PUNJAB NATIONAL BANK

ACCOUNT OPENING FORM (All BRANCHES)

The Manager, Branch Office.. Dist. No.

Customer ID No: (Sole/first A/c holder only) Account No. (16 digits)

FOR RESIDENT INDIVIDUALS (SINGLE/ JOINT) ACCOUNTS

(FOR OFFICE USE ONLY)

1. I/we request you to open the following account. I/we agree to be bound by the banks rules in force from time to time. (Tick the relevant box on right side).
(A) Savings Fund Account (To be filled in Block Letters) (B) PNB Prudent Sweep SF (Sweep In and Out Facility Required fordays) (E) Overdraft/Cash Credit $ (C) Current Account $

(D) PNB Smart Roamer Current Account $ (Sweep In and Out Facility Required fordays) (G) Recurring Deposit
Monthly Instalment Rs No. of instalments Interest rate .%

(F) PNB Spectrum FixedDeposit@

(H) Flexi-Recurring Deposit

Monthly Core amount Rs No. of instalments Interest rate .%

(I)

Tax Saver FD@ (Separate declaration annexed)

(J) Flexible Rate Deposit@

(K) OTHERS (specify):

@Amount Rs.Period: Year..Months...Days.. On maturity Annually Half Yearly Quarterly Monthly Interest payment frequency (Pl. tick in the appropriate box)

Interest Rate: ..%

Credit Interest to SF/CA/ CC/OD Account No.________________ Credit maturity proceeds to SF/CA/ CC/OD Account No.__________________

TDS DETAILS

TDS, if applicable: Yes/No If Yes,

If no, exemption reference No.______________________ Whether Form 15 G/H* submitted : YES Renew for Principal only NO

Instruction for Auto Renewal on maturity of deposit (Tick the relevant column)

Renew for Principal & Interest

Period for which Auto renewal required: No. of times

2. Name of sole/first account holder (in block letters) Mr./Ms.

First Name Middle Name Last Name

$ I /We am/are not availing any credit facility with any other Bank(s)/branch(es) of your Bank and I/We undertake to inform you, in writing, as soon as any credit facility is availed by me /us from any other Bank/branch of your Bank. OR I/We am/are availing credit facilities with other bank(s)/branch(es) of your bank, as per details given in the enclosed sheet

* Form 15G for General Category & Form 15 H for Senior Citizens

PNB 1084 A

3. Names of the joint account holders (If applicable) (in block letters) i. Mr./Ms.
First Name Middle Name Last Name

ii. Mr./Ms.
First Name Middle Name Last Name

4. Mode of operation (tick whichever is applicable)

Self Either or Survivor Former or Survivor Any one of us or Survivor(s) Jointly Any Other#

# Specify__________________________

5. Nomination required :

YES

NO

If Yes, please fill form DA-1.

6. ATM/DEBIT CARD: I/we may please be issued ATM Card/ATM cum Debit Card as per following details. I/we have read the terms and conditions governing the use of ATM/DEBIT card.
Name of I Card holder Name of 2nd Card holder Name of 3rd Card holder
st

7. Account numbers of the customer on which ATM-cum-Debit card services are required (in case the customer has more than one account with Bank)
Main Account No. nd 2 Account No. rd 3 Account No. (delete whichever is not applicable) i) I/We_________________________________________________ hereby nominate Mr./Ms. s/d/w/o ____ aged___________years to receive the ___________________________________r/o money payable by the Insurance Company in the event of my/our death. I further declare that his/her receipt shall be sufficient discharge to the bank. (ii) As the nominee is minor on this date, I appoint Mr./Ms.__________________________________________________________________ r/o ____ aged___________years to s/d/w/o receive the money on behalf of nominee during the minority of nominee.

8.Nomination for ATM/DEBIT CARD Holder (ACCIDENTAL INSURANCE):

9. Internet Banking : I/we may please be allowed Internet Banking as per the following details. I/we have read the terms and conditions
governing the use of Internet Banking. i) Name of the account holder (s) authorized for using internet banking services : a.________________________________________________________ b.__________________________________________________ ii) Account numbers on which internet banking services are required (in case the customer has more than one account with Bank) Main Account No. 2nd Account No. 3rd Account No.

10. Request: i) Please issue Pass Book: ii. iii. iv. v. vi. vii. viii.

OR Statement of account:

(at my residence/Office /e-mail address (Any one)) Y Y Y Y Y Y Y N N N N N N N

I wish to avail Met-life insurance facility I wish to avail Medi-claim insurance facility I wish to avail Locker facility I wish to avail on-line Trading facility I wish to avail cheque book facility I wish to avail Credit Card facility

Date:

Customers Signature/ Thumb Impression

: 1. _______________________________________ 2. ___________________________________

Place:... 3. ___________________________________ Cheque Book issued bearing No. From:__________________ to _______________

SIGNATURE OF AUTHORISED OFFICIAL

PUNJAB NATIONAL BANK

Branch Office.. Dist. No..

