BANK ACCOUNT OPENING FORM

[kkrk la-
..................................... 'kk[kk@ A/C No. _______________________________
Branch

(lHkh dkye Li"V v{kjksa esa Hkjs tk,a) (All Columns to be filled in block letters) fnukad@Date ___________
iwjk uke@FULL NAME iq=@iq=h@iRuh@S/O / W/O / D/O O;olk;@OCCUPATION
1.
2.
3.
4.
izFke tekdrkZ dk irk VsyhQksu@TELEPHONE tUe frfFk (vo;Ldksa ds [kkrs gsrq)@
ADDRESS OF FIRST DEPOSITOR DATE OF BIRTH (MINOR'S A/C ONLY)

ukekafdr O;fDr;ksa dk fooj.k@PARTICULARS OF NOMINEE (S)

a [kkrk [kksy]as ftlds fy, eSua @s geus izkjEHk esa #- _______________________

fuosnu gS fd vki esj@s gekjs uke ij viuh fdrkcksa esa cpr cSd
______________________________________________ #i;s tek djok;s gSAa eS@a ge ?kksf"kr djrk gw@djrs gSa fd cpr [kkrk lac/a kh cSd a
ds fu;eksa dks i<+ fy;k gS rFkk eS@a ge budh ck/;rk dks Lohdkj djrk gw@djrs gSAa
I/We hereby request you to open in your books a SAVING BANK ACCOUNT in my/our name(s) for which I/We deposit initially
Rs. _________________________ (Rupees __________________________________________________ Only). I/We declare
that Bank's Savings Rules have been read by me/us and I/We accept them as binding upon me/us.

[kkrs dk ifjpkyu }kjk fd;k tk;sxk ,oa Lo;a thoh@geesa ls dksbZ ,d@mkjthoh
'ks"k jkf'k dk Hkqxrku fuEukuqlkj gksxk Me Either/Anyone of us/Survivor
ACCOUNT TO BE OPERATED BY la;Dq r :i ls
AND BALANCE PAYABLE TO Jointly Hkonh;@Yours Faithfully,
ifjp; INTRODUCTION 1. ____________________________________________
izekf.kr djrk gw fd eSa Jh@Jherh@lqJh ____________________
dks fiNys _____________ ekg@o"kks ls tkurk gw vkSj vkosnu&i= 2. ____________________________________________
esa fn;s x;s mlds O;olk; vkSj irs dh iqf"V djrk gwA
I Certify that I know Mr./Mrs./Ms. ___________________ 3. ____________________________________________
____________________________________ Since the past
________________________ months/yrs and confirm his/ 4. _____________________________________________
her occupation and address as stated in this application

[kkrk la- ifjp;drkZ ds gLrk{kj

A/c No. ______________ Introducer's Signature tekdrkZ ds gLrk{kj@Signature of Depositor (s)
uewuk gLrk{kj@Signatures (Specimen)
1. _______________________________________________ lR;kfir
VERIFIED
2. _______________________________________________ izkf/kd`r gLrk{kjh@AUTHORISED SIGNATORY
3. ________________________________________________
4. _______________________________________________ fnukad@Date ________________

Nomination Acknowledgement

ikorh (tekdrkZ dks okil djs)a / ACKNOWLEDGEMENT (To be returned to the depositor)
tekdrkZ dk uke o irk / Name and Address of the depositor ______________________________________________________
[kkrs dk Lo:i o [kkrk la[;k / Nature and Account Number _______________________________________________________
Nomination in favour of ___________________________________________________________________ ds i{k esa uke funs'Z ku
fnukad/ \Date __________________ dks iathdj.k la-/ vide Regn. No. _______________________________ }kjk iathd`r fd;k x;kA
d`rs iatkc ,.M fla/k cSad / For PUNJAB & SIND BANK

Nomination details on the back of form. ys[kkdkj@izcU/kd / Accountant / Manager

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QkeZ la- 472 Form No.-472
QkeZ Mh , 1 / Form - D A 1
cSad tekjkf'k;ksa ds lanHkZ esa cSaddkjh fofu;eu vf/kfu;e 1949 dh /kkjk 45 tsM , rFkk
cSaddkjh dEiuh (ukefunsZ'ku) fu;e 1985 ds fu;e 2(1) ds vUrxZr ukefunsZ'ku
Nomination under Section 45 ZA of the Banking Regulation Act, 1949 and Rule 2 (1) of
the Banking Companies (Nomination) Rules, 1985 in respect of bank deposits

eS@a ge I/We ________________________________________________________________________________________

