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Address Type* Residential Business Registered Office DMS Ref No Account No. Branch SOL ID (For Office use only) Scheme Code US Reportable Other Reportable (Refer Appendix1) CURRENT ACCOUNT OPENING FORM FOR LEGAL ENTITY/RESIDENT INDIVIDUAL SAVING ACCOUNT/TERM DEPOSIT ACCOUNT OPENING FORM FOR ELIGIBLE LEGAL ENTITY General Instructions: 1. Fields marked with "*" are mandatory 2. Tick where ever applicable 3. Please fill the form in BLOCK letters I/W e request you to open a Saving, Current , Term Deposit account Date _____________________ CKYC Registered Yes No If Yes CKYC No. 1. ENTITY / INDIVIDUAL DETAILS Name* Registration No./CIN/Trade License No./ Any other identification No. Date of Incorporation* / Registration/ Date of Birth D D M M Y E A R Date of Commencement of Business* D D M M Y E A R Place of Incorporation* Country of Incorporation* Country of Residence as per Tax laws* IE Code ( If applicable) Tax Identification Number (TIN) TIN Issuing Country PAN Form 60 (Please fill Form 60) GSTIN Nature of Business - Brief about activity :___________________________________________________________________________________________________________ Number of controlling person(s) resident outside India for tax purposes (Please provide details of each Controlling Person resident outside India for Tax purposes separately in ‘Annexure-3’) 2. CONSTITUTION OF APPLICANT Individual Proprietorship Partnership HUF Pvt Ltd Public Ltd Society AOP/BOI Trust Liquidator LLP Artificial Juridical Person Others Not categorized________________________. In case of Ltd Co, Whether listed in stock exchange Yes No If Registered under FCRA, FCRA registration no. Valid upto D D M M Y E A R 3. PROOF OF IDENTITY (PoI)* (Certified copy of any one of the following Proof of Identity[PoI] needs to be submitted) Certificate of Incorporation / Formation Registration Certificate Resolution of Board / Managing Committee Memorandum and Article of Association / Partnership Deed / Trust Deed Identification information in respect of person authorised to transact Others, please specify______________________________________________ 4. PROOF OF ADDRESS (PoA)* (Certified copy of any one of the following Proof of Address [PoA] needs to be submitted) 4.1. CURRENT / PERMANENT / OVERSEAS ADDRESS DETAILS Address Type* Residential Business Registered Office Unspecified Proof of Address* Certificate of Incorporation / Formation Registration Certificate Others_______________________________________________________ Line 1* Line 2 Line 3 City / Town / Village* State / U.T Pin / Post Code* Country* Tel. (Off) Tel. (Res) Mobile FAX Email ID 4.2 CORRESPONDENCE / LOCAL ADDRESS DETAILS* (To be given only if different from the above) Address Type* Residential Business Registered Office Unspecified Proof of Address* Certificate of Incorporation / Formation Registration Certificate Others_______________________________________________________ Line 1* Line 2 Line 3 City / Town / Village* State / U.T Pin / Post Code* Country* Tel. (Off) Tel. (Res) Mobile FAX Email ID 4.3 ADDRESS IN THE JURISDICTION WHERE ENTITY IS RESIDENT OUTSIDE INDIA FOR TAX PURPOSES* / 2nd CORRESPONDENCE / LOCAL ADDRESS DETAILS Address Type* Residential Business Registered Office Unspecified Proof of Address* Certificate of Incorporation / Formation Registration Certificate Others_______________________________________________________ Line 1* Line 2 Line 3 City / Town / Village* State / U.T Pin / Post Code* Country* Tel. (Off) Tel. (Res) Mobile FAX Email ID 5. RELATED PERSON/ BENEFICIAL OWNER DETAIL (Please fill separate KYC page and FATCA / CRS declaration form for each Individual /Related Person) Related Person Type Director Promotor Karta Trustee Partner Proprietor Authorised Signatory Court Appointed Official Beneficiary Other __________________________ Whether Sr. Name Customer ID (for existing customer) CKYC Number (if any existing) beneficial owner 1 2 3 PAGE 1 6. PAYMENT DETAILS FOR OPENING ACCOUNT Amount(Rs)_________________________ Cash Debit SB/CA/OD A/c Number Cheque No. _______________________,Date _________________, Drawn on _____________________, Bank______________________, Branch______________________ 7. ESTIMATED TOTAL INCOME AND NET WORTH Estimated Annual Income (In Rs.) Upto 1 lac 1 to 5 lacs 5 to 10 lacs 10 to 25 lacs Above 25 lacs Net worth (In Rs.) Upto 10 lacs Above 10 lacs to 1 Crore Above 1 crore to 5 crore Above 5 crore 8. EXPECTED TURNOVER IN ACCOUNT AND THRESHOLD TRANSACTION LIMITS (PLEASE SPECIFY) Expected Level of Turnover in Account per month : ________________________________________ Expected Threshold Value Transactions Cash Clearing Transfer Debit (Rs.) Credit (Rs.) 9. FACILITIES REQUIRED* ATM cum Debit Card (Only for Individual/proprietor) Yes No Name to be printed on card • Cheque book Yes No | Internet banking Yes No Mobile Banking Yes No • E-statement to be sent to my /our email-id • Mobile Number to be registered * * Mobile registration will link to SMS alert facility • In case of no mobile no., specify reason Don’t have mobile Others_________________________________________________________ 10. NOMINATION REQUIRED (Applicable