Account Opening Form. For Individuals

Transcription

1 Account Opening Form For Individuals 481-Ver 1.1-arch 2014 CB Bank Limited 026 / v 15 / 1.9

2 Indicative List of ocuments that can be provided to open a Bank Account escription of ocument Can be obtained for Identity Address PAN Card Passport Voter's Id issued by Election Commission of India riving Licence Letter issued by UIAI containing details of name, address and Aadhaar number or any other document as notified by the Central Govt in consultation with RBI or Aadhaar Letter or Aadhaar Card Job card issued by NREGA duly signed by officer of the State Government *Identity card with applicant's photograph issued by Central/ State Government epartments, Statutory / Regulatory, Public Sector Undertakings, Scheduled Commercial Banks and Public Financial Institutions (Low Risk customers) *Letter issued by a gazetted officer with a duly attested photograph of the person. *Senior Citizen Card issued by any State Government *Letter with attested photograph issued by recognized public authority such as Collector / Tehsildar / agistrate Legal Guardianship Certificate issued by the Local Level Committees set up under the National Trust for the Welfare of Persons with Autism, Cerebral Palsy, ental Retardation and ental isabilities Act, 1999 and under the ental Act, 1887 appointing Legal Guardians for persons with disability can be accepted to open an account (for accounts of people with disability) Passport Voter's Id issued by Election Commission of India riving License Letter issued by UIAI containing details of name, address and Aadhaar number or any other document as notified by the Central Govt in consultation with RBI or Aadhaar Letter or Aadhaar Card Job card issued by NREGA duly signed by officer of the State Government Passbook with attested photograph from any Scheduled Commercial Bank* Address card issued by India Post * Letter from Block evelopment Officer/ Revenue Official* Letter from scheduled bank as per Annexure K * Social security card issued by State Govt. * Certificate issued by Gram Panchayat * eclaration from joint holder to consider the address as proof of address along with proof of relationship * Passbook with attested photograph from any Scheduled Commercial Bank with latest completed 3 months account statement * Letter from Block evelopment Officer/ Revenue Official * Letter from Scheduled Bank as per Annexure K * Social security card issued by State Govt.* Certificate issued by Gram Panchayat * *Accepted only for Low Risk Customers Please te: 1. Customer must sign the Account Opening Form (AOF) in the presence of Bank Officials 2. The cheque provided as the initial Account Opening Amount (AOA) must be signed by the prospective customer and this signature should match with the signature on the AOF. icro Finance Customers Additional ocuments that can be Obtained Letter / Certificate issued by the Village Sarpanch / ukhiya / Village Administrative Officer / Village Panchayat / Panchayat Secretary / Block evelopment Officer / Panchayat President / Panchayat Council Officer / Gazetted Officer / Revenue Officer / andal Officer, containing the name, recent photograph and address of the applicant Copy of Farmer Passbook issued by Public Sector / Co-operative Banks Extracts of Land Records or Land Khata maintained by a Government authority at the local level Caste Certificate issued by an authorized Government entity Letter / Certificate issued by the Village Sarpanch / ukhiya / Village Administrative Officer / Village Panchayat / Panchayat Secretary / Block evelopment Officer / Panchayat President / Panchayat Council Officer / Gazetted Officer / Revenue Officer / andal Officer, containing the name, recent photograph and address of the applicant Copy of Farmer Passbook issued by Public Sector / Co-operative Banks Extracts of Land Records or Land Khata maintained by a Government authority at the local level Caste Certificate issued by an authorized Government entity Certificate from the Post Office / Postal Authorities Certificate from the Ward Officer or, from an Officer of equivalent rank, maintaining Election Rolls Instruction for filling Account Opening Form Please fill the form preferably in BLACK ink only Hint boxes give tips and highlight important points across the form A B C Please use in CAPITAL LETTERS only Please tick the appropriate boxes Please write your NAE as it appears in all your support documents Specify the addresses along with City, State and PIN Code Please countersign in full for any overwriting / alteration ALL PHOTOCOPIES of documents to be SELF-ATTESTE by the applicant

3 Bank Use only (* Fields are andatory) Application.: IN Customer I: Account.: *Segment Code R / CSE / RO / CBE (Code): Branch: SOL Code: ate: I / We hereby apply for a relationship with your Bank under which I / we wish to open an account. Funding: Txn. / I.: ate: Value ate: Relationship Form Savings Classic Premium BSBA Privilege Banking (HNI) Elite Corporate Payroll (Basic) Corporate Payroll (Plus) Fixed eposit Cash Back Others (please specify including Personal Current A/c.) Personal etails : Applicant 1 *Name: (* Fields are andatory) (First Name) (iddle Name) (Last Name) *Short Name: *ate of Birth: r. rs. s. r. Prof. Capt. Others *Status: inor Sr. Citizen Pensioner Other General Staff, if yes, Employee. *Gender: ale Female Existing Customer I: (If applicable) Third Gender aximum 32 characters. aximum 19 characters. This name would appear on the ebit Card *Nationality: Category: Indian General Other (pl. specify) OBC SC ST Others arital Status: Single arried *other s aiden Name: *Card: ebit Card required AT Card required es es International ebit Card required Cheque Book required es es Rupay Visa es es Type of card would be based upon the product *Permanent Account Number (PAN): Form 60 Form 61 Aadhaar Number: our 12 digit unique identification number Current Residential Address: City: Pin: If PAN number is not available please fill in Form 60 or Form 61 (incase of agricultural income and if one enters into any transaction specified in rule 114B) Landmark: State: Telephone: (with ST Code) *Preferred Id: Permanent Address: Same as Current Residential Address Country: *Preferred obile.: All alerts will be sent to the preferred obile Number and I. obile Number will be used for SS Banking registration for eligible accounts. City: Pin: Landmark: State: Telephone: (with ST Code) Office Address: Landmark: State: Extn.: City: Telephone: (with ST Code) Fax: (with ST Code) ailing Address: Residential Office Permanent (ou must tick mark one option) Pin: Address proof of mailing address is mandatory. Otherwise, default address picked would be Current Residential Address 3