(uke vkSj irk@irs@Name(s) and Address(es))

fuEufyf[kr O;fDr dk uke funsfZ 'kr djrk gw@djrs gS]a ftUgsa esjh@gekjh@vo;Ld dh e`R;q gks tkus dh fLFkfr es]a tekjkf'k ftldk foooj.k uhps
fn;k gqvk gSA Nominate the following person to whom in the event of my/our/minor's death the amount of the deposit,
(particulars whereof are given below) may be returned by Punjab & Sind Bank _________________________________

('kk[kk@dk;kZy; dk uke irk) / (Name and address of branch/

ds }kjk okfil dj nh tk,A ftlesa jkf'k tek gSA office in which deposit held.
tekjkf'k @ Deposit ukferh @ Nominee
tekjkf'k izHksnd la- vfrfjDr tkudkjh tekdrkZ ls fj'rk ;fn ukferh vo;Ld gS
dk Lo:i Distinguishing ;fn dksbZ gks uke irk ;fn dksbZ gks mez rks mldh tUe frfFk
Nature No. Additional Name Address Relationship with Age If nominee is minor,
of A/c details, if any depositor, if any his date of birth

pwfa d vkt dh rkjh[k esa ukferh vo;Ld gS vr% eS@a ge ukferh dh vko';drk ds nkSjku esjh@gekjh@vo;Ld dh e`R;q gks tkus dh fLFkfr esa
Jh@Jherh@dqekjh As the nominee is a minor on this date, I/We appoint Shri/Smt./Kum. ___________________________

(uke] irk rFkk mez / Name, address and age)

dks ukferh dh vksj ls tekjkf'k izkIr djus ds fy, fu;qDr djrk gw@djrs gSAa 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.
LFkku@Place : fnukad@Date :
lk{kh@lkf{k;ksa ds uke@gLrk{kj vkSj irk@irs
Name (s) Signature (s) and Address (es) of witness (es) @

* tekdrkZ@vksa ds gLrk{kj@vaxB
w s dh Nki
* Signature (s) / Thumb Impression (s) of depositor (s)
* ;fn jkf'k vo;Ld ds uke tek dh xbZ gS rks ukefuns'Z ku ,sls O;fDr }kjk gLrk{kfjr gksuk pkfg, tks vo;Ld dh vksj ls dk;Z djus ds
fy, fof/kd :i ls vf/kd`r gksA Where deposit is made in the name of a minor, the nomination should be signed by a
person lawfully entitled to act on behalf of the minor.
dkV nsa ;fn ukferh vo;Ld ugha gksA Strike out if nominee is not a minor.
@ vaxB w s dh Nki nks lkf{k;ksa }kjk lR;kfir dh tk,A Thumb impression (s) shall be attested by two witness.
ukefuns'Z ku Lohdkj fd;k tkrk gS rFkk iathdj.k la[;k / Nomination accepted and registered vide Regn. No. ______________
fnukad / dated ____________________ }kjk iathd`r fd;k tkrk gSA
d`rs iatkc ,.M fla/k cSad / For PUNJAB & SIND BANK

ys[kkdkj @ izcU/kd @ Accountant / Manager

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 ANNEXURE TO
ACCOUNT OPENING FORM

'kk[kk dk;kZy;@Branch Office : _____________________ 'kk[kk dksM@Branch Code _____________________

O;fDrxr lwpuk 'khV (xksiuh;) @PERSONAL INFORMATION SHEET (CONFIDENTIAL)

izR;sd [kkrk/kkjh ls i`Fkd QkeZ izkIr fd;k tk, @ (Separate form for each account holder needs to be taken)

[kkrk la[;k@Account No. ____________________________ [kkrk [kksyus dh frfFk@Date of Opening _______________________

uke@Name __________________________________________________________________________________________

firk@ifr dk uke@Father's/Husband's Name _________________________________________________________________

iSu la[;k@PAN No. ___________________________________________________________________________________

la;qDr [kkrs dh fLFkfr esa&vkosnd ds lkFk laca/k

In case of joint AccountRelationship between the applicants : ______________________________________________

QeZ@daiuh dk uke@Firm/Company Name : ___________________________________________________________________

QeZ@daiuh esa mijksDr dh fLFkfr

Status of Individual in Firm/Company___________________________________________________________________

fuokl dh fLFkfr
Residential Status : _________________Hkkjrh; Indian @vfuoklh Hkkjrh; Non Resident Indian (NRI) ______________

LFkkuh; irk@Local Address _______________________________________________________________________

_______________________________________________________________________

LFkk;h irk@Permanent Address _______________________________________________________________________

_______________________________________________________________________

O;olkf;d irk@Business Address ______________________________________________________________________