Photograph: Please paste recent Passport Size photograph.

Photograph: Please paste recent Passport Size photograph.

Customer ID Account No.

SPECIMEN SIGNATURES/THUMB IMPRESSIONS

3. Names of the Account Holder(s) (In block letters)

i. ii. iii. Mr. Mr. Mr. Ms. Ms. Ms.

Signature(s) verified by: Mode of operation

(With GBPA No. & Date)

FOR BRANCH USE ONLY

GBPA/SPA / PF NUMBER

SIGNATURE
1. Information entered in the system by 2. Entered Information Verified by

DATE

ATM-cum-Debit Card no.

Date of issue

Issued by (Signature with GBPA/SPA no.)

Internet issued (Mention User ID)

Date of issue

Issued by (Signature with GBPA/SPA no.)

PUNJAB NATIONAL BANK Branch Office. Dist. No.

FORM DA-1: NOMINATION

Nomination under Section 45 ZA of Banking Regulation Act, 1949 and Rule 2(1) of the Banking Companies (Nomination) Rules 1985 in respect of Bank Deposits, I/ We @ Name(s) ________________________________________________________________________________________________ R/o_____________________________________________________________________________________________________________ Nominate the following person to whom in the event of my/our/ minors death, the amount of deposit in the account may be returned by Punjab National Bank, B.O.______________

DEPOSIT
Nature of Account Account No. Additional Details, if any Name Address

NOMINEE
Relationship with depositor, if any Age If nominee is minor his/her Date of birth

* As the nominee is minor on this date, I/we appoint

Mr/Ms_______________________________________________________

Age________ Address______________________________________________________________________________________ _________________________________________________________________________________________________________ to receive the amount of the deposit on behalf of the nominee in the event of my/our/minors death during the minority of the nominee. Place:_________________________________ Date:__________________________________

@ Signature(s)/thumb impression(s) of depositors

@Where the deposit is made in the name of minor, the nomination is to be signed by natural/legal guardian of the minor to act on behalf of
the minor. *Strike out if nominee is not a minor

WITNESSES#
Name & Signature of the first witnesses Name___________________________ Signature:________________________ Address:_________________________ Place:___________________________ Date:____________________________ Telephone No._____________________ Name & Signature of second witnesses Name___________________________ Signature:________________________ Address:_________________________ Place:___________________________ Date:____________________________ Telephone No._____________________

#Thumb impression(s) shall be attested by two witnesses, otherwise it shall be attested by one witness. .

ACKNOWLEDGEMENT Received on ________________nomination form no. DA 1 for making Nomination from (Name of deposit Holder(s)) ___________________________ in respect of (Type of Account.) _________________ Deposit Account No.________________ ___________________________

Date_____________________.
For Punjab National Bank

(Authorised Official) (GBPA NO )

(ALL BRANCHES)
Photograph: Please paste recent Passport Size photograph.

PUNJAB NATIONAL BANK

Branch Office... Dist. No..

CUSTOMER MASTER FORM (To be filled in separately by every individual)

(To be filled by bank)

1. Customer ID No. (Tick the appropriate boxes, wherever required)

1. Name of Account Holder (In block letters) Mr./Ms.

First Name Middle Name Last Name

2. Father/Husbands Name 3. Gender

Male

Female

4. Place of Birth 6. Nationality 8. Category Pardanashin GENERAL/ OBC / SC / ST Phy.Hand. OTHERS

5. Date of birth (DD/MM/YYYY) 7. Religion HINDU / MUSLIM / SIKH / CHRISTIAN / OTHERS Illiterate Blind 9. Status

10. Identification mark__________________________________________________________________ 11. Address : (a) Present Residence

Address

Owned

Parental

Rental

Employer provided

City (State) Telephone No. (with STD Code) E-mail (b)Permanent Residence Address

PIN Mobile No.

Owned

Parental

Rental

Employer provided

City (State) Office / Business Address City (State) Telephone No. (with STD Code)

PIN

PIN

12. minor:

YES Father

NO

If yes, furnish details of guardian Mother Guardian

a. Relationship with Minor

b. Name of Guardian: Mr./Ms. c. Address of Guardian

13. Whether staff member: 14. Occupation :

SalariedGovt./PSU sector Medical Salariedothers Legal

YES

NO

If yes, PF account no._____________

Retired Govt./PSU sector CA/CS

RetiredOthers BusinessTrading

Student

Housewife

Self employed Other (specify)

Others - Not working

BusinessIndustry/Mfg.

