Account Opening Form
Account Opening Form
9-tem
cCOUNT OPENING FORM FOR RESIDENT INDIVIDUAL (PART-1) a
Across CUSTOMER INFORMATION SHEET (CIF CREATION/AMENDMENT) Odisha Gramya Bank
A Govt of india Undertakng)
Naton for (In case of joint account, Part-I (CIF Sheet) to be taken for each customer)
Customer
Ercellence Date DDNMODEL
Branch Name: IL I B r a n c h Code L
elds marked asterix () are mandatory.Please fill up in BLOCK letters only and use black ink for signature
(For office use only) Bank/Branch to affix rubber stamp of
narnc arid code no.
Customer ID: Application ype:NewUpdate
|Account No: CKYC
No:I I I
(Mandatory for CKYC update request)
Account type: Normal Small (For low risk customers)
. Personal Details
Existing Customer ID: (f applicable)
|Name
(Same as ID Proof) Prefix
Maiden Name
PlaceCity of Birth
I IL 1 s 0 3166 Country of Code of Birth*
Country of Tax Residence in India only and not in any other country or territory outside India*
Citizenship
Yes N o (E No, please fill the FATCA details form- Annexure I)
PAN /Tax Identification Number or equivalent (tf isued by jurisdication) LL L f PAN is not submitted, submit Form 60- Annexure*)
2. Contact Details (All communications will be sent on provided Mobile No./ Email-1D)
District:
City/Village*
State: U II Pin:" IU
LJCorrespondence Local Same as Current/Permanent Address
5. Address details Unspecified
Registered Office
Address type* Residential/Business Residential Business
Address*
City/Village* District:|
State:* Pin:
6.If the Proof of Address (OVD) provided does not contain current address- please provide any of the documents below.
Utility Bill PPO/FPPO Property or Municipal tax receipt
by employer/ issued by State or Central Governmentleave departments, statutory or regulatory bodies, FuD allotung OrnICa
JLetter of allotment of accomodation issued financial institutions and listed companies. Similarly,
and license agreements with such employerS
undertaking, scheduled commercial banks,
accomodation.
Document No
L Date:
Da DDMN
Selfcertified Truecopies| Notary
8. FOR OFFICE USE/ATTESTATION Documentsreceived
Whether self-certification &r documents received as part of account opening process have been verified and found correct YES/NO
(Branch to proceed with opening only when certification is (YES))
Certified that the implications and conditions for the operation of the account have been explained to the depositor (only in case of illiterate applicant)
Details of one or two identification marks, if any, such as a mole or scar (mandatory for illiterate applicant)
In person verification carried out and Signature/LTI of the applicant verified by:
SS No
Date Signature
(2)
ACCOUNT OPENING FORM FOR INDIVIDUAL
(PART -1)
(SAVING BANK, CURRENT ACcOUNT AND TERM DEPOSITS) Date: 1
Fields marked asterix (*) are mandatory.Please till up in BLOCK letters only and use black ink tor signature
(For office use only)
Account NNo.
I
IWe request you to open my/our deposit account with
your branch/bank as under: (Tick (V) relevant type of account)
I Type of Account
SAVINGS BANK ACCOUNT
BSBDA BSBDA SMALL ACcOUNT CURRENT ACCOUNT FIXED DEPOSIT/RD
2 Mode of Operation
self UEither or Survivor Former or Survivor Any one or Survivor Jointly Operated
Other
3 Services Required
1 ATM-CUM-DEBIT CARD
Name as would appear on the card
lstApplicant Yes No
2nd Applicant Yes No
(Mobile no. is mandatory for services 2 to 8)
2 CHEQUE BOOK
YES
(Only for Regular SB/Current Accounts)
NO 4. SMS ALERTS(Charges Applicable)
YES NO
SMS Alerts on Registered Mobile Number
(Not available for Regular BSBD/Small Accounts)
3. INTERNET BANKING REQUIRED:
5. PHONE BANKING SERVICES: YES NO
Transaction rights required 6. MOBILE BANKING: YES NO
lst Applicant NO 7. PASSBOOK REQUIRED
2nd Applicant NO (For Savings Bank Account)
YES
NO
(Available only for singly operated accounts and joint accounts 8 e-Statement(at monthly intervals), in lieu of
operated by Either or Survivor mode.In case of accounts operated as
paper copy Required Not Required
Former or Survivor mode INB tacility is available to Ist
applicant only)
4 Fixed Deposit: For the follovwing
products/facilities, please furnish options/details:
TERM DEPOSIT IERM DEPOSIT(REINVESTMENT) ANNUITY DEPOSIT TAX SAVING SCHEME
Amount: Rs.. Rs. (in words). *********************************************************
6REcURRINGDEPOSIT
Monthly/ Core Monthly instaliment. Rs. Rs. (In words)
Period Years.
