Blood Relative Declaration

Account Number :

(To be filled by Primary Applicant)

Name of First Applicant:
Mr. / Ms. / Dr. _________________________________________________________________________
(first name) (middle name) (last name)

I hereby solemnly declare that I stay with

Mr. / Ms. / Dr. ________________________________________________________________
(first name) (middle name) (last name)
The proof of my current / permanent address as mentioned on the account opening form is in the name of
my spouse / blood relative.

My Relationship with Address Proof Holder:

 Spouse

 Parent (Father / Mother)

 Child (Son / Daughter)

 Brother / Sister

I am enclosing the below as a proof of relationship

 Passport

 Birth Certificate

 Marriage Certificate

 Ration Card

 Matriculation Certificate

 Court Affidavit

 School Leaving Certificate

 PIO and OCI card issued by Indian Government.

Declaration by the Account Holder:

I, the primary account holder solemnly affirm:
My current / permanent address is as mentioned in the Account Opening Form
The information given above is correct and nothing has been concealed. I am aware it is illegal and a
criminal offence to deliberately furnish false information or suppress information.
That I undertake to be entirely responsible for any loss/ expenses incurred by the Bank on account of relying
on my declaration
___________________
(Signature of primary applicant) Place: __________ Date: __________

Declaration by the Address Proof Holder:

I, the address proof holder solemnly affirm:
I, have no objection to allow the Primary Applicant to use my address for bank communication purposes.
The said primary applicant resides with me at my residential address for which I have provided a valid proof
as per banks requirements
The information given above is correct and nothing has been concealed and I am aware it is illegal and a
criminal offence to deliberately furnish false information or suppress information.

______________________________
(Signature of address proof holder) Place: __________ Date: __________