4 Customer Profile *Occupation: Salaried Business Self Employed House Wife Student Politician Agri Allied Retired / Pensioner Salaried: Proprietorship Partnership Pvt. Ltd. Public Ltd. Public Sector Central / State Government ultinational To be filled if the occupation is salaried Nature of Business: anufacturing Jewellers Trading Services Retailing Agriculture Stock Broker Real Estate To be filled if the occupation is business Nature of Self Employment: octor CA / CS Lawyer Architect Consultant Engineer Banking / Financial Services To be filled if the occupation is self employed Education: Graduate Post Graduate Professional Others Gross Annual Income (`): Less than 50K 50K - < 1.5 Lakhs 1.5 Lakhs - < 3 Lakhs 3 Lakhs - < 5 Lakhs 5 Lakhs - < 10 Lakhs 10 Lakhs - < 50 Lakhs 50 Lakhs and above Residence: Self Owned Family Owned Rented Company Lease Existing Credit Facility: House Loan Vehicle Loan Consumer Loan Education Loan Business Loan Credit Card Vehicle: Two Wheeler Four Wheeler Both ne Joint Applicant (* Fields are andatory) (Guardian to fill a inor eclaration Form separately) ## If applicable, please attach age proof * Fields are andatory Joint Applicant 1 *Name: *ate of Birth: r. rs. s. r. Prof. Capt. Others *other s aiden Name: Existing Customer I: (If applicable) (First Name) (iddle Name) (Last Name) aximum 32 characters Relationship with 1st Applicant: arital Status: Single arried *Gender: ale Female Third Gender *Nationality: Indian Other (pl. specify) *Card: ebit Card required AT Card required es es International ebit Card required Cheque Book required es es Rupay Visa es es Type of card would be based upon the product *Short Name: aximum 19 characters.this name would appear on the ebit Card *Status: inor Sr. Citizen Pensioner Other General Staff, if yes, Employee. *Permanent Account Number (PAN): Form 60 Form 61 Aadhaar Number: our 12 digit unique identification number *Occupation: Salaried Self-employed Self-employed Professional Housewife Retired Student Others (please specify): Nature of Business: anufacturing Trading Services Retailing Agriculture Stock Broker Real Estate Jewellers If PAN number is not available please fill in Form 60 or Form 61 (incase of agricultural income and if one enters into any transaction specified in rule 114B) To be filled if the occupation is business Current Residential Address: City: Pin: Landmark: State: Telephone: (with ST Code) Country: *Preferred obile.: *Preferred Id: 4

5 Joint Applicant 2 *Name: *ate of Birth: r. rs. s. r. Prof. Capt. Others *other s aiden Name: Existing Customer I: (If applicable) (First Name) (iddle Name) (Last Name) aximum 32 characters Relationship with 1st Applicant: arital Status: Single arried *Gender: ale Female Third Gender *Nationality: Indian Other (pl. specify) *Card: ebit Card required AT Card required es es International ebit Card required Cheque Book required es es Rupay Visa es es Type of card would be based upon the product *Short Name: aximum 19 characters.this name would appear on the ebit Card *Status: inor Sr. Citizen Pensioner Other General Staff, if yes, Employee. *Permanent Account Number (PAN): Form 60 Form 61 Aadhaar Number: our 12 digit unique identification number *Occupation: Salaried Self-employed Self-employed Professional Housewife Retired Student Others (please specify): Nature of Business: anufacturing Trading Services Retailing Agriculture Stock Broker Real Estate Jewellers If PAN number is not available please fill in Form 60 or Form 61 (incase of agricultural income and if one enters into any transaction specified in rule 114B) To be filled if the occupation is business Current Residential Address: City: Pin: Landmark: State: Telephone: (with ST Code) Country: *Preferred obile.: *Preferred Id: ode of Operation Self Jointly Either or Survivor Former or Survivor Guardian Others: (Please Specify) Initial Payment etails Payment By Cash (To be deposited by the customer at teller counter only) Cash eposited on: rawn on: (Bank) Amount `: Amount in words: Cheque.: Cheque ated: Please note: All cheques should be CROSSE and in favour of CB Bank Limited A/c (our Name) ebit to CB Bank A/c.: Services SS Banking & Alert Facility: Alerts facility enables you to receive alerts on your and / or obile regarding large debit, large credits, Standing Instruction failure, balance below Account Quarterly Balance and balance update. New alerts may be added from time to time. Please te: Authorised signatory/ies of the Firm / Company / Trust / Association / Society are eligible for free obile alert facility subject to compliance of terms and conditions as stipulated by the Bank from time to time. I / We don t wish to receive any Bank related promotional calls, SS alerts or s. CB On The Go (obile Banking) Account Statement Internet Banking Utility Bills Phone Banking Preferred Language Options: English Hindi arathi Gujarati Tamil Telugu Please fill a separate obile Banking Registration Form for Joint Account Holder Passbook Investment: Life Insurance utual Fund Wealth anagement General Insurance 2-Way Sweep eposit etails: Facility required: es (please tick appropriate options) Reverse Sweep (Transfer of funds from Savings Account to Term eposit Account) Sweep (Transfer of funds from Term eposit Account to Saving Account) Please te: Reverse Sweep to Fixed eposit account shall happen only, if the balance in the account exceeds threshold limit and Sweep shall happen if the balance in the account goes below the threshold limit. All deposits will be under Re-investment scheme with Auto Renewal Facility, this facility may differ from product to product and from time to time. Account Statement: Frequency of statement would be as per the product feature. Both 5