Month(s).
Standing instruction (if any) Debit Account No.
On Maturiry, credit proceeds to Account No.
Isue Banker's Ch /Draft lssue STDR for aperiod of
For the above Term
Deposit Account, please deduct applicable TDS from (SB/CAAccount No.)
(3)
7 Nomination (If required fill Form DA-1)
Details of Nominee
Name:
Rclationship with the depositor. **************************** Age. Date of Birth of nominee(in case of minor)
Years..
As the nominee is a minor on this date,I appoint Shri/Smt/Kum.. Age IEars . *
Addres.. ********* ***********************************************************************e************ to receive the amount of deposit on behalf of the nominee in the event of my/minor s death during
the minority ot the nominee
Signature of the Applicants/Thumb impression of the Applicants) (Signature of the Applicants/Thumb impression of the Applicants)
Signature of the first witness
|Signature of the second witness
Name:
*************************** 1gDature: Name ***
Address
**********
***********************
-SIgnature..
Address..
(Witnesess are required only in case of applicant is illiterate and if affixing thumb impression) Place
IWe do not want to nominate any person in this account
(Signarureof the Applicants/Thumb impression of the Applicants) (Signature of the Applicants/Thumb impression of the Applicants)
I hereby declarethat Idonot maintain aBasicSavingsBank Deposit Account(BSBDA) with any ocherBank/Branch (Applicablein case of BSBD Account)
Place
Date:
(gnatuie of the Apphcants ihuinh impreslOn Ol the Appicants)
1) Internet Banking (INB) Kir No. ***** ****** Inials Personalised Cheque
) INB Viewng nht Tranaaction rights gven on | U init ids RINB
(4)
TERMS AND CONDITIONS FOR OPENING OF SB ACCOUNTS
I affirm and declare that I have read over and understood the rules and regulations of the "Bank" and those relating to various services offered by the Bank including but not
limiting to debit card/internet banking/SMS banking/ Tele-Banking/Mobile Banking/Virtual Banking and any other facilities. I agree to abide
by the same as amended/modified from time to time by
the Bank/Regulator/Govemment published through circulars, notifications, notice board/websites/newspaper
publications, etc. I waive the rights, if any, to have personal notice in
respect of such
amendments/modifications.I agrec that the transactions and requests executed in
my account (s)through internet, mobile, tele- banking or virtual banking under
my User ID and password/PIN/OTP
will be legally binding on me &z I am responsible for the maintenance of secrecy and confidentiality of the authentication credentíals and other
any
agree that Bank has got al the rights to debit my account tor any service charge, expenses or other dues whích the Bank is entitled/ liable to recover information/details/OTP/PIN,
from me. etc., ín such matters.
hereby undertake to intorm the Bank on any change in my communication address or constitution.
3. I confim and declare that I am not prevented/prohibited/restricted by any applicable legal/regulatory/contractual or other provisions from opening and/or maintatning the accounts or to
transact with the Bank in any other way.
