Axis Saving Ac Opening Form

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SA   VINGS  VING S BANK A CCOUNT CCOUNT

OPENING FORM FOR  RESIDENT INDIVIDU INDIVIDU ALS Date :

D D

M M

Y

Y

Y

Form Type   R

Y

S

B

A A  

 A/c No. :

For Office Use :   A/ A/c. to be opened at _________________________________________ Br Branch Code

Ledger No.

A/c. Label

DETAILS  A) PERSONAL DETAILS

Scheme Code

A/c. Report Code

SE Code

A/c. Manager

Please open my/our Savings Bank Account. Please fill the form in BLOCK LETTERS only. Fields marked

i

 APPL ICAN T TITLE

FULL NAME

Please leave one space between words

e. g. R

A

J

E

N

D

R

A

i (star)

R A

are MANDATORY.

J

K

A

D

A

M

PRIMARY JOINT DATE OF BIRTH #

GE ND E R

MA R R I ED

M I NO R * *

(Please  )

PAN NUMBER***

P RI M AR AR Y

D D

M M

Y

Y Y

Y

M

F

Y

N

Y

N

or

FORM 60 / 61 attached

JOINT

D

M M

Y

Y Y

Y

M

F

Y

N

Y

N

or

FORM 60 / 61 attached

D

# If Senior Citizen, provide proof of Date of Birth

**If Minor, please fill-up minor declaration section below *** If PAN No. is not available, please attach form 60 or 61 O

 Ex  Existing Customer If Yes, Cust. ID

S al a ri e d

C

S elf Employed

C U

Business

R et ir e d

S t ud e n t

Ho u s e w i f e

Others (Please Specify)

P

PRIMARY

Y

N

JOINT

Y

N

 A   T  I O N

B) DEBIT CARD DETAILS

i

Ca rd rd Re Re q qu u irir ed ed

Na me me a ass de de si si rre e d o n De b bii t Ca rd rd

PRIMARY

Y

N

 VISA

MAS TER

GOLD

JOINT

Y

N

 VISA

MAS TER

GOLD

Mother’s Maiden Name

Debit Card Nominee’s Name

PRIMARY JOINT Nominee’s Relationship with the card holder

If Minor, Date of Birth

Name of Guardian

PRIMARY

D

D

M M

Y

Y Y

Y

JOINT

D

D

M M

Y

Y Y

Y

C) MINOR DECLARATION Fa the r

Type of Guardian:

 Mr  Mr.

Full Name Name   of Guardian

Mother

Court Appointed

Ms.

I hereby hereby dec declar lare e that that the date date of birth birth of the min minor or who is my is / / and I am his / her nat natura urall and lawful lawful gua guardi rdian an / gua guardia rdian n appoin appointed ted by cou court rt order order,, d date ated d / / (copy (copy enclos enclosed) ed).. I sha shall ll rep repres resent ent the sai said d m mino inorr iin n a all ll future future tra transa nsacti ctions ons of any des descri cripti ption on in the abo above ve acco account unt unt until il the sai said d minor attains majority. I indemnify the Bank against the claim of the above minor for any withdrawal / transactions made by me in his / her account. Date:

D

D

M M

Y

Y

Y

Y

 Sign ature of Guard ian

D) ADDRESS DETAILS

[   [ Communication  Address i

CITY STATE

Permanent Address

i

COUNTRY

Same as communication address

Please provide complete address for faster courier deliveries.

PIN CODE

Please note the address as below

CI T Y

STATE C O UN T R Y

STD Code

PI N CO D E

Tel. No. (Office)

Ext. No.

Tel. No. (Residence)

Fax No.

PRIMARY JOINT Mobile Number

E-mail Address (e.g. [email protected])

Preferred Language for Communication *

PRIMARY JOINT *Other than English

E) MODE OF OPERATION

i

S elf

Either or survivor

Former or survivor

Jointly by all

Minor A/c. operated by Guardian

Others

F) INITIAL DEPOSIT DETAILS

Encash24 Required

 

Payment by 

Cash

Cheque No.

Date:

D

D

M M

Y

N Y

If yes, attach separate encash24 declaration form Y Y

Y

Drawn on

Debit my / our existing account. Account No.

G) CHANNEL FACILITIES Mobile Banking Service

Y

The mobile banking service will activated onservice the Primary number provided above. This is be a chargeable beyondApplicant’s a free trialmobile period.

E-statement

Y

Bank Deposit amount Rs.

N

In case you select E-statement option, physical statement shall be disabled.

Branch Ps.

Please refer Terms and Conditions for charges, wherever applicable.

i

N

Anyone or survivor

iConnect Required

 

Inquiry only

Cheque Book Required

Y

N If Yes, Please  below

YN

Inquiry and Fund Transfer Y

N

Signature of Applicant 

This form is processed through automated system. Please ensure that all mandatory fields have been filled correctly else the form is liable to be rejected.