6 Tax eduction at Source TS to be deducted if applicable: es TS Exemption submission date : If, TS Exemption Reference. Enclose TS Certificate for exemption. Form 15G / 15H, etc. to be submitted at the beginning of every financial year and while making fresh deposits during the year. Term eposit etails (* Fields are andatory) Type of eposit onthly Interest Payout (IC) Quarterly Interest Payout (QIC) Quarterly Compounded (RIC) Simple Interest (for deposits less than 6 months) Tax Saver ONL Simple Interest payable for deposits of less than 6 months tenor Amount of eposit Please issue Term eposit in the Name(s) of Account Holder by Cash/ebit to Account.: for an amount of ` (Rupees only) eposit Period ays onths ears (eposit period is minimum 14 days and maximum 10 years) Senior Citizen es Interest Rate. % ate of Birth (OB) proof required to avail benefits for Senior Citizens. Interest Payment Instructions Transfer to CB Bank A/c.: Issue emand raft Payable at *aturity Instructions (Tick any one) Auto Renew Principal and Interest Repay Principal and Interest Auto Renew Principal and Pay Interest Payment Instructions (upon closure) Transfer to CB Bank A/c.: Issue emand raft Payable at Please tick here if you wish to receive physical eposit Confirmatin Advice (CA) otherwise your CA will be sent at your registered I with the Bank. CB iamond Khushiyali eposit etails onthly Instalment Amount ` K can be created in the name of the Primary Applicant only eposit Period ays onths ears (eposit period is minimum 14 days and maximum 10 years) onthly Instalments to be collected through Senior Citizen es on ebit to Account. of every month Interest Rate. % ate of Birth (OB) proof required to avail benefits for Senior Citizens. aturity Instructions Transfer to CB A/c.: eclaration where Applicant is inor I hereby declare that I am the natural guardian / lawful guardian appointed by the Court order dated (copy enclosed) of aster / iss inor's Name I shall represent the said minor in operating the Bank Account till he / she attains majority. I agree to indemnify the Bank against any claims for any transactions made in the account(s). I undertake and confirm that I shall avail various services of the Bank (wherever applicable) like Phone Banking, obile Banking, Internet Banking, Bill Pay only for the benefit of the minor and I shall abide by all terms and conditions governing the various services and shall intimate the Bank in writing immediately upon the inor attaining majority. *Customer id: * Incase Father / other / Guardian is an existing customer Name of Father / other / Guardian Signature of Father / other / Guardian 6