4. Iagree that my personal KYC details may be shared with Central KYC registry or any other competent authority. I hereby consent to recefve information from the
Gol/RBI or any other authority through SMS/e-mail on my registered mobile number/ e-mail address. I also agree that the non-receipt of any such SMS/e-mail shall notBank/Central KYC Registry/
make the Bank lHable for
any loss or damage whatsoever in nature.
5. I hereby certily thatI have declared my status as per the rules applicable under section 285BA of the Income Tax Act, 1961 as notified by Central Board of Direct Taxes (CBDT) vide
Notification No. S.O. 2155(E) dated 7 August 20OL5 and RBI Circular Ref No. DBRAMLBC.No.36/ 14.01.001/2015-16 dated
modification/amendment thereof.
28 August 2015 in the matter including any subsequent
understand, acknowiedge and authorize that as per the provisions of Income Tax Act, Rules made thereunder and the
6. I
residential status and/or other criteria stipulated therein, the Bank may have to
the
guidelines issued by the Government/RBI in the matter depending upon
report the details in respect of my account(s) as per the prescribed format to the Central Board of Direct Taxes
(CBDTor other Government Agencies to comply with the obligations as per the Inter- Governmental Agreements (1GA) in respect of Foreign Accounts Tax Compliance Act (FATCA)
and Common Reporting Standards (CRS) and / or any other similar
arrangements.
7. Icertify && declare that the intormation provided me for opening account and
by other services herein or
avaíling through website/electronically applicable
as to me
by me as well as in the documentary evidence provided by me for opening account and availing other services are, to the best of my knowledge and belief, true, correct and complete and signed/authenticated
that I have not withheld any matenal information that may affect the assessment/categorization of my account as a U.S. Reportable Account or Other Reportable Account or otherwise. In case any of
the information or details provided by me is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.
9. I also agree that my faiure to disclose any material fact/information known to me now or in future or my failure to remedy any deficiency in documents/iníormation/other details within the
stipulated period, may invalidate me from transacting in the account and the Bank would be within its right to put restrictions in the operations of my account or to close it or to report to any regulator
and/or any authority designated by the Government of India(Gol}/RBI for the said purpose or take any other action as may be deemed appropriate by the Bank under the guidelines issued by CBDT/
RB/Gol from time to time.
10. I also agree to furnish and intimate to the Bank any other particulars that are called upon me to provide on account of any change in law either in India or abroad in the above matter or otherwise
12 I undertake to submit data/infonmation together with fresh KYC documents for updation of KYC details at periodical intervals as may be required by the Bank
13. I understand that the account will be activated and debits will be allowed only after completion of Customer Due Diligence relating to KYC by the Bank
6. Thve eceved the Welcome Kit containing INB Kir and ATM card/cheque book and understand that in case ofany misuse/misplacement of he coatents of the Kit, the Bank willnot be liable
for any loss/damage.
7 berecby ceríy that the Savings Bank Account would be used by me to route transactions of only non-business/non-commercial naturein the event of occurence of such transactions
ay uch cranactions that may be construed comnercialbusincs/dubious or undesiable, the Bank eserves the right to unlateraly freez operations in such accounts and ior close the
or as
ascount
8 have been advised ofAvernge Monchly Balance{(AMB) requírement for the account to be opened and given to understand that these requirements are subject to revision/changes and such revision
changcs wll be uploaded in the Rank's site whích will be acceptable to me as a notice to that effect.
9. Jcontim that the product features of BSBD account have been explained to me(applicable to BSBD account applicant)
2. T have been advied that f i do not provide my mobile number, I will not be eligible for any facility of electronic transactions ocher than ATM cash withdrawals
23. In ol any overdrar is created by wong credits/n shall make good che
cae
Teller/A TMs, we same with interest as applicable.
%. 1beeby decare that the details furnished above are true and comect to the best of my knowledge and belicf and I undertake to inforum you of any changes therein, immediately in cas any of the above
indormation is forund to be false or untrue or minleading ormisiepresenting I am aware that I may be held liable for it.
25 iWe cozfim that the product leatures of account have been explained to me
Account No.
