FINANCIAL INCLUSION ACCOUNT OPENING FORM

No. Date D D M M Y Y Y Y

Product Code (Tick One) Indus Easy Indus Small Photograph

Name of the Branch

(Latest photograph
Village / Town Sub District/Block not older than six month.
District State Customer to Sign
across the photograph)
SSA Code/Ward No.

APPLICANT DETAILS All fields marked with ** are mandatory

Prefix First Name Middle name Last Name
Full Name**

Marital Status** Single Married Others Gender** Male Female Third Gender DoB** D D M M Y Y Y Y

Father/Spouse Name**
Mother’s Maiden Name**

Communication Address**

City/Town/Village PIN
State Country

Tel No.** S T D - Mobile**

Permanent Address

City/Town/Village PIN
State Country

PAN** MNREGA Job Card No.

Occupation/Profession*
Annual Income No of dependents

Details of Assets: Owning House Yes No Owning Farm Yes No No. of Animals Please specify
Any Other___________________

Existing Bank A/c. of family members / household Yes No If yes, No. of A/cs.

Aadhaar Number

I wish to seed my Aadhaar with NPCI mapper, enabling my account to receive Direct Benefit Transfer (DBT) benefits from Govt. of
India. I do not wish to further receive DBT benefits in my previous account with ____________________________________Bank.
I voluntarily give my consent to IndusInd Bank to use my Aadhaar details to authenticate me from UIDAI, link the Aadhaar to my account
and customer profile (CIF) with the Bank for the purpose of receiving DBT/ subsidy from Govt of India. I am aware of usage of Aadhaar
number and this information submitted will not be used for any purpose other than specified above.
Declaration as per Your Country of Birth India Other than India Tax Resident India Other than India
FATCA/CRS*
(If answer of any of the above is 'Other than India' please submit the FATCA/CRS annexure for individuals. For T&C, visit www.indusind.com)

I request you to issue me a Rupay Card.

DECLARATION
I hereby apply for opening of a Bank Account. I declare that the information provided by me in this application form is true and correct. The terms and conditions applicable have
been read over and explained to me and have understood the same. I shall abide by all the terms and conditions as may be in force from time to time. I declare that I have not availed
any Overdraft or Credit facility from any other bank. I understand that as my account is a Basic Savings Bank Deposit (Small) Account, I/ we cannot hold any other account in this bank.
I confirm that I am not having any other bank account in my name in this bank. Also if I have any other account I shall get the same closed within 30 days of opening of this account.
In case of breach of any of the above requirements / limitations, the bank will be entitled to block / close my account.

Place Witness Signature in case of TI or signature in

local language of the applicant
Date D D M M Y Y Y Y
(Signature/ Thumb Impression of Applicant)

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 NOMINATION
Nomination under Section 45ZA of the Banking Regulation Act 1949, and rule 2(1)
of the Banking Companies (Nomination) Rules 1985 in respect of bank deposits.

I want to nominate as under

Date of Birth Person authorised in case to receive the amount of deposit on

Name of Nominee Relationship Age
in case of minor behalf of the nominee in the event of my /minor(s) death

Place

Date D D M M Y Y Y Y
(Signature/ Thumb Impression of Applicant)

Witness1_____________________________________________________ Witness 2_____________________________________________________

_____________________________________________________ _____________________________________________________
(Name, Signature and Address) (Name, Signature and Address)

FORM NO. 60
1. Full Name of declarant

2. Address

3. Particulars of transaction: Opening of Account

4. Amount of transaction (`): (Rupees Only)

5. Are you assessed to tax? Yes No

6. If Yes
a) Details of Ward/Circle. Range where the last return of income was filed?
b) Reason for not having Permanent Account No/ GIR No?
c) Details of document produced in support of address in Column (1)

Verification
I, do hereby declare that what is stated above is true to the best of my knowledge and

belief. Verified today, the day of 20

Place
(Signature of declarant)

This is the left/right hand thumb impression of Mr./Mrs/Ms

and has been placed on this form in my presence.
The account holder Mr./Mrs/Ms has signed in my presence
after the contents had been fully explained to the account holder in his/ her vernacular language and he /she admits the same.

Name & Signature of Sourcer with ECN

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