_______________________________________________________________________

nwjHkk"k la[;k (fuokl) Telephone No. (R) ______________________________ QSDl la[;k@Fax No. _____________________

dk;kZy; (O) ________________________________________ eksckby la[;k@Mobile Number __________________________

A. O;fDrxr lwpuk@ PERSONAL INFORMATION :

i) tUefrfFk@ Date of Birth
frfFk ekg o"kZ
D D M M Y Y Y Y

ii) Js.kh@Category : - v-t-@v-t-tk-@lkekU;@SC / ST / GENERAL iii) fyax % iq#"k@L=h Gender - MALE / FEMALE

iv) /keZ@Relegion : a) fgUnw@HINDU b) eqfLye@MUSLIM c) fl[k@SIKH d) bZlkbZ@CHRISTIAN

e) ckS@BODH f) tSu@JAIN g) vU; (d`i;k mYys[k djsa)@ANY OTHER (SPECIFY)

v) oSokfgd fLFkfr@Marital Status : fookfgr@Married vfookfgr@Unmarried

vi) 'kS{kf.kd ;ksX;rk,a@Educational Qualification :

vf'kf{kr@Illiterate ek/;fed@Middle gk;j lSds.Mjh@HSC

Lukrd@Graduate Lukrdkskj@Post Graduate

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vii) O;olkf;d ;ksX;rk,a (Li"V mYys[k djsa)@Professional Qualifications (specify)

viii) O;fDr dk edku@The individual's residence is

fdjk, dk gS@Rented Lo% LokfeRo dk gS@Self Owned ikfjokfjd laifk@Family owned

daiuh }kjk iznk@Company provided dksbZ vU; (d`i;k mYys[k djsa)@Others specify.

B. I O;olk; (tks Hkh ykxw gks mu ij (()) fu'kku yxk,a

OCCUPATION : Tick () whichever is applicable

1. ukSdjhis'kk 2. Lo- fu;ksDrk@O;olkf;d 3. O;kikjh 4. fo|kFkhZ

Salaried Self-Employed / Professional Business Student

5. lsokfuo`k 6. d`"kd vFkok mlls lacaf/kr xfrfof/k;k 7. x`fg.kh

Retired Agricultural & Allied House Wife

8. vU; (d`i;k mYys[k djs)a @Other (Specify ____________________ )

fu;ksDrk dk uke@ Name of the employer / Name of the business entity

B.II ;fn Lo% fu;ksDrk @ O;olkf;d gSa rks fuEu esa ls tks Hkh ykxw gks ml ij (()) fu'kku yxk,a
If Self Employed / Professional. Tick () whichever is applicable

1. MkWDVj@Doctor 2. odhy@Lawyer 3. bathfu;j@Engineer 4. lunh ys[kkdkj@C.A.

5. O;kikjh@Business 6. dksbZ vU; (d`i;k mYys[k djs)a @Other (Specify ______________________)

B.III O;kikj dh fLFkfr esa O;olkf;d xfrfof/k dk uke ,oa mldk Lo:i
Name & Nature of Business Activity in case of Business

__________________________________________________________________________________________

fuf/k;ksa dk L=ksr@Source of Funds : _____________________________________________

[kkrk [kksyus dk iz;kstu@Purpose of opening of this account _______________________________

[kkrs esa laHkkfor f;k O;ogkj (izkfIr;ksa@Hkqxrku@sfMV@MsfcV izfof"V;ksa dk Lo:i)

Potential Activity expected in the Account (pattern of receipt/ payment/ Credit/ Debit entries)______________

_____________________________________________________________

vk; dk dksbZ vU; L=ksr@Any other source of Income _____________________________________

C. (i) ekfld vk;@Monthly Income tks Hkh ykxw gks ml ij (()) fu'kku yxk,a / Tick () whichever is applicable
A. #- 20,000 rd@Up to Rs. 20,000
B. #- 20,001 ls #- 50,000 rd@ Up to Rs. 20,001 to 50,000
C. #- 50,001 ls #- 1 yk[k rd@ Up to Rs. 50,001 to 1 lac
D. #- 1,00,001 ls #- 5 yk[k rd@ Up to Rs. 1,00,001 to 5 lacs
E. #- 5,00,001 ls #- 10 yk[k rd@ Up to 5,00,001 to 10 lacs
F. #- 10,00,000/- yk[k ls vf/kd@ Above Rs. 10,00,000/-
(ii) VuZ vksoj (a) ekfld VuZvksoj b) okf"kZd VuZ vksoj
Turn over________________ Monthly Turnover________________ Annual Turnover ________________
(4)
D.I ifjokj ds lnL;ksa dk fooj.k@Detail of Family Members

(i) ifr@iRuh dk uke tUe frfFk

Spouse's Name ______________________________________ Date of Birth __________________________

