Branch Office...

Dist. No........
FORM DA-1 : NOMINATION
Nomination under Section 45ZA of Banking Regulation Act, 1949 and Rule 2(1) of the Banking Companies (Nomination) Rules
1985 in respect of Bank Deposits,

l/ We @ Name(s);

Nominate the following person to whom in the event of myiourl minor's death, the amount of deposit in the account may be returned
by Punjab National Bank, B.O.

DEPOSIT NOMINEE
Nature Account No. Additional Name Address Relationship Age lf nominee is
of Details, if with depositor, minor his/her
Account anv if anv Date of birth

* As
the nominee is minor on this date, l/we appoint MriMs
Age

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.

Place:

Date: @ Signature(s) / #Thumb impression(s) of depositors

@Where the deposit is made in the name of minor, the nomination is to be signed by natural/legal guardian of the minor to act on
behalf of the minor.
*Strike
out if nominee is not a minor
WITNESSES
Name & SiEnature of the first witnesses Name & Signature of second witnesses

Name

Signature: Signature:

Address: Address:

Place:

Date: Date:

Telephone No. Telephone.No.

#Thumb impression(s) shall be attested by two witnesses; otherwise it shall be attested by one witness.

NOMINATION REGISTERED

The above mentioned nomination is registered at serial no. in respect of (Type of

AccoUnt.) Deposit Account No.
Date

For Punjab National Bank

(Authorised Official)
ciil PNB 1177 - 194/14(100) MCS
(GBPA NO. )
FOR OPENING/RENEWAL OF TERM DEPOSIT
FOR CUSTOMER HAVING ACCOUNT IN THE BANK

The Manager,

Branch Office

\ccount No.
(16 diqits)

1. FULL NAME, in GAPITAL Lettels (teaving a space between first, middte & tast name) 2. Gustomer lD No.
i
ii
ilt

3. lAA/e request you to open/renew the following account. l/we agree to be bound by the bank's
rules in force from time to time. (-Tick the relevant box on right side).
* Recurring Deposit Flexi-Recurri ng Deposit
TERM DEPOSIT Monthly Installment Rs........ Monthly core amount Rs........
#. Fixed Deposit (Specify)
No. of installments.........@ . No. of installments.........@ ...

Sign

*Standinq instructions : Kindlv debit monthlv instalment from account no. on --------------------of everu month
lnterest payment On maturiW Annually Half Yearlv Quarterly Monthly Credit Interest to SF/CA/ CC/OD
frequency Account No.
(Pl. tick in the Credit maturity proceeds to SF/CA/
appropriate box) cc/oD
Account No.

TDS, if applicable: Yes/No lf no, exemption reference No.

TDS DETAILS lf Yes, Whether Form 15 G/H* submitted : YES tO
I I
* Form 15G for general category, 15H for Senior Citizen PAN NO.

Instruction for Auto Renewal on maturity of Renew for Renew for Period for which Auto renewal required.
deposit (Tick the relevant column) Principal& Principalonly No. of times...
lnterest

4. MODE OF OPERATION whichever is icable

Self Either or Former or Any one of us or Any Other
Jointly (Soecitu)
Survivor Suwivor Suwivo(s)

5. NOMINATION REQUIRED: YES tr NO n ff Yes, please fill form DA-l (Overleaf).

Date: Customer Signature/ 1

Place: Thumb lmpression 2.

3.

(Signature of authorized official)

,fiil PNB 1177 - 194/14(100)MCS Verified by (With GBPA No.)