Agriculture

PNB 1084 B

15. Marital status

Married

Single

16. Educational qualification :

Up to SSC Graduate Post Graduate Other (specify)_______________

17. Total annual income (individual) ;

Up to Rs.50000 Rs. 50000 - Rs. 1.5lakh Rs.1.5 lakh - Rs 5 lakh Above Rs.5 lakh

18. Annual turnover (in case occupation is business) __________________________ Nature of business (Commodity type)________________________________________________ Whether documentary proof in support of item no. 17 & 18 provided : If yes, type of Proof : Balance Sheet
Sales Tax Return Excise Return Income-tax Return Other (specify) _______________

YES

NO

19. Whether Income Tax Assessee?

YES

NO

IF Yes, furnish PAN/GIR NUMBER (If PAN/GIR No. is not applicable, submit Form No. 60/61)

PAN/GIR Number
20. Proof of identity :
Passport Driving license PAN Card Voter ID Card Others (specify)_________________ Govt. /Defence ID Card

21. Proof of address :

Electricity Bill Driving Licence Telephone Bill Govt / Defence ID Card Passport Ration Card

Others (Specify)__________________

22. Name of spouse (In block letters)

Mr./Ms.
First Name Middle Name Last Name Telephone No. (with STD Code) E-mail Customer ID No. (if any) PIN CODE Mobile No. Whether employed/self employed

If yes, furnish office/Business address Office/Business Address

Telephone No. (with STD Code)

23. Whether dealing with any other bank, if yes, please give details

NAME OF THE BANK AND BRANCH

Facilities/services being availed SF CA OD TL

OTH

24. Whether already dealing with PNB, if yes, please give details Nature of Account Account No.

Branch Office

25. Loans availed: (tick whichever is applicable, if yes, mention name of financing institution/bank with amount)
Sl.No. Type of Loan CAR LOAN CONSUMER LOAN HOUSING LOAN MORTGAGE LOAN EDUCATION LOAN ANY OTHER YES NO NAME OF INSTITUTION AMOUNT

1. 2. 3. 4. 5. 6. 7. 8. 9.

26. Assets (approximate value) Rs._________________ Details(*) :

Vehicle owned Life policy for Pension policy Medical Insurance Yes Yes Car Upto Rs 1 lac No No Two wheeler Upto Rs 2 lacs Others Upto Rs 5 lacs None Above Rs 5 lacs

If yes, give details______________ If yes, give details______________

Other Assets :_________________________________________________________________________________ 27. Investments (approximate value) Rs._________________ Details(*) (Stocks & Shares/NSCs/PPF, other deposits etc) (tick appropriately)
{

Investments
Amount :

Nationalized Banks Company Deposits Property

up to Rs 1 lac

Pvt. Banks Mutual Funds Gold

Upto Rs. 2 lac

Foreign Shares PPF

up to Rs 5 lac

Others Bank Deposits Others

Above Rs 5 lac

28.

INTRODUCTION: I know Mr./Ms._____________________________for the past _______years _______months as a ____________________ (e.g.) friend , relative, neighbour etc. and confirm his/ her occupation as a ____________________ and confirm address(s) as mentioned herein. a. Introducers Name_____________________________ b. Introducers address: ______________________________________
Signature of the Introducer:___________________________________ Introducers Account No.

Phone ________________________ Introducers Customer ID No.

29(*). Spouses qualification :

Up to SSC Graduate Post Graduate Others (Specify)_______________

30(*).Details about your family members :

Age Group No. of Males Up to 10 yrs + 11 to 20 yrs + 21 to 45 yrs + 46 to 60 yrs + Above 60 yrs = Total

No. of Females

31(*). Any relative settled abroad?

Yes

No Address

If Yes, please mention their names and addresses.

Name 1. 2. 3. How many times have you been abroad in last three years? (*) Optional

Never

1 to 5 times

Above 5 times

32.

DECLARATION :

I have read (a) the Account Rules and hereby agree to be bound by the terms and conditions outlined in these rules which govern the account(s) which I am opening/will open with Punjab National Bank and (b) amendments to the rules made from time to time and those relating to various services availed by me. I understand that the bank may at its absolute discretion discontinue any of the services completely or partially without any notice to me. I have also been made aware of the charges applicable on various services provided by the Bank. I authorise the bank to debit my account for recovery of service charges/incidental charges as applicable from time to time. I hereby declare that the information furnished above is true and correct to the best of my knowledge. Date__________________ Place__________________

SIGNATURE/THUMB IMPRESSION OF CUSTOMER

33. Declaration in case of a minor account : I hereby declare that the date of birth of the minor is ____/____/_____ who is my (relationship) __________________ and I am his/her natural
guardian/lawful guardian appointed vide court order dated_________________(copy enclosed). I shall represent the said minor in all future transactions of any description in the above account until the said 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 _____________________ PLACE _____________________

SIGNATURE/THUMB IMPRESSION OF GUARDIAN

FOR BRANCH USE

Risk Category : High risk Medium risk Low risk
SIGNATURE 1. Introducers signature verified by 2.Creation of customer master authorized by 3.Account opening Authorized, copies of documents obtained verified, Customers name checked with the barred list and Risk category verified by

Negligible risk
GBPA/SPA/ PF NUMBER DATE