7 Form 60 / 61 for Primary Applicant (to be filled by those who do not have either PAN or GIR) In case of Agriculture Income, please fill up form 61 separately. Form Full name and address of the eclarant: 2. Particulars of transaction: 3. Amount of the transaction: 4. Are you assessed to tax: es 5. If es, a) etails of Ward / Circle / Range where the last return of income was filed: b) Reason for not having PAN / GIR.: 6. etails of the document being produced in support of address in column (1): Verification I, hereby declare that what is stated above is true to the best of my knowledge and belief. Verified today, the day of 20 ate: Form 61 [See provision to clause (a) of rule 114C(1)] Form of declaration to be filed by a person who has agricultural income and is not in receipt of any other income chargeable to income-tax in respect of transactions specified in clauses (a) to (h) of rule 114B. 1. Full name and address of the eclarant: 2. Particulars of transaction: 3. etails of documents being produced in support of address in column (1): es 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. ate : Place : Verification Signature of the eclarant I, hereby declare that what is stated above is true to the best of my knowledge and belief. Verified today, the day of 20 ate: Place: Signature of the eclarant Place: Signature of the eclarant Form 60 / 61 for Joint Applicant 1 (to be filled by those who do not have either PAN or GIR) In case of Agriculture Income, please fill up form 61 separately. Form Full name and address of the eclarant: 2. Particulars of transaction: 3. Amount of the transaction: 4. Are you assessed to tax: es 5. If es, a) etails of Ward / Circle / Range where the last return of income was filed: b) Reason for not having PAN / GIR.: 6. etails of the document being produced in support of address in column (1): Verification I, hereby declare that what is stated above is true to the best of my knowledge and belief. Verified today, the day of 20 ate: Form 61 [See provision to clause (a) of rule 114C(1)] Form of declaration to be filed by a person who has agricultural income and is not in receipt of any other income chargeable to income-tax in respect of transactions specified in clauses (a) to (h) of rule 114B. 1. Full name and address of the eclarant: 2. Particulars of transaction: 3. etails of documents being produced in support of address in column (1): es 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. ate : Place : Verification Signature of the eclarant I, hereby declare that what is stated above is true to the best of my knowledge and belief. Verified today, the day of 20 ate: Place: Signature of the eclarant Place: Signature of the eclarant Form 60 / 61 for Joint Applicant 2 (to be filled by those who do not have either PAN or GIR) In case of Agriculture Income, please fill up form 61 separately. Form Full name and address of the eclarant: 2. Particulars of transaction: 3. Amount of the transaction: 4. Are you assessed to tax: es 5. If es, a) etails of Ward / Circle / Range where the last return of income was filed: b) Reason for not having PAN / GIR.: 6. etails of the document being produced in support of address in column (1): Verification I, hereby declare that what is stated above is true to the best of my knowledge and belief. Verified today, the day of 20 ate: Form 61 [See provision to clause (a) of rule 114C(1)] Form of declaration to be filed by a person who has agricultural income and is not in receipt of any other income chargeable to income-tax in respect of transactions specified in clauses (a) to (h) of rule 114B. 1. Full name and address of the eclarant: 2. Particulars of transaction: 3. etails of documents being produced in support of address in column (1): es 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. ate : Place : Verification Signature of the eclarant I, hereby declare that what is stated above is true to the best of my knowledge and belief. Verified today, the day of 20 ate: Place: Signature of the eclarant Place: Signature of the eclarant 7

8 mination etails (Form A 1) es, I want to nominate the following person minee Name:, I do not want to nominate anyone I / we nominate the following person to whom in the event of my / our / minor s death the amount of the deposit / in the account may be returned by CB Bank Limited Preferable for Single & Joint Account holders Address: Relationship with Applicant, if any * As the nominee is a minor on this date, I / we appoint (Name & Address) Name : Age: to receive the amount of the deposit / in the account on behalf of the nominee in the event of my / our death during the minority of the nominee. In case you have specified a nominee above, please indicate if you wish to make mention of the nominee name on the passbook, statement & CA issued in respect of your account and / or the passbook issued to you es I / We do hereby declare that what is stated above is true to the best of my / our knowledge and belief. Witness(es): ears Name : ate of Birth: Signature(s) / Thumb Impression(s) of depositor(s) mination under Section 45ZA of the Banking Regulation Act, 1949 and Rule 2(1) of the Banking Companies (mination) Rules 1985 in respect of bank deposits. Thumb impression is required to be attested by 2 witnesses. In case of signature, no witness is required. Signature : Address : Signature : Address : Place : ate: Place : ate: *Strike out if nominee is not a minor. ** Where deposit is made / account is held in the name of the minor the nomination should be signed by a person lawfully entitled to act on behalf of the minor. Group Personal Accident Insurance es, I wish to enroll es, I wish to enroll for the auto renewal of for Group Personal Accident Insurance Group Personal Accident Insurance for additional Sourcing Staff Name: 3 years 5 years 10 years HRS Number: Group Personal Accident (GPA) Plan (Please tick any one of the below 8 options) Coverage eath + Permanent Total isability eath + Permanent Total isability + ouble benefit for salaried person for accident on duty by Rail / Road / Air *minee: *ention Guardian / Appointee Name in case minee is a minor: Plan Sum Insured ` Premium ` Option Chosen (þ) Plan A Plan G Plan B Plan C Plan F Plan H Plan Plan E 5,00,000 10,00,000 15,00,000 25,00,000 30,00,000 10,00,000 15,00,000 25,00, ,834 3,057 3,669 1,356 2,038 3,363 The maximum Sum Insured allowed for any one customer, across one or more policies, should not exceed ` 30 Lakhs (standard variant only). *Relationship of minee with Applicant: *minee Gender: ale Female Third Gender *PLEASE TICK (ü) AGAINST THE APPLICABLE ESCRIPTION, IF OU FALL UNER AN OF THE BELOW LISTE CATEGORIES. IF OU FALL UNER ORE THAN ONE OF THE LISTE TITLES BELOW, PLEASE TICK AGAINST ALL THE APPLICABLE HEAS. Head of Stateor Central Government Senior Politician Senior Government / Judicial / ilitary Officer Senior Executive of State or Central-Owned Corporation Important Political Party Official List of hazardous occupation which are not covered in GPA: Aircraft pilots and crew, Armed Forces personnel, Artistes engaged in hazardous performances, Aerial crop sprayer, Bookmaker (for gambling), emolition contractor, Explosives users, Fisherman (seagoing), Jockey, arine salvager, iner and other occupations underground, Off-shore oil or gas rig worker, Policeman (Full time), Pop usicians, Professional sports person, Roofing contractors and all construction, maintenance and repair workers at heights in excess of 50ft / 15m, Saw miller, Scaffolder, Scrap metal merchant, Security guard (armed), Steeplejack, Stevedore, Structural steelworker, Tower crane operator, Tree feller, Ship crew, Travel agency business, Air coupon & ticket business. Any other Politically Exposed Person (PEP) / Related to PEP Signature of the Applicant 8