for individual and proprietor accounts) Yes No If yes: Please complete nomination details 11. MANDATE FOR ACCOUNT OPERATION Self Proprietor Any one partner / Trustee / Director By Karta (HUF) Jointly by all Any two jointly As per resolution As per Letter of Authority Others (specify) 12. DECLARATION & UNDERTAKING a. I/We confirm having received, read and understood the Most Important Terms and Conditions and hereby agree to be governed by them for the accounts which I/we am/ are opening with Dena bank along with the amendments from time to time on various services. b. I/We accept and agree to be bound by the said terms and conditions stated above including those which are limiting the Banks liability . c. I/We understand that the Banks at its sole discretion amend or discontinue any services completely or partially without any notice to me/us. d. I/We agree that the Bank may debit my account for service charges as applicable from time to time. e. I/We also declare that the authorisations and declarations given by me/us to the Bank herein are out of my/our free will with full knowledge and awareness. f. I/We hereby declare that the information furnished above and also in the personal information form is true and correct to my best of my/our knowledge. g. I/We authorise the Bank/their representatives to verify the details given in these forms for due diligence. I. SMS alerts will be on chargable basis. j. I/We confirm that I/we do not have any existing customer ID / customer ID apart from the one mentioned. In case found otherwise, Bank reserves right to consolidate the customer IDs as it may decide, without prior notice to me/us. k. I/We hereby give consent for accessing my/our credit report from CIBIL or other agencies based on information provided by me/us. l. My/Our personal KYC details may be shared with Central KYC Registry. I/We hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email address. m. I/We would like to avail of Instant Credit Facility up to Rs. 20,000 in my/our account. In the event of return of cheque/s, I/We undertake to immediately provide the funds against the dishonored cheque/s along with the applicable interest for the respective period. n. I/We Declare that I/We do not have credit facilities / current account/s with other bank/s or other branches of your Bank. I/We undertake to inform you in writing as soon as any credit facility is availed of by me/us from any other Bank / Branch of your Bank. I/We have credit facilities / Current accounts with other bank/s or other branches of your bank. (Please attach details of such facilities separately) Name of bank & branch Account No. Nature of Facility Amount SIGNATURE ( USE BLACK INK ONLY) F I R S T F S E C O N D F T H I R D N A M E N A M E N A M E Paste (never staple) Paste (never staple) Paste (never staple) passport size photo and passport size photo and passport size photo and sign across it and also in sign across it and also in sign across it and also in the box provided below. the box provided below. the box provided below. Branch Round stamp to Branch Round stamp to Branch Round stamp to be affixed on the corner be affixed on the corner be affixed on the corner of pasted photo of pasted photo of pasted photo Signature Signature Signature FOR BANK USE I hereby confirm that, The account opening form is properly filled and I have completed due diligence as prescribed by bank & complied with all KYC/ AML requirement. The information furnished by the applicant/s has been properly entered in the system by us and applicant/s has / have signed in my / our presence and KYC Verification has been done by us as per Bank guidelines. FATCA declaration has been obtained for individual / entity as per circular. The CRILC and CIBIL iScan verification has been done and NOC from existing banker has been obtained in applicable cases. The business unit has been visited by our officer Mr./ Ms._______________________________ and the report is found satisfactory. Account Risk Rating High Medium Low Signature of Bank Official Date : ___________________ P.A. No. ________________ HRMS ID ________________ PAGE 2 TO BE SUBMITTED FOR EACH INDIVIDUAL/RELATED PERSON KNOW YOUR CUSTOMER (KYC) | INDIVIDUAL / RELATED PERSON For office use only Application Type* New Update CKYC Number (Mandatory for KYC update request) 1. DETAILS OF INDIVIDUAL/RELATED PERSON* Addition of Related Person Deletion of Related Person Update Related Person details CKYC Number of Related Person (if available*) ( If CKYC number is available, only ‘Related Person Type’ and ‘Name’ is mandatory) Related Person Type* Individual Director (DIN) Promoter Karta Trustee Partner (DPIN) Proprietor Authorised Signatory Court Appointed Official Beneficiary 1.1 PERSONAL DETAILS Prefix First Name Middle Name Last Name Name* (Same as ID proof) Maiden Name (If any*) Father / Spouse Name* Mother Name* Date of Birth* D D M M Y E A R Gender* M- Male F- Female T-Transgender Other Marital Status* Married Unmarried Others Nationality* IN- Indian Others Residential Status* Resident Individual Non Resident Indian Foreign National Person of Indian Origin Customer Type Sr.
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