Account Opening Form

Online Nil - 100% Official Form

Bank Banner (একবার আপলোড করুন, অটো সেভ হবে):

Customer Photo:

Reference No:

Customer Name:

Account No:

Customer ID:

Aadhaar No (Auto Masked):

Mobile No:

Date of Birth:

Gender: MALE FEMALE OTHER

Category (Caste): SC ST OBC GENERAL

Religion: HINDU ISLAM CHRISTIAN SIKH OTHER

Occupation Type: SELF EMPLOYED SERVICE MAN BUSINESS FARMER STUDENT HOUSEWIFE LABOUR

Education: BELOW 10TH 10TH PASS 12TH PASS GRADUATE LAW GRADUATE/POST GRADUATE

Father's / Guardian's Name:

Marital Status: UNMARRIED MARRIED WIDOWED DIVORCED

Spouse Name (If Married):

Nominee Name:

Nominee Rel. & Age:

MOTHER FATHER WIFE HUSBAND SON DAUGHTER

Annual Income (Rs): 60,000 72,000 96,000 1,20,000 1,50,000

Annual Turnover (Lakh):

Full Address:

Place (Signature):

PAN No (Optional):

Account Opening Form

1. TYPE OF ACCOUNT: I wish to open the following type of account SB Basic savings Bank deposit Account

2. NATURE OF ACCOUNT: OTHER INDIVIDUAL

3. FULL NAME, in CAPITAL Letters (leaving a space between first, middle & last name)

Reference No	:
Customer Name	:
Sex	:
Account No	:
Customer ID	:
Aadhaar No	:
Mobile No	:

Customer
Photo

4. Mode of Operation : SELF

5. ADDRESS:

Flat No./Bldg. Name Street/Road/Locality City/District/ State with pincode	:
Tel.No / Fax No.(with STD code) Email	:

6. CUSTOMER PROFILE:

Date of Birth	:		Educational Qualification	:
Nationality	:	INDIAN	Category	:
Religion	:		Occupation Type	:
PAN/GIR no	:		Designation / Profession	:	ALL CUSTOMERS NOT FALLING UNDER THE CATEGORY OF HIGH/MEDIUM RISKS ARE TO BE CLASSIFIED UNDER LOW RISK CATEGORY I.E. SALARIED EMPLOYEES, ACCOUNTS WITH 1 LAC-5 LAC
Annual Income	:		Annual turnover	:

Name of Father / Guardian	:
Marital Status	:
Name of Spouse (if married)	:

7. KNOW YOUR CUSTOMER (KYC) DOCUMENTS:

Type of document	Document ID No.	Issuing Authority	Place of Issue	Date of Issue	Valid up to
ID Proof		UIDAI
Address Proof		UIDAI

I attach the copies of documents opted for and produce the original copies of these documents for verification.

8. Nomination :

I want to nominate as under

Name of the nominee	Relationship	Age	Person authorised in case of minor to receive the amount of deposit on behalf of the nominee in event of my/minor's death during the minority of nominee.

Date:

Place:

Signature of declarant

WITNESS IN CASE OF NOMINATION (FOR THUMB IMPRESSION ONLY)


Name & Signature of the first witnesses
Name:- ___________________________ Signature:- ___________________________ Address:- ___________________________


Name & Signature of the second witnesses
Name:- ___________________________ Signature:- ___________________________ Address:- ___________________________

To be filled by those who do not have either PAN/GIR: (Select appropriate form)

Form No. 60 To be filled by person without PAN 1. Are you assessed to tax? Yes / No

Form No. 61 To be filled by a person who has agricultural income and is not in receipt of any other income chargeable to income tax I hereby declare that my source of income is from agriculture and i am not required to pay income-tax on any other income, if any.

Declaration

I do hereby declare that what is stated is true to the best of my knowledge and belief.

Date:

Place:

Signature of declarant

Declaration/Undertaking

a) Please seed my Aadhaar / UID Number issued by UIDAI. I hereby give my consent to the Bank to use my Aadhaar details to authenticate me from UIDAI by using my biometrics for the purpose of Bank account.

b) I declare that I am desirous of receiving entitled benefits or subsidies of welfare schemes funded from the Consolidated Fund of India in my account directly.

Date:

Place:

Signature of declarant

For Official Use:

Specimen Signature/ Thumb impression of the customer

Rupay Debit Card issued Signature Verified Account Verified Signature of declarant

Photograph Name Signature GBPA/PF No Date

Registration of Nomination

BANGIYA GRAMIN VIKASH BANK



(Authorized Official)
Name ______________________
GBPA No ______________________