Name:
Addition of Related Person LDeletion of Related Person
(If KYC Number and name are provided, below details are optional)
PROOF OF IDENTITY(POI) OF RELATED PERSON"
A-PASSPORT
C-DRIVING LICENCE
D-UID(AADHAR)
E-NREGAJOB CARD
F-LETTER ISSUED BY NATIONAL POPULATION REGISTER CONTAINING DETAILS OF NAME & ADDRESS
G-OTHERS (Any Document notified by the Central Governmen/RBI)
Document No/ldentification Number*
FATCA DeclarationForm
Address
City/Village District
State Pin:
of Tax Residence in India, and/or in USA@ And or In any other Country or Territory Outside India as Under:
Multipie Tax Residency: Details of Country
ldentification type (TIN or Other, please specify)
|Country of Tax Residence# Tax ldentification number orequivalentif issued by jurisdiction
District
CityVillage State:
Sub-District:
ZIP/Post Code
Country Name
Place
Signature/thumbimpression ofthe Applicant/Applicants
Date
(6)
ACKNOWEDGEMENT DA-1
nomination made by you in favour of: Date:
We acknowiedge receipt ot
Name of the Nominee. *************** . 8. ICArs... Yours faithfully
Number..
With respect to your ACcount ******************************* *****
Minors Accounts
Minors who can adhere to unitorm signature and are not less than ten years old can open accounts in their single name .
Minors may open joint accounts with their guardians.
How To Open An Account?
In ordinary coursc, applicant(s)should attend the Bank personally for completion of formalities for opening the account. They will duly fill in and sign the prescribed application form Applicant(s)
should submit KTC documents, declaration as applicable for RBI/CBDT and two copies of his/her/ their recently taken passport size photographs
Account holders signatures must legible and well formed. Signatures should not be in capital or block letters. Each account will be given a distinctive account number. While dealing with
the Bank.this number shoud be invariably quoted by the account holder(s). The account holders, in their self-interest, are expected to adhere to uniform signature as per specimen recordled with
the Bank while operating the accounts and addressing any correspondence to the Bank
Pass Book
The pass book änd cheque book supplied to the account holder should be kept in a safe place. The Bank will not be responsible for any loss or incorrect payment attributable to the account holders
neglect in this regard. For withdraving cash by means of a withdrawal form, the pass book must be presented. Withdrawals using cheque forms and Debit card can be etfected
without pass book. Deposits may be made without production of the pass book. Pass book should be got updated regularly. The pass book will be returmed to the account holder
immediately after completion of the transactíon duly updated. In case it is not collected within a weeks time, it will be returned to them by Registered AD. post/ Courier at their cost.
The account holders should carefullyexamine the entries in their pass books and draw the Banks attention to errors or omissions, if any.
Duplicate in lieu of the lost or mutilated pass book may be issued on receipt of a written request from the account holder after necessary enquiries, completion of formalities and recovery or
prescribed charges. The current charges prescribed for thís are available at the Banks website and Contact Centre. This information can also be obtained from Branches.
Cheque Book
The Bank will issue the first cheque book after completion of all formalities with regard to opening of the account. Bank shall issue Cheque Book subject to recovery ot charges as applicabie
The current charges prescribed for this are available at the Banks website and Contact Centre. This information can also be obtained from Branches
The account holders must use only the cheques from the cheque books issued to them by the Bank The Bank reserves the right to refuse payment of any cheques
drawn otherwise. Ordinarily, Bank will not issue more than one cheque book at a time or before exhausting all or nearly all cheque leaves issued previously. Cheques must be written
legibly. Stop payment instructions in respect of cheques issued or lost can be registered with the Bank on payment of a prescribed service charge. The current charges prescribed for
this are available at the Banks website. This information can also be obtained from Branches
General
Savings Bank account is essentially a facility to build up savings and hence must not be used as a Curent Account. Bank may close an account should it have any reason to Bbelieve that the account
holder has used her/his account for a purpose for which it is not allowed.
