ACCOUNT TYPE NRE... NRO E or S Mode Of Operation Joint A or S F or S For Term/ Recurring Deposits: Period Periodicity Standing Instructions (SI) for RD Mly Qly Qly Hly Interest Credit A/C Yly On Maturity Credit Account (RD) Debit Account (NRI CASA) SI Frequency Mly L or S Hly Yly SI Debit Amount Period Sl Execution Date Full Name : Mr/Mrs/Ms Father Name Mother Name Marital Status Married Name of Spouse Date Of Birth Gender Male If Staff PF Female Pan no Permanent Address Overseas Address STATE Mobile Contact Occupation: Salaried Self Employed Business Student Pin Others If Self Employed or Business Specify Nature of Activities Employer s Name & Address E-mail Phone Passport Issue Date Expiry Date Visa/PIO/OCI Card Visa Expiry Date Place Of Issue Seafer APPLICANT 2 Full Name : Mr/Mrs/Ms Father Name Marital Status Date Of Birth Overseas Address Mother Name Married Name of Spouse Gender Male If Staff PF Female Pan no Permanent Address STATE Mobile Contact Pin
Occupation: Salaried Self Employed Business Student Others If Self Employed or Business Specify Nature of Activities Employer s Name & Address E-mail Phone Passport Issue Date Purpose of Opening the Account Channel Facilities Saving Repayment of loans Collections Instruments Other 1 ATM CARD 2 Cheque Book 3 Place Of Issue Visa/PIO/OCI Card Visa Expiry Date Account Activity Expiry Date (Please Tick) Seafer Source of Fund Salary Parents Personal Savings Rental/Interest/Dividend/ Proceeds of Shares/Investment Other International Domestic (EMV Chip) Email Alert Expected Monthly Remittance Expected Monthly Withdrawals Up to Rs 10000 Rs 10001 50000 Rs 50001-100000 Rs 100001 500000 Above Rs 500000 Up to Rs 10000 Rs 10001 50000 Rs 50001-100000 Rs 100001 500000 Above Rs 500000 Card Type Mobile Banking Mobile Alert Please Suggest 3 User ID I confirm that I personally know the applicant/s... for the last... months/year and confirm his/her/their identity, occupation and address/es Introducer s Details If staff PF A/C Name... Signature. Address...... Declaration (please tick) I/We hereby declare that.... is/are n-resident Indian/s holding Indian Passport/s. For PIO s I/We hereby declare that.. is/are Person/s of Indian origin holding. (issuing country) passport/s, satisfying one of the following conditions, for which proof is attached: 1. Held an Indian passport in the past. 2. Father/Mother/grandfather/grandmother (name) is/was citizen of India by virtue of the constitution of India or the Citizenship Act 1955. For Seafarer s: I/We hereby declare and confirm that I/We am/are n-resident Indian/s on contract with. (name and address of the shipping company) registered in (Country). For Accounts in the name of Minors: I hereby certify that was born on and attains majority on. and Iam Relationship with Minor.. Nature of Account. Account. For Politically Exposed Persons: I am a politically Exposed Person who performs important functions for the State in the capacity as Senior Official of Govt. or Political Parties or closely related to Politically Exposed Person/s by name Positions Held Name of the Party/Organization Designation Period of Office Political Party Government Organization 1.I/We hereby undertake: (A) To inform the bank immediately on my/our coming back to India for permanent settlement/residence. (B) To inform the bank immediately on any change occurring in my business/office/communication address/other contact details. (C) In respect of NRO/NRE A/cs, all the debits and credits will be carried out strictly as per FEMA regulations. (D) To pay any overdraft created in my/our account inadvertently together with applicable
Signature. interest and without demur. (E) To inform the bank of the wrong credits in my/our account, pertaining to other customers and refund the same together with applicable interest and without demur. 2.I/We understand & declare that: (A) I/We have read and understood the Terms and Conditions (a copy of which I am in possession of ) governing the opening and operation of NRE account under Savings/Current/Fixed/Recurring Deposits Schemes of MDC Bank and those relating to various services including but not limited to ATMs/Debit Card/Mobile Banking/Tele Banking/Internet Banking/Mobile & e-mail alert/imps/cheque Book-Delivery/Acknowledgement. I/We accept and agree to be bound by the said Terms and Conditions. I/We agree that the Bank may debit my account for service charges applicable from time to time. Apart from this the Current Schedule of Charges has been received by me/us and I/We agree with the same. I/We further understand and agree that any subsequent changes in the tariffs/service charges shall be published by the Bank in its website and/or on the notice boards of its branches, which shall be sufficient notice to me/us regarding such change. (B) The above account will be opened on the basis of the statements/declarations made by me/us and I/we also agree that if any of the statements/declarations made herein is found to be not correct in material particulars you are not bound to pay any interest on my/our deposits. (C) In the event of my NRI status is changed in future, my/our existing NRI account will be re-designated to Resident/RFC account (s) (as applicable). (D) Rate of interest applicable, premature withdrawal