(ii) iq= dk uke tUe frfFk

Son's Name ______________________________________ Date of Birth __________________________

iq= dk uke tUe frfFk

Son's Name ______________________________________ Date of Birth __________________________

(iii) iq=h dk uke tUe frfFk

Daughter's Name ______________________________________ Date of Birth __________________________

iq=h dk uke tUe frfFk

Daughter's Name ______________________________________ Date of Birth __________________________

D.II* dksbZ fj'rsnkj fons'k esa jgrk gS % gk @ ugha] ;fn gk] rks mldk uke ,oa irk*
Any relatives settled abroad : Yes/ No if yes, mention their name and address *

A) uke@Name _________________________________ irk@Address _______________________________________

_________________________________________________

B) uke@Name _________________________________ irk@Address _______________________________________

_________________________________________________

C) uke@Name _________________________________ irk@Address _______________________________________

_________________________________________________

E* fiNys 3 o"kks esa vki fdruh ckj fons'k x, gSa\ @ How many time you have been abroad in last 3 years ?

dHkh ugha@Never 1 ls 5 ckj@1 to 5 time 5 ckj ls vf/kd@Above 5 time

* ;g lwpuk nsuk LoSfPNd gSA rFkkfi vR;f/kd tksf[ke okyh Jsf.k;ksa esa vkus okys [kkrksa ds fy, ;g lwpuk nsuk vfuok;Z gSA
This information is optional. However, in case of high-risk category accounts, this is mandatory.

F. D;k vkids ikl sfMV dkMZ gSa gk@ugha ;fn gk rks d`i;k mlds ckjs esa fof'k"V tkudkjh nsa
Do you have Credit Card Yes / No If yes which one (Specify) each

(i) ohtk@Visa (ii) ekLVj@Master (iii) vU;@Other

G. D;k vU; cSad@cSadksa esa [kkrk@[kkrs gSa % gk@ugha ;fn gk rks mlds@muds ckjs esa tkudkjh nsa%&
Dealing with other Bank/s : Yes / No If yes (Specify):-

a rFkk 'kk[kk dk uke@Name of the Bank and Branch

cSd B) [kkrs dk izdkj@Types of account

(i)_________________________________ _________________________

(i)_________________________________ _________________________

(i)_________________________________ _________________________

(5)
H orZeku .k lqfo/kk,a ;fn dksbZ gSa rks mudk mYys[k djsa
Existing credit facilities, If any

a) dkj yksu@Car loan gk@ugha Yes / No

b) vkokl .k@Housing loan gk@ugha Yes / No

c) miHkksDrk .k@Consumer loan gk@ugha Yes / No

d) izfrHkwfr ds fo# .k@Loan Against security gk@ugha Yes / No

e) 'kS{kf.kd .kEducation loan gk@ugha Yes / No

f) O;olkf;d@d`f"k .k@Business / Agriculture Loan gk@ugha Yes / No

g) vU;@Other gk@ugha ;fn gk rks mldk mYys[k djsa Yes / No if yes (specify)

I ifjlaifk;k dqy ewY; #- (vuqekfur) d`f"k Hkwfe

Assets : Total Value : Rs. _______________ (Approx) Agriculture land ________________

tks Hkh ykxw gks ml ij () dk fu'kku yxk,a

Tick () which ever is applicable

a) okgu dkj nks ifg;k okgu ewY;

Vehicle Car Two wheeler Value

b) edku tgka vki jgrs gSa iSr`d@Lo fufeZr fdjk, dk gS [kjhnk gqvk gS
House you live in Ancestral / Own Rental Purchased

c) edku dh dher #- 5 yk[k rd #- 10 yk[k rd #- 10 yk[k ls vf/kd

Value of the House up to Rs. 5 lacs up to Rs. 10 lacs above Rs. 10 lacs

d) thou chek ikfylh #- 1 yk[k rd #- 2 yk[k rd #- 2 yk[k ls vf/kd

Life Insurance Policy up to Rs. 1 lac up to Rs. 2 lacs above Rs. 2 lacs

e) vU; fuos'k #- ,d yk[k rd #- 2 yk[k rd #- 2 yk[k ls vf/kd

Other Investment up to Rs. 1 lac up to Rs. 2 lacs above Rs. 2 lacs

f) dksbZ vU; ifjlaifk (Li"V djs)a #- 1 yk[k rd #- 2 yk[k rd #- 2 yk[k ls vf/kd

Any other Asset (Specify) up to Rs. 1 lac up to Rs. 2 lacs above Rs. 2 lacs

(xzkgd ds gLrk{kj)
(Signature of the Customer)

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