9 A worldwide personal accident cover plan that is specially designed to give comprehensive protection to help you / your family against finance crises due to Accidental eath or Permanent Total isablement. Key Features: Worldwide Cover Waiting Period Sum Insured Options: Coverage eath + Permanent Total isability eath + Permanent Total isability + ouble benefit for salaried person for accident on duty by Rail / Road / Air Plan Sum Insured ` Premium ` Option Chosen (þ) Plan A Plan G Plan B Plan C Plan F Plan H Plan Plan E 5,00,000 10,00,000 15,00,000 25,00,000 30,00,000 10,00,000 15,00,000 25,00, ,834 3,057 3,669 1,356 2,038 3,363 The maximum Sum Insured allowed for any one customer, across one or more policies, should not exceed ` 30 Lakhs (standard variant only). Key Benefits: eath Benefit: In the unfortunate event of a fatal accident, the Sum Insured shall be paid to the nominee of the Insured Person. In the unfortunate event of an accident resulting in Permanent Total isability, the Insured Person shall be paid the following % of Sum Insured. a) 100% sum insured in case of loss of sight of both eyes, or of the actual loss by physical separation of two entire hands or two entire feet, or of one entire hand and one entire foot, of such loss of sight of one eye and such loss of one entire hand or one entire foot. b) 100% sum insured in case of loss of use of two hands or two feet or of one hand and one foot, or of such loss of sight of one eye and such loss of use of one hand or one foot. c) 50% sum insured in case of loss of sight of one eye, or of the actual loss by physical separation of one entire hand or of one entire foot. d) 50% sum insured in case of total and irrecoverable loss of use of a hand or a foot without physical separation. e) 100% sum insured in case of permanent and total disability which absolutely disables insured person from engaging in any employment or occupation. For those opting for ouble benefit for eath & Permanent Total isability cover: Claim will be paid for salaried persons who are involved in an accident on duty while traveling by Rail / Road / Air. Who can be Insured Person? This insurance is available to persons who are aged between 18 and 70 years at the commencement date of the Policy and are Account holders of CB Bank Limited (CB Bank). This is an insurance plan underwritten by Royal Sundaram Alliance Insurance Co Ltd. for customers of CB Bank. our participation in this insurance product is purely on a voluntary basis. CB Bank will be the Group anager for this insurance product and will only be responsible for distributing the insurance product to all members of this group. All Claims under the policy will be solely decided upon by Royal Sundaram Alliance Insurance Company Ltd. This application shall be processed and the premium amount as per option chosen by you shall be debited if it is found acceptable by Royal Sundaram Alliance Insurance Company Limited. The insurance cover shall start on 1st day of succeeding month of the premium amount debit in your CB Bank Account ( commencement date ). This insurance cover will be valid for a period of 1 (one) year from the commencement date, provided you continue to remain a CB Bank account holder during this period. This insurance cover will cease to exist in case the CB bank Account is dormant, freezed or lien marked for any reason whatsoever. The application will not be accepted till the time such account related disputes are resolved and the said CB Bank Account is reactivated. Renewal reminders for this policy will be conveyed through SS alerts and by CB Bank on your registered obile. and I respectively. If for any reason you need to communicate with Royal Sundaram Alliance Insurance Company Limited, it is adequate that you mention the aster Policy number, CB Bank account number and the branch details. Claim intimation can also be made to Royal Sundaram Alliance Insurance Company Ltd, by contacting them on This is only a brief summary of the insurance product. Please refer to aster Policy. PACB00001 (available on CB Bank s website issued to CB Bank by Royal Sundaram Alliance Insurance Company Limited for complete information on terms, conditions and exclusions. Royal Sundaram Alliance Insurance Company Limited, Sundaram Towers, 45 & 46, Whites Road, Chennai ACKNOWLEGENT Name of the Applicant: CB Bank Account Number: CB Bank Account Opening Form Number: ate: Instruction received to debit ` from CB Bank Account towards Group Personal Accident Insurance Premium. (te: Certificate of Insurance will be couriered at your mailing address / ed on your registered I post issuance of the policy. Insurance cover will start on 1st day of succeeding month of the premium amount debit from your Account with CB Bank Limited) This application is for Group Personal Accident Insurance Cover only. It is not a cover for Life Insurance or ediclaim. Applicant s Signature: Authorized signatory for CB Bank Limited: List of hazardous occupation which are not covered in GPA: Aircraft pilots and crew, Armed Forces personnel, Artistes engaged in hazardous performances, Aerial crop sprayer, Bookmaker (for gambling), emolition contractor, Explosives users, Fisherman (seagoing), Jockey, arine salvager, iner and other occupations underground, Off-shore oil or gas rig worker, Policeman (Full time), Pop usicians, Professional sports person, Roofing contractors and all construction, maintenance and repair workers at heights in excess of 50ft / 15m, Saw miller, Scaffolder, Scrap metal merchant, Security guard (armed), Steeplejack, Stevedore, Structural steelworker, Tower crane operator, Tree feller, Ship crew, Travel agency business, Air coupon & ticket business. Royal Sundaram Alliance Insurance Co. Ltd. Call Write customer.services@royalsundaram.in Visit CB 24-Hour Customer Care Call Toll Free: customercare@dcbbank.com Web: 9

