ACCOUNT OPENING FORM: TERM DEPOSIT

for Existing Individual Customers (A Scheduled Commercial Bank)

Branch Name: ..................................................................................................... Branch Code: ..................................... Date D D M M Y Y Y Y

Account Number:

Please open following Deposit Accounts in my/our names

Bulk FD Cumulative - 431 FD Plus Cumulative** (No WDL) - 411 Senior FD Cumulative - 413

Bulk FD Non - Cumulative - 432 FD Plus Non-Cumulative** (No WDL) - 412 Senior FD Non - Cumulative - 405

Tax Saver FD Cumulative - 474 Regular FD Cumulative - 409 Senior Citizen Tax Saver Fixed Deposit - 476

Recurring Deposit - 456 Regular FD Non - Cumulative - 402 Recurring Deposit : Senior - 457

Home Investment Plan - 465 Gold Investment Plan - 461 College Investment Plan - 459

Home Investment Plan (Senior) - 463 Gold Investment Plan (Senior) - 464 College Investment Plan (Senior) - 462
**Fixed Deposits with no Premature withdrawal.
(Fill seperate FD Plus declaration form)

MOP Details

Mode of Operation: Self Either or Survivor Former or Survivor Jointly Minor Under Guardian Others.................................

First Applicant Details

Applicant Name
CRN PAN No. Senior citizen (>=60 years): Y N
(if not available, then attach Form 60)

Minor Y N if yes, then fill up the declaration below Mobile Number + 9 1

Declaration in case of Minor (To be filled if MOP is Minor Under Guardian)

I, hereby declare that the minor is my ..................................................................................................................................... and I’m his/ her natural/ legal guardian
appointed by court vide order dated ................................................. . I shall represent minor for all further transactions in the above account until the said minor
attains majority. I indemnify the minor against the claim of the above for my withdrawal/transactions made by me in his/her account.

Date Name of the Guardian Signature of the Guardian

Second Applicant Details

Applicant Name
CRN PAN No. Senior citizen (>=60 years): Y N
(if not available, then attach Form 60)
Mobile Number + 9 1
(*in case of more than two applicants, kindly fill Joint Applicant Annexure)

Fixed Deposit details

A. Amount Rs...............................................................................(In Words................................................................................................................................................)

B. Tenure Years Months Days
C. Interest to be paid Monthly Quarterly Half Yearly Yearly Cumulative

D. Maturity Instructions: Auto Renewal Y N Renew Principal Only Renew Principal with Interest

E. Mode of Payment: Debit from My/our Existing A/C No.

NEFT/RTGS.Ref..................................... Bank ................................. SA/CA account no. ..........................................

in the name of...............................................

F. Deduct TDS (If Applicable) Y N

If No, attach Form 15G/15H Income Tax Exemption Certificate/Letter from IT Department for the financial year

* In case payout/renewal instructions are not provided at the time of booking, term deposits will be renewed at the prevailed rates as per
the original instructions on the maturity
* Payment of interest and Principal amount on maturity will be paid to Jana Bank SA/CA account only
* Payment of periodic interest will be paid to Jana Bank SA/CA account only

Acknowledgement (to be filled by Bank official)

Received a deposit booking request for the amount of Rs. _____________________ by way of debiting from CA/SA account number______________________
for the tenure of _____________________ The applicable rate of interest is ____________
TD V2 - 02062022

Is Nomination requested Y N

If Yes, Nominee Name ____________________________________________________________

Name of the Bank Official Signature

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ACCOUNT OPENING FORM: TERM DEPOSIT
for Existing Individual Customers (A Scheduled Commercial Bank)

Recurring Deposit

A. Amount Rs...............................................................................(In Words................................................................................................................................................)

B. Tenure Months C. Debit A/C Number each month for Recurring Deposit
D. Date of RD installment D D M M Y Y Y Y

E. Deduct TDS (If Applicable) Y N

If No, attach Form 15G/15H Income Tax Exemption Certificate/Letter from IT Department for the financial year

*On maturity, amount will be credited to same account number (Customer’s own Jana Bank SA/CA account) as mentioned above in (C) while booking Recurring Deposit

Nomination (DA1 Form) (Only one individual nominee permitted)

I wish to nominate I do not wish to nominate****

Nomination under Section 45 ZA of the Banking Regulation Act, 1949 and Rule2 (1) of the Banking Companies (Nomination) Rules 1985 in respect of bank deposits

I/We (Name) ......................................................................................... (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 JANA SMALL FINANCE BANK.

Name Address: Same as Primary Applicant

If different from Primary Applicant

Relationship with depositor, If any Age Years Date of Birth of nominee D D M M Y Y Y Y

*As nominee is minor I/We appoint (name) Relationship with minor*

Address: Same as Primary Applicant If different .........................................................................................................................................................................................................

to receive the amount of deposit on behalf of the nominee in the event of my/our/ minor's death during the minority of the nominee

Nominee Mobile Number:

Signature of Primary Applicant** ............................................................................ Signature of the Joint Applicant(s) ............................................................................................

*Strike out if nominee is not a minor **Where account is opened in the name of a minor, the nomination should be signed by a person lawfully entitled to act on behalf of the minor.
*** In case of thumb impression, nomination to be filled in as an annexure **** I have understood the benefits of nomination and still do not wish to nominate

Customer Declaration

I/we hereby solemnly declare that the information voluntarily provided above is up to date and true to the best of my knowledge and belief and I/we hereby
submit my/our recent KYC documents. I/we acknowledge and agree that I/we have read, understood and accepted the terms and conditions and the other
terms and conditions relating to deposit services stipulated on www.janabank.com (the “Website”). I/We agree that the Bank shall have the right to
modify/amend any of the terms and conditions from time to time, at Bank's own discretion, which may be hosted and noticed on the Website and the same
shall be sufficient notice, to me/us regarding such modification/amendment and I/we shall be bound by such modification/ amendment.

Signature of the Primary/1st Applicant Signature of the Second/Joint Applicant

Name: ............................................................................................ Name: ...........................................................................................

Date D D M M Y Y Y Y Date D D M M Y Y Y Y

Bank Official Declaration

Declaration by the Branch:

I hereby certify that this account opening form is complete in all respects and relevant documents have been obtained as per the KYC guidelines of the Bank
and RBI (as amended from time to time) and performed due diligence to verify the genuineness of the customer.

Signature of Bank Official Name Employee No

Please visit www.janabank.com for more queries on CASA related information. Registered Office:
Jana Small Finance Bank Limited,The Fairway Business Park,
Branch Details # 10/1, 11/2 & 12/2B, Off Domlur, Koramangla Inner Ring Road,
Next to Embassy Golf Links, Challaghatta, Bengaluru -560071.
Branch Code : ........................................................
TD V2 - 02062022

Address : ................................................................................................................................

..................................................................................................................................................

Contact No. : .........................................................

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