1 KARASSERY SERVICE CO-OPERATIVE BANK LTD. ISO 9001:2008 Certified H.O. Mukkam, Kozhikode - 673 602 Phone : 0495 - 2293700 (30 Lines). Fax: 0495 - 2294445. E-mail:[email protected] wwww.karasserybank.com BRANCHES : KARASSERY. PH : 0495 2298568 NELLIKKAPARAMBA PH : 0495 2209999 MARANCHATTY PH : 0495 2277377 SUBCENTRES : THAMARASSERY PH : 0495 2222222 RAMANATTUKARA PH : 0495 2442888 ACCOUNT OPENING FORM FOR KARASSERY BANK PENSION FUND (Please fill the form in BLOCK LETTERS only) Office Use only Customer ID A/c Type No. Date To The Manager, .....................................Branch. 2 Dear Sir, I / We wish to open Karassery Bank Pension fund in my/our name. I / We agree to abide by the rules and regulations which have been read/explained to me/us. I/We hereby tender Rs. ............................................. (Rupees ..................................................................................................only) for the same. I. APPLICANT’S DETAILS Applicant No. 1 Name in full : ...............................................................................Sex: M/F.................... S/o., D/o., W/o, H/O. ................................................. Age............ DOB............................. House Name : ............................................................................................................. Place.............................................................Post.......................................................... PHOTO Dist................................................ State..................................Pincode........................ Address for Communication : ..................................................................................... Place.............................................................................Post.................................................................... Tel (R) ................................... (O) ..................................Mob............................................. E-mail ID ........................................................................................................................ PAN/GIR.No.......................................... (If not available attach Form 60/61) Membership No ................................. Category : General/Staff/Sr. Citizen/Minor. Religion: Hindu/Muslim/Christian/Others.......................................... Caste: SC/ST/OBC/General/Others ....................................................................................................................... Occupation : Salaried/Business/Doctor/Engineer/Lawyer/Retired/Student/Farmer/Others.......................................... Marital Status : Single/Married Number of Children: ...................................................................................... Name & Address of Spouse : ............................................................................................................................ S/o., D/o., W/o, H/O. ...................................................................................................................... Age............ House Name : .................................................................................... Post ........................................................ Occupation of Spouse:...................................................................................................................................... Applicant No. 2 Name in full : ...........................................................................Sex: M/F........................ S/o., D/o., W/o, H/o. .................................................... Age............ DOB............................. Address : ..........................................Place.......................................Post......................... PHOTO .......................... Dist...................................State...............................Pincode..................... Address for Communication : ..................................................................................... Place.............................................................................Post.................................................................... Tel (R) .................................. (O) ..................................Mob............................................. E-mail ID .......................................................................................................................................................... PAN/GIR.No.......................................... (If not available attach Form 60/61) Membership No ...................................... Category : General/Staff/Sr. Citizen/Minor. Religion: Hindu/Muslim/Christian/Others............................................ Caste: SC/ST/OBC/General/Others ......................................................................................................................... Occupation : Salaried/Business/Doctor/Engineer/Lawyer/Retired/Student/Farmer/Others............................................. Marital Status : Single/Married Number of Children: .................................................. 3 Name & Address of Spouse : ............................................................................................................................ S/o., D/o., W/o, H/O. ...................................................................................................................... Age............ House Name : .................................................................................... Post ........................................................ Occupation of Spouse:...................................................................................................................................... II. ACCOUNT OPERATION INSTRUCTIONS : Single/ Either or Survivor/ Former or Survivor/ Any one of us or any of the survivor of the last survivor/ Jointly/ Jointly all of us or Jointly the survivors or the last survivor. III. DETAILS OF PENSION FUND Pension Fund Date of Period Pension Fund Pension Fund Monthly Amount Choosing Maturity Date Maturity Value the scheme IV. NOMINATION : I/We nominate the following person to whom in the event of my/our/minors death, is entitled to receive the amount in the account. Name ............................................................. Address............................................................................ ............................................................... Relationship with the applicant (if any) ....................................... (if nominee is a minor) age........................ Date of Birth ............................................................................ as the nominee is a minor on this date, I/we appoint Mr./Ms. ......................................................................... Age.......................... Address................................................................................... to receive the amount the account on behalf of the nominee in the event of my/our/minors death during minority of the nominee. Signature of the Applicant V I/We authorise the Bank to debit my/our account No......................... with Rs. .......................................... and credit the pension fund account on monthly due dates. VI I/we hereby agree to transfer the maturity proceeds of the fund to a Fixed Deposit for ....................... years, for receiving the monthly interest as pension. DECLARATION I/We hereby declare that the particulars given above are true and correct. I/We have read and understood the Terms and Conditions and agree to the Terms and Conditions governing the opening of Pension Scheme with Karassery Service Co-operative Bank Ltd. No. D-2628. I/We am/are bound by the said Terms and Conditions. (1) ................................................................................ (2) ............................................................................................. Name & Signature Name & Signature (Ist applicant) (2nd applicant) Specimen Signature Specimen Signature 4 Imc-t»cn _m¶v s]≥j≥ ^≠v (KBPF) \n_-‘-\-Iƒ 1. GsXmcp C¥y≥ ]uc\pw Cu ^≠n¬ AwK-ambn tNcm-hp-∂-Xm-Wv. c£n-Xm-°-fpsS Hmt∏m-Sp-IqSn ssa\-¿am-cpsS t]cnepw ^≠v XpS-ßm-hp-∂-Xm-Wv. 2. ^≠ns‚ Imem-h[n Npcp-ßn-bXv 120 amkhpw ]c-am-h[n 240 amk-hp-am--bn-cn-°pw. Cu Ime-b-f-hn-\p- ≈n¬ 12 amkØns‚ KpWn-X-ß-fmbn GXp Imem--h-[n°p thW-sa-¶nepw ^≠v Xp-S-ßm-hp-∂-Xm-Wv. 3. amk XhW Ipd-™Xv 1000 cq]bpw AXns‚ KpWn-X-ß-fp-ambncn°pw. 4. ^≠v XpSßn hogvN hcp-Ønb AwK--Øn\v _m°n \n¬°p∂ XpI°v tkhnwKvkv _m¶v ]eni \nc- °n¬ ]eni sImSp-°p-∂-Xm-Wv. 5. hogvN hcp-Ønb AwK-Øn\v s]≥j≥ ^≠v Bcw-`n®v BZysØ 5 h¿j-Øn\p tijw Ft∏mƒ thW-sa-¶nepw ^≠v t¢mkv sNøm-hp-∂-Xm-Wv. 6. ^≠v XpS-ßp∂ ka-bØv Hcp Ah-Im-in-sb \n¿_-‘-ambn´pw tN¿Øn-cn-t°-≠-Xm-Wv. Ah-Im-insb am‰p-∂-Xn\v AwK-Øn\v Ft∏mƒ thW-sa-¶nepw _m¶ns\ kao-]n-°m-hp-∂-Xm-Wv. 7. s]≥j≥ ^≠nte-°p≈ XpI amkw-tXmdpw IrXy ka-bØv AS-®n-cn-t°-≠Xpw ]ng-∏-eni Hgn-hm- °p-∂-Xn¬ {]tXyIw {i≤n-t°-≠-Xp-am-Wv. h¿jw XhW Imem-h[n XpI amk-Ønse s]≥j≥ 10 1000 x 120 month 205569.00 1713.00 11 1000 x 132 month 239574.00 1996.00 12 1000 x 144 month 277109.00 2309.00 13 1000 x 156 month 318541.00 2655.00 14 1000 x 168 month 364275.00 3036.00 15 1000 x 180 month 414756.00 3456.00 16 1000 x 192 month 470477.00 3921.00 17 1000 x 204 month 531983.00 4433.00 18 1000 x 216 month 599875.00 4999.00 19 1000 x 228 month 674814.00 5623.00 20 1000 x 240 month 757533.00 6313.00 GsX-¶nepw Imcy-Øn¬ X¿°w D≠m-hp-Itbm As√-¶n¬ hni-Zo-I-cWw Bh-iy-ambn hcn-Itbm