 

(KYC) DETAILS H) KNOW YOUR CUSTOMER (KYC)   Provide KYC document (Attach photocopies of the following documents and produce the original copies of these documents for verification.)

Document for proof of Identity

Document Identification No.

Issuing Authority

Place of issue

Document for proof of Address

Document Identification No.

Issuing Authority

Place of issue

PRIMARY JOINT

PRIMARY JOINT For Salary Accounts - Employee Code

Reference Details

(Any one of the following)

Letter from Employer verifying identity and permanent address OR 

Referrer’s cust id

Introduction by a designated Company Official and KYC documents as above

Relationship Referrer’s Signature

Signature with Company Seal

I) PRIMARY HOLDER’S PERSONAL INFORMATION Educat ion

Non M Ma atric

If salaried, employed with

Undergraduate

Grad./ Post Grad. Gen. (B. Sc., M. Com., etc.) Govt. Sector

Grad/Post-Grad. P Prrofessional ((B BE,MBA ,MBBS et etc)

Public Ltd. Co.

Pvt. Ltd. Co.

Mult in at ion al

I ns t it u t i o n

Name of Company Grade

C le r k

O f fi c er

Junior Mgmt.

Middle Mgmt.

Senior Mgmt.

If Self-Employed Profession

CA

Engg.

D oct or

P r o p r i et o r s h i p

Part ners hip

Monthly Household Income (Rs.)

Upto 5,000

5,001-10,000

20,001-50,000

50,001-1,00,000

>1,00,000

J) NOMINATION DETAILS (FORM DA1) Nomination under Section 45 ZA of the Banking Regulation Act, 1949 and Rule 2(1) of the Banking Companies (Nomination) Rules 1985 in respect of bank deposits. I / We ( name)

( Address)  Address) 

nominate the following person to whom in the event of my / our / minor’s death the amount of deposit in the above account, may be returned by AXIS BANK Ltd.

NOMINEE (Only one individual nominee permitted) Na me

Address : Same as primary applicant :

If different from primary applicant Relationship with depositor, if any

Age

Years If nominee is a minor, his / her date of b biirth :

* As the nominee is a minor on this date, I / We appoint ( name)  Address : Same as primary applicant :

D

D

M M

Y Y

Y

Y

Relationship with the minor*

If diffferent ferent from from p prim rimary ary a appli ppliccant ant

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 nominee. Signature of witness

** Signature of primary depositor

Name

Name

 Address

Address

Date:

Signature of Joint holder(s)  holder(s) 

Place

*Strik *Strike e out if nominee nominee is not not a minor minor

** Where deposit deposit is made in the the name of a minor minor,, the nominatio nomination n should be be signed by a person person lawfully lawfully entitle entitled d to act on behalf behalf of the minor minor.. DECLARATION

Primary Applicant 

Please paste Passport Size colour Photograph here

I/We have read and understood the Terms and Conditions (a c opy of which I am in possession of) governing the opening of an account with AXIS BANK and those relating to various services including but not limited to ATMs / Debit Card / Mobile B anking / Phone Banking / Ne t Banking / Bill Pay Facility. I/We accept and agree to be bound by the said Terms and Conditions including those excluding/limiting the Bank’s liability. I/We understand that the Bank may, at its absolute discretion, discontinue any of  the services completely or partially without any notice to me/us. I agree that the Bank may debit my account for service charges as applicable from time to time. I/We am/are residents of India. Apart from this, the current Schedule of Charges has been received by me and I agree with the same. I agree to maintain AQB of Rs ________________________________ in my account.

Signature of Primary Applicant

Signature of  Primary Applicant 

Joint Applicant  Please paste Passport Size colour Photograph here

Signature of Bank Official in whose presence signed

Signature of  Joint Applicant 

Signature of Joint Applicant

Date :

D D

M M

Y

Y

Y Y

EMP. No.

  y   y    b   b   y    b    d   d   e    d   v   e   e   n   i    i   e   n   f   c   a   i   r   e   c   e    R    S    V

DECLARATION BY THE BRANCH I hereby certify that this account opening form is complete in all respects and relevant documents have been obtained. The Account may please be set up in Finacle. Enclosure Details (This information must be filled-up by the branch before sending AOF for automatic processing)

Num Number ber of Add-on forms forms encl enclosed osed : Camp. Code

0

For AXIS BANK Limited

Num Number ber of Pag Pages es of KYC docum document entss enclosed osed : Camp. Reference Number

Special Instructions for CPU  Affix Special Scheme Sticker < <  S   B   R   E    S    J    A   N 2   0   0   9   3   .2  > >

Branch Head / Authorised Signatory  S. S. Number : ___________________________

  y    l   n   o   e   s    U    B    U   n    H   o   n   o   n    /   o   s    U    d   d   e   e    d   k    P   v   n   i   e   r    C    i   a   e   n   f    i   r   c   a   r   m   e   c   e   e   o    F    R    S    V   R

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