To

The Branch Manager MIZORAM COOPERATIVE

Mizoram Co-operative Apex Bank Ltd. APEX BANK LTD.
_______________________ Branch ACCOUNT OPENING FORM
SAVINGS AND CURRENT ACCOUNTS
Kindly allow me/us to open an account at your Bank as per details given below.
Type of Customer
Individual SHG Trust Govt Institution
Society Senior Citizen Public/Private Company Others (Pls Specify)
Minor Association Firm/Institution
Type of Account
Savings Bank Account (without Cheque Book) Current Account Others (Pls Specify)
Savings Bank Account (with Cheque Book) No Frills Account
Mode of Operation
Self Only Either or Survivor Jointly or severally Authorised Person Others
Operator’s Name (as mentioned in the Identity Proof )
Sole/First Operator’s Name : Mr Mrs Ms Others ________

Second Operator’s Name : Mr Mrs Ms Others ________

Third Operator’s Name : Mr Mrs Ms Others ________

Account Name (as would appear on Passbook)

Specimen Signature(s)/Thumb Impression

Signatures of the First Operator

Name of the First Operator Paste a passport size

photograph inside this
box

1st Operator

Signatures of the Second Operator

Name of the Second Operator Paste a passport size

photograph inside this
box

2nd Operator

Signatures of the Third Operator

Name of the Third Operator Paste a passport size

photograph inside this
box

3rd Operator

For Office Use Only For Office Use Only

If any applicant is Having
Customer id 1st 2nd 3rd Accounts in any Branch of
the Bank, Fill the Existing
Savings Bank Account No Customer Id
Current Account Account No
Name of Father/Husband
Sole/ First Operator

Second Operator

Third Operator

First Operator’s Address Details

Residential/Permanent Address

District State PIN

Present Address (If Different from Permanent Address)

District State PIN

Second Operator’s Address Details

Residential/Permanent Address

District State PIN

Present Address (If Different from Permanent Address)

District State PIN

Third Operator’s Address Details
Residential/Permanent Address

District State PIN

Present Address (If Different from Permanent Address)

District State PIN

Other Details
First Operator Second Operator Third Operator

Date of Birth
Gender Male Female Male Female Male Female
Marital Status Married Unmarried Married Unmarried Married Unmarried
Nationality
Telephone No
Mobile No.
Religion
Category ST SC OBC Gen ST SC OBC Gen ST SC OBC Gen
Edu. Qualification UG Grad PG Othr UG Grad PG Othr UG Grad PG Othr
Income (Annually)
Occupation
E-mail ID
Blood Group
 Value Added Services

1. ATM - CUM - DEBIT CARD

ATM Card Required : Yes No
Type of Card : Instant Card (Card without Name)
Personalised Card (Card with Name)
Name to be printed on the Card
.
2. INTERNET BANKING
Internet Banking Required : Yes No
Login Type : Individual Joint Corporate

3 SMS Alert
SMS Alert Required : Yes No
Enable SMS alert on this mobile number
(in case sms alert is not indicated, it will be treated as Yes)

Form DA - 1 (Nomination Form)

Nomination under section 45ZA of the Banking Regulation Act, 1949 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 deposit, particulars whereof are given below, may be
returned by Mizoram Cooperative Apex Bank Ltd.

DEPOSIT DETAILS
Type of Deposit : SB CA Account No
Additional Details, if any ______________________________________________________________________

DETAILS OF NOMINEE
Is Nominee a customer : Yes No Customer Id :
Name :
Address :

District State PIN

Relationship with Depositor ___________________________ Date of Birth Age

(In case of minor) As the nominee is a minor on this date, I/We appoint Mr/Mrs/Ms ____________________________
___________________________________ aged ________ years of _______________________________________
_______________________________________________________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.

Date : ______________________

Place : ______________________ Signature(s) /Thumb impression(s) of depositors

 Form 60

Form of declaration to be filled by a person who does not have either a Permanent Account Number or General Index Registration
Number and who makes payment in cash in respect of transaction specified in clause (a) to (h) of rule 114B
Full Name and Address of the Declarant ______________________________________________________________
_____________________________________________________________________________________________
Particulars of Transaction - Opening of SB CA CC account(s)
Amount of transaction _____________________________________
Are you assessed to tax? Yes No
If Yes,
i) Details of Ward/Circle/Range where the last Return of Income tax was filed.
ii) Reason for not having Permanent Account Number/General Indes Registration Number __________________
______________________________________________________________________________________

Details of documents being produced in support of address in column (1) ____________________________________

_____________________________________________________________________________________________

Verification
I/We ___________________________________________________________, do hereby declare that what is stated
above is true to the best of my/our knowledge and belief. Verified today, the ______ day of _____________ 20 ______

Signature of the Declarant Place : ______________________________

Identity Proof
The undermentioned Officially Valid Documents can be used for proof of Identity and Proof of Address
Voter ID Card Driving Licence PAN Card
Aadhar Card Passport NREGA Card
Document acceptable to Branch/Chief Manager _______________________________________________________________
Document No. : ________________________ Issued By : _____________________________________________________
Issue Date : ________________________
Address Proof
* required only if the above Officially Valid Documents cannot be produced or if the address differ
Ration Card Electricity Bill Salary Slip (with Address) Telephone Bill Institute ID
Bank Ac statement Letter from Recognised Public Authority Letter from reputed employer
Address proof acceptable to Branch/Chief Manager ___________________________________________________________
Document No. : ________________________ Issued By : _____________________________________________________
Issue Date : ________________________

FOR OFFICE USE ONLY

Verified all the documents attached with originals and found this Account opening form is complete in all respect as per KYC
Guidelines and Account is opened.
Account Open Date
Account Closed On

Verifying Official Chief/Branch Manager/Officer incharge