10 Experience banking like never before CB Elite Account w choose your lucky number as your savings or current account number along with a host of free benefits and services. CB NRI Services CB Bank offers a bouquet of products and services ranging from CB NRE / NRO Accounts and Term eposits to CB Wealth anagement Solutions. CB CashBack Account A unique savings account that pays you cash every time you spend using your ebit Card. CB Investment Services Experience state-of-the-art personalised financial planning along with the best investment products that suit your risk appetite. Free access to Visa ATs in India Use your CB ebit Card for cash withdrawals and balance enquiries at any Visa AT in India at no cost. CB Gold Loan Avail instant loan against your gold jewellery / ornaments. The loan amount can be as high as 80% of the appraised gold value. CB iamond Khushiyali eposit A small deposit every month leads to a large assured amount for the future. ou can deposit as low as ` 1000 per month. CB Business Loan our property can now fund your business expansion. Avail of term loans for your business against the security of your residential or commercial property. 10

11 Risk Classification for Primary Applicant * Kindly fill the following details: Expected Annual Turnover (`): Upto ` 1 Lakh Upto ` 10 Lakhs Upto ` 50 Lakhs Upto ` 1 Crore Upto ` 5 Crores Upto ` 10 Crores Upto ` 25 Crores ore than ` 25 Crores Expected number of transactions in a month: Up to to 50 ore than 50 Basis of Categorisation: Politically Exposed Person omiciled in Risk Country Trust Sleeping Partner High Risk Profession Information: Politically Exposed Person due to position / status as: If omiciled in Risk Country - Country Name: Nature of Business / Occupation: *etails of Customer s Source of Funds & Estimated Net Worth: Income from Employment Income from Business Income from Investments Inherited Funds Risk Classification of Account (L / / H): Risk Classification for Joint Applicant 1 * Kindly fill the following details: Expected Annual Turnover (`): Upto ` 1 Lakh Upto ` 10 Lakhs Upto ` 50 Lakhs Upto ` 1 Crore Upto ` 5 Crores Upto ` 10 Crores Upto ` 25 Crores ore than ` 25 Crores Expected number of transactions in a month: Up to to 50 ore than 50 Basis of Categorisation: Politically Exposed Person omiciled in Risk Country Trust Sleeping Partner High Risk Profession Information: Politically Exposed Person due to position / status as: If omiciled in Risk Country - Country Name: Nature of Business / Occupation: *etails of Customer s Source of Funds & Estimated Net Worth: Income from Employment Income from Business Income from Investments Inherited Funds Risk Classification of Account (L / / H): Risk Classification for Joint Applicant 2 * Kindly fill the following details: Expected Annual Turnover (`): Upto ` 1 Lakh Upto ` 10 Lakhs Upto ` 50 Lakhs Upto ` 1 Crore Upto ` 5 Crores Upto ` 10 Crores Upto ` 25 Crores ore than ` 25 Crores Expected number of transactions in a month: Up to to 50 ore than 50 Basis of Categorisation: Politically Exposed Person omiciled in Risk Country Trust Sleeping Partner High Risk Profession Information: Politically Exposed Person due to position / status as: If omiciled in Risk Country - Country Name: Nature of Business / Occupation: *etails of Customer s Source of Funds & Estimated Net Worth: Income from Employment Income from Business Income from Investments Inherited Funds Risk Classification of Account (L / / H): 11

12 eclaration Regarding Signing in Vernacular Language / By Illiterate / Blind Person I, r./s. (the eclarant - either Bank Official or customer of Bank) have read out and explained the contents of this Account Opening Form of CB Bank Limited (the Bank) to the Applicant(s) r. / s. in language and he / she / they have confirmed that he / she / they has / have understood the same and have agreed to abide by all the terms and conditions of the said Account Opening Form. Pursuant to the same the aforesaid Applicant(s) is / are affixing his / her / their signature(s)/thumb impression(s) as given herein below: Name and signatures of Applicants Name and signature of the eclarant ate : Place : Letter From Customer - Recording A ifferent Signature (When Signature recorded on any of the document provided for Signature Proof is different from the one recorded on the AOF) To be signed by the Customer in the presence of the Bank Official attesting the Signature The Branch anager CB Bank Limited Branch ate: Sir / adam, With reference to the (name of the document on which the signature differs) provided by me as proof of my signature along with the Account Opening Form, I request you to please record with yourselves my specimen signature as below, as the signature on the above referred document differs from the one provided on the Account Opening Form : (Signature as per document submitted) (Signature now requested to be admitted) This difference in the signature is because ours faithfully, (Signature of the Customer) (Name of the Customer) Signed in my presence Name & Signatures of the Officer along with Signature Code Number Letter From Customer Opening of NO FRILL Accounts in VALUE SAVINGS SCHEE under relaxed KC rms The Branch anager CB Bank Limited Branch Sir / adam, I / We am / are aware and agree that if the balance in my / our account and / or the aggregate credits in my / our account exceed/s the limits specified by Reserve Bank of India, I/we agree to be subjected to full KC norms applicable at that point of time and affirm that I/we shall comply with the same as per requirements of the Bank failing which, the Bank has the right to suspend the operations or close the account by giving a notice of 15 days. ours faithfully, (Signature of the Customer) Letter From Customer Opening of Corporate Payroll Account with ailing Address as Office Address The Branch anager CB Bank Limited Branch Sir / adam, I am / We are aware of the risks that would arise due to receipt of customer deliverables at the corporate address by any unauthorised person and I / we shall not hold the Bank responsible and liable for any loss or damage that I / we may suffer, due to the Bank recording and treating the corporate address of my / our company as my / our mailing address. ours faithfully, (Signature/s of the Customer/s) CB Bank Limited 12