of the deposit, premature termination of the deposit in the event of death of the depositors, TDS on interest earned and filing/renewal/cancellation of the nomination will be as per RBI/IBA/Income Tax/Bank s rules in force from time to time. (E) I/We will not make available to any person resident in India any foreign exchange against reimbursement in India in Rupees or otherwise. I/We hereby undertake to inform the Bank immediately on my/our coming back to India for permanent settlement/residence. I/we understand that the bank may at any time and without notice to me/us combine and consolidate all or any of my/our accounts and PRIMARY APPLICANT JOINT APPLICANT set off or transfer any sum or sums standing to the credit of anyone or more of such account in or towards the sattisfaction of any of my/our liabilities to the bank on any account or in any other respect whether such liabilities be actual or contingent, primary or collateral and several or joint. unless and until modified or cancelled by filing a fresh nomination form/request for Please paste Please paste cancellation, a nomination once filed will continue to be applicable to the Passport size Passport size deposit when renewed without any change in the name and constitution color photograph color photograph of the account. (F) I/we understand that there will be no interest paid in here here NRE/NRO Current Accounts. (G) Term Deposits will be automatically renewed on maturity for a similar Term at the rate of interest prevailing on the maturity date on same terms and conditions unless instructed by me/us to the contrary or credit to my/our NRE/NRO SB/CA A/c... on maturity on receipt of FD receipt duly discharged by me/us/facility for partial withdrawal in units/automatic loan facility. (H) I/we hereby declare that the above details are correct. (I) I/we wish to avail the add-on facility/facilities, as selected above, in my account. (J) For the purpose of availing the services in respect of joint accounts, I/we enclosing the mandate from the joint account holders. (K) in the cases of all types of joint accounts, name of the first person will be considered for all Income Tax Sgnature Sgnature Purpose. (L) I/we will verify the account details/balances periodically (at least once in every 3 months) and ensure correctness of the same in order Place... Place... to avoid/curtail fraudulent transactions occurring in the account, irrespective of the reasonable care and caution exercised by the Bank. Please open a deposit account in my/our name/s as per the scheme selected. I/we agree to maintain Average Quarterly/Monthly Balance of Rs.. in the account. ATM CARD / MOBILE BANKING / MOBILE ALERT / EMAIL ALERT / TELE BANKING INDIVIDUALS (Applicable for accounts of Individuals having more than one operators) Name of Joint Account Holders (other than user) 1... 2... 3... I/We authorize... (applicant) to avail of ATM card/mobile Banking/Mobile Alert/Email Alert/Telebanking Service in respect of all the account linked to his/her/our customer Id(s) mentioned inthis application form. I/We undertake to ratify and confirm whatever the applicant does or causes to do through these service (s). This authority shall continue to be in force until any one or all of us revokes it by a notice in writing delivered to you. Signature of Joint Account Holders (Other than user)
FORM DA 1 mination under Section 45 ZA of the Banking Regulations Act, 1949 and Rule 2 (1) of Banking Companies (mination) Rules, 1985 in respect of bank deposits I/We... (Name/s and address/es) nominate the following person to whom in the event of my/our/minor s death the amount of the deposit, particulars where of are given below, may be returned by The Malappuram District Co-operative Bank Ltd., Br... Deposit Nature of Deposit Distinguishing. minee Additional details, if any Name Address Relationship with depositor, if any Age If nominee is a minor, date of birth 2. As the nominee is a minor on this date, I/We appoint sri/smt/...... (Name and address) aged... years 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 niominee. Place: Date: Name (s), Signature (s) and address (es) of witness (es) @ *Signature (s)/thumb impression (s) of depositor (s) te: *Where deposit is made in the name of a minor, the nomination should be signed by a person lawfully entitled to act on behalf of the minor & strike out if nominee is not a minor. @ Thumb impression(s) shall be attested by two witness. For office Use : Address Proof ID Proof Photos Verified with the UN List and no matching details identified Customer Risk Rating Lead ID Low Medium Customer Search made, no exists in the name of the applicant High PAN card verified through online official link KYC rms complied with Signature of introducer verified Ye Clerk Asst Manager Principal Officer
Annexure 1 - FATCA-CRS Self Certification Form Individual New Accounts Country # Tax Identification Number% Identification Type (TIN or Other%, please specify) Certification ACKNOWLEDGEMENT Branch :... Date :... Shri./Smt./Ms... Dear Sir/Madam, Reg: mination in respect of your Deposit Account... With us. Ref: Your application in form DA1... Dated... We acknowledge receipt of your letter of nomination dated... minating Shri./Smt./Ms... Your Faithfully, Manager.