Deposits
No restrictions on cash deposit at Non Home branch. Cheques,
drafts or other instruments drawn only in favour of the account holder will be accepted for credit of the account. Third party instruments endorsed in favour of the account holder will NOT be
accepted No drawings against accepted instruments will be normally permitted until these are realized In satisfactorily conductedaccounts,immediate credit will be afforded for outstacion /
local instruments upto the value laid down from time to time. The nomal collection and out of pocket changes will berecovered.The current limit and charges prescribed for this
are avaílable at the Ranks website and Contact Centre. This information can also be obtained from Branches. Overdue interest will be recovered for instruments subsequently retumed
unpaid.
Withdrawals
The account holder can withdraw money personally from her/his ordinary Savings Bank Account by using Banks standard withdrawal form. The pass book must accompany the withdrawal form.
The withdrawal form can be used only for receiving payments by the accountholder him self/ herseli. ATM cum Debit card can also be used in ATMs for casbh withdrawal
All withdrawals must be in round Rupes only. Third party payments through withdrawal forms are permitted upto Rs.100/- only. A letter of authorty as per the
precribed format, along with the pass book should be sent to the Bank through an authorized representative to receive payment in case the account holder is unable to attend personally to withdraw
cash from her/his account.
Charges prescribed for exceeding this limit are available at the Banks website and Contact C
This inaformation can also be obtained from Branches. Cash withdrawal can be made from the accounts of the sick. old or incapacitated account holders who are unable to attend the
Bank and/or also not able to put cheir signature or thumb impression for withdrawing cash by conmpleting the laid down formalities
Overdrafts
Overdirafts in Savings Bank accounts may be permitted under exceptional cireumstanceswith prior armangements only. Chequesdrawn in excess of the balance in the account will be returned
unpasd. Service charge will be recovered cach time a cheque is returned unpaid for want of suffcient funds Charges prescribed for this are available at the Bauks webasite and
Contact Centre This information can also be obtained from Branches.
Inoperative Accounts
Account bolders ae advised to operate their accounts regularly. Accounts not operated are clasified as Inoperative after the stipulated time period of 24 months since last operation The currenr
pirescnbed charges in this regard are available at the Banks website and Contact Centre. This information can also be obtained from Branches.
Standing Instrucions
The accouat holder can request the Bank for efecting periodical payment of insurance premium, membership fees, etc. by debit to her/ his account on payment of service changes The current
prescribed chages for Seanding lnstruction are available at the Banks website. This information can also be obrained from Branches.
Payment of Interest
As per REl gudeliacs applicable from time to time. Interest will be calculated on a daily product basia. Interest will be credited to the account at quarterly intervals. Interest will be paid only it t
works out to Re V-or mone. There ater fsfcy paise and more will be rounded off to the next higher rupee and anyhing less will be ignoned. In case of accounts frozen by the enforvement authorities
Bank shall continue to cedit the inerest to the account on a regular basis.
Transfer & Closure Of Account
Accounts may be transiened between branches of the Bank at the request of the account holder(). Request for closure of account should state the reason for closure. The pass book must accompany
such request Joint accounts can be cloed only at the request of all such jointsignatories Service charge at prescribed rate will be recovered if an account is closed after 14 days upto one year of its
opening The curent charges prescrbed for this are available at the Bank's website. This information can also be obtained from Branches
Change in Rules
The Bank reserves the right to alter, delete or add to any of these Rules and service charges for which the customer will be duly notitied through Bank's website and /or branch notice
board
Fearures ofBSBD account. The deponit of cash at bank branch as well as ATMs/CDMs, Issue of Cheque Boks
Receipt/ credit of noney through any electronic channel or by means of deposit / collection of cheques drawn by Central/ State Government agencies and departments.
No limit on number and value of deposits that can be made in month. v. Maximum 4 withdrawals including ATM withdrawals v.ATM Card orATM-cum-Debit Card
(7)