13 eclaration I / We have read, understood and hereby agree to the Terms and conditions as applicable to my / our account set forth on CB Bank Limited ( CB Bank, the Bank ) website at I / We understand that access to any changes / updates in terms and conditions applicable to this relationship shall be available on the Bank s website only. I / We do hereby declare that information furnished in this Form is true and correct to the best of my / our knowledge and belief. I / We hereby authorize issuance of AT / ebit Card and provision of Phone Banking, obile Banking Services, Internet Banking and Bill Payment Services. I / We am / are aware of Charges Applicable for various services offered and I / we affirm, confirm and undertake that I / we have read and understood the Terms and Conditions for usage of the Phone Banking, obile Banking Services, Internet Banking and Bill Payment Services of CB Bank as set forth in the Bank's website and I / We will adhere to all the terms and conditions as applicable from time to time. I / We further authorize the Bank to debit my / our Account(s) towards any applicable charges for any / various service / services provided as applicable from time to time. I / We understand and agree the consent given for updation / registration / requests for free obile alert facility shall be valid till such time I / we withdraw the same in writing. Unless specifically advised, the Bank will continue to send SS alerts on the number requested by the Authorised signatory/ies of the Firm / Company / Trust / Association / Society. The Bank shall not be responsible and liable for any consequences which may arise owing to change in name/s of authorized signatories or partners or directors or trustees or members of the Firm / Company / Trust / Association / Society. I / We declare, confirm, understand, accept, acknowledge and agree: (a)that all the particulars and information given in this application form (and all documents referred or provided therewith) are true, correct, complete and up-to-date in all respects and I / We have not withheld any information. I / We understand certain particulars given by me / us are required by the operational guidelines governing banking companies. I / We agree and undertake to provide any further information as and when the Bank may require. (b) That I / we have had no insolvency proceedings initiated against me / us nor I / we have ever been adjudicated insolvent. (c) That I / we have read the application form and brochures and am aware of all the terms and conditions of availing finance or service or products from the Bank. (d) That the Bank reserves the right to reject any application without providing any reason and reference to me / us. I / We agree and understand that the Bank reserves the right to retain the application forms, and the documents provided therewith, including photographs, and shall not return the same to me / us. (e) To inform the Bank regarding change in my residence /employment and to provide any further information as and when the Bank may require from time to time. (f) That if the Account is under Corporate salary Scheme: I / We have also read and understood Terms and Conditions under which Salary Scheme is offered to my / our organization and employees. I / We agree that my / our employer has full right to reserve any instruction given by them to credit my account for any amount within a period of three working days and I / we will not dispute or hold the Bank responsible for such debits in my / our account. I / We understand that it is my / our responsibility to inform (in writing) the Bank immediately on termination of my / our employment with my / our current employer, whereupon I / we will cease to enjoy any or all benefits under Salary account scheme. (g) That I / we shall not hold the Bank liable for furnishing of the processed information / data / products thereof to other Banks /Financial Institutions / Credit Providers / Users registered as above. (h) That I / we have to complete further application for specific liability products / services from the Bank as prescribed from time to time, and that such further applications shall be regarded as an integral part of this application (and vice versa), and that unless otherwise disclosed in such further forms as prescribed, the particulars and information set forth herein as well as the documents referred or provided herewith are true, correct, complete and up-to-date in all respects. (i) That such further applications will require incorporation of the application form number, and / or such details as the Bank may prescribe, to facilitate data management. (j) That I / we authorize the Bank to issue a ebit cum AT Card to me / us. (k) That the issue and usage of the ebit cum AT Card is governed by the terms and conditions as in force from time to time and I / we agree to be bound by the same. (l) That the terms and conditions of ebit cum AT Card are liable to be amended by the Bank from time to time. (m) That I / we unconditionally and irrevocably authorize the Bank, to debit my / our Account annually with an amount equivalent to the fee and charges for use of the ebit cum AT Card. (n) That continuation of the account with the Bank is at the sole discretion of the Bank and in case the Bank is dissatisfied with the conduct of the Account / accountholder, the Bank has the right to close the account after giving me / us one month's notice or withdraw the concessions in to or any service granted to me / us or charge the Bank's applicable rates for such services. (o) That the Bank may at its absolute discretion, discontinue any of the services completely or partially without any notice to me / us. (p) That in case of return of Account Opening Amount (AOA) cheque, for any reason whatsoever, the Bank would close the account without any reference to me / us. (q) That CB On The Go facility will be offered to customers whose account is an individually operated resident account. (r) That CB mobile Banking will also not be available to n Resident Accounts. Group Personal Accident Insurance Plan: Applicable only to Primary Applicant (a) That I hereby opt to enroll under Group Personal Accident Insurance Plan ( Plan ). The terms and conditions of the Plan have been duly explained by CB Bank and I have completely understood the same. (b) That I authorize CB Bank to debit the above chosen premium amount from my CB Bank Account towards the payment for this Plan. (c) That the insurance cover shall start on 1st day of the succeeding month of the premium amount debit in my CB Bank Account ( commencement date ). (d) That this insurance cover will be valid for a period of 1 (one) year from the commencement date, provided I continue to remain a CB Bank account holder during this period. (e) That in case auto renewal is chosen without specifying tenure, policy will be auto renewed for a tenure of 1 (one) year by default and applicable premium amount debited from my CB Bank Account. (f) That in the event of an admissible claim due to my death, my nominee shall be receiving the claim amount. (g) That CB Bank shall not have any role in the claim process and the claim shall be processed and settled by Royal Sundaram Alliance Insurance Company Limited ( Royal Sundaram ), as per the claim process stipulated by Royal Sundaram, from time to time. (h) That the claim shall be processed as per the terms and conditions of the aster Policy. PACB00001 issued to CB Bank by Royal Sundaram. Group Personal Accident Insurance: Applicable only to Primary Applicant This application is for Group Personal Accident Insurance Cover only. It is not a cover for Life Insurance or ediclaim. Section 41 of the Insurance Act, 1938 Prohibition of rebates - 1. person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer. Provided that acceptance by an insurance agent of commission in connection with a policy of life insurance taken out by himself on his own life shall not be deemed to be acceptance of a rebate of premium within the meaning of this sub-section if at the time of such acceptance the insurance agent satisfies the prescribed conditions establishing that he is a bona fide insurance agent employed by the insurer. 2. Any person making default in complying with the provisions of this section shall be punishable with fine which may extend to five hundred rupees. Signature of Primary Applicant Signature of Joint Applicant 1 Signature of Joint Applicant Ver 1.1-arch 2014 CB Bank Limited 026 / v 15 / 1.9 mination Form Received: es Acknowledgement Please provide this number for future reference 1st Applicant s Name: Joint Applicant 1: Joint Applicant 2: Name of the minee: Name of the Bank Official: Employee code: ate: Branch: Signature of Bank Official 13

14 Customer Information & ue iligence (CI) Form - For Primary Applicant Information Countries where business associates located (for Businessmen, only) etails Source of Funds for Credits in the Account Savings Salary Business Proceeds Sale of Property Investments Inheritance Professional fee Other (please specify) Wire Transfers Expected Into the Account es Value ` From the Account es Value ` Foreign Inward Remittances Expected es Approximate Value ` Customer Information & ue iligence (CI) Form - For Joint Applicant 1 Information Countries where business associates located (for Businessmen, only) etails Source of Funds for Credits in the Account Savings Salary Business Proceeds Sale of Property Investments Inheritance Professional fee Other (please specify) Wire Transfers Expected Into the Account es Value ` From the Account es Value ` Foreign Inward Remittances Expected es Approximate Value ` Customer Information & ue iligence (CI) Form - For Joint Applicant 2 Information Countries where business associates located (for Businessmen, only) etails Source of Funds for Credits in the Account Savings Salary Business Proceeds Sale of Property Investments Inheritance Professional fee Other (please specify) Wire Transfers Expected Into the Account es Value ` From the Account es Value ` Foreign Inward Remittances Expected es Approximate Value ` For Bank Use Only Any of the Signatories / Beneficial Owners of the entity a Political / Public Figure or related to a Political / Public Figure es if yes, please give position oes it seem that the initial eposit and/or the declared transaction profile is in line with the status/occupation declared? es Signed in my presence Name & Signatures of the Officer along with Signature Code Number CB 24-Hour Customer Care Call Toll Free: customercare@dcbbank.com Web: Please call CB 24-Hour Customer Care to enquire about your account application status CB Bank Limited 14

15 Signatures and Photographs Thumb Impression Signature ate: Please affix a recent photograph Please affix a recent photograph. Sign across the photo Please affix a recent photograph Sign across the photo Thumb Impression Signature ate: Please sign in Black Ink within the box. Signature shall be considered for all Cheque clearances and any future communication with the Bank Thumb Impression Signature ate: Please affix a recent photograph Sign across the photo Please do not forget to collect your Acknowledgment slip Approved by B / BO (Name, signature with signature code) with seal *Incase of Thumb Impression, Sign in B/BO presence Confirmation I confirm having met the Applicant/s in person. For Office Use Only I confirm having met r. / s., in person at c CB Bank Limited, Branch, c Current Residential Address, c Permanent Address, c Office Address (anyone address as mentioned in the application form) and hereby confirm the identity and address as provided in this account opening form and also confirm having verified the copy of the documents (as applicable) against originals as produced by the applicant/s. I also confirm that the form has been signed by the applicant is in my presence. I have also verified the Tel.. by calling the no. mentioned in this account opening form. Name of Bank Official: r. rs. s. Employee.: ate: Signature of Bank Official 15

16 CB Family Savings Account Link minimum 2 & maximum 5 family savings accounts in a group Earn upto ` 20,000* p.a cash back on all debit card spends at merchant establishments with your CB ebit Card, issued for each family member *Terms & conditions apply. CB Bank Limited