I/We request you to open my/our Saving Bank Account in your bank. My/Our personal details are as follows:

(01)

Operational Instructions:

Either or Survivor Jointly or Survivor Former or survivor

Any of us or any one of the survivors or the last survivor Other (Please Specify)

Current /Permanent Address: -

Mobile No. ------------------------------ Tele. (Off.) ------------------------------- Tel. (Res.) -------------------------------

Email ID: - ---------------------------

Communication Address: - If it is different than permanent address: .........................................................................................

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

SAVINGS ACCOUNT OPENING FORM (INDIVIDUAL)

Head Office : . 9/10, Aadarsh Shivneri, Opp. Modern High School, Koregaon, Tal : Koregaon, Dist.: Satara- 415 501www.pccb.in

Date: ........../........../....................

Account No.:

Branch: ...............................................................

Customer No.:

KNOW YOUR CUSTOMER (KYC)

Personal Details:

Name: (Same as on ID Proof) ..................................................................................................................................................................................

Father's Name : ..............................................................................................................................................................................................

Mother's Maiden Name: ...........................................................................................................................................................................................

Date of Birth : dd mm yyyy

Gender : Male Female Transgender

Marital Status : Married Unmarried Others

Nationality : Indian Others Passport No. ...................................Visa Valid Upto dd mm yyyy

PAN No.: ......................................................................................... AADHAR No.: .............................................................................................

Passport No.: ................................................................................. Annual Income: .........................................................................................

Occupation: Service/Private/Public Govt. Sector Retired Professional

Agriculture Business Self Employed Housewife Student

Workplace: Employer's Name and Address: ........................................................................................................................................................

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

Proof of Identity: (Certified copy of any one of the following proofs of identity, please tick)

A. Passport B. Voter ID Card C. PAN Card D. Driving License E. UID Aadhar F. NREGA Job Card

G. POA Address .......................................................................................................................................................................................................

Proof of Address: (Certified copy of any one of the following proofs of addresses, needs to be submitted)

A. Passport B. Voter ID Card C. PAN Card D. Driving License E. UID Aadhar F. NREGA Job Card

G. POA Address .......................................................................................................................................................................................................

(02)

As the nominee is minor on this date, I/we appoint Shri./ Smt. ............................................................................................................................

Address ................................................................................................................................................................................................ to receive

the amount of deposit on behalf of the nominee in the event of my/our death during the minority of the nominee.

I/We nominate following named person as my/our Nominee after my/our death who is entitled legally to receive the money as per Banking

Regulation Act, 1949 and the Co-operative Bank (Nomination) Rule, 1985 (only one person can be nominated per account).

Nomination Form DA-01

(For individual/sole proprietorship account only)

Nomination Required: Yes No

Facilities required: Please Tick

Mobile Banking Debit Card SMS Banking e-statement

Introduction by an Existing Account Holder:

Mr./Mrs. ........................................................................................................ Customer No. ....................................................

S.B/Current/CC/Account No. .................................................., Branch ........................................ Tel./Mob.No. ........................................................

I know Mr./Mrs. .............................................................................................. for a period of .............. years and confirm his/her address.

Date: ........../........../.................... Signature of Introducer ........................................................................

(03)

Declaration and Undertaking by Applicant:

I/We declare that:

1. I/We have read and understood the rules of opening a Savings/Current Account of the Bank and terms and conditions (which may be amended

from time to time) relating to Internet Banking, Mobile Banking, Debit Card, SMS Banking, E-Statement, E-Passbook and other services as

mentioned. I/We accept them as binding upon me/us. I/We accept and agree to bound by terms and conditions limiting the Bank’s liability.

2. I/We understand that the Bank may, at the absolute discretion, discontinue any of the services completely or partially without any notice to

me/us. I/We agree that the Bank may debit charges to my/our account for operations affected through transactions from Savings/Current

Account and/or use of Internet Banking/SMS Banking/Debit Card/Rupay Card etc.

3. I/We request to link this account to my/our AADHAR Card Number/s submitted to you for receiving subsidy/government benefits/salary etc.

4. The information provided by me/us in this Form is in accordance with Section 285BA of the Income Tax Act, 1961 read with Rules 114F to 114H

of the Income tax Rules, 1962. It shall be my/our responsibility to educate myself/ourselves and to comply at all times with all relevant laws

relating to reporting under section 285BAof the Act read with the Rules thereunder.

5. The information provided by me/us in this Form and in its supporting Annexures as well as in the documentary evidence/s provided is true,

correct and complete to the best of my/our knowledge and belief, and that I/we have not withheld any material information that may affect the

assessment/categorization of the account as a reportable account or otherwise. I/We hereby accept and acknowledge that the Bank shall have

the right and authority to carry out investigations from the information available in public domain for confirming the information provided by

me/us to the Bank at any point of time.

6. I/We permit/authorise the Bank to collect, store, communicate process and share information relating to the account and/or any of the above

mentioned facilities and all transactions therein, to regular Centers, Central KYC Registry and any other Bank including my/our confidential

information as and when required for compliance with any law or regulation, whether domestic or foreign.

7. I/We undertake the responsibility to declare and disclose immediately from the date of change, any changes that may take place in the

information provided in this Form, its supporting Annexures as well as in the documentary evidence/s provided by me/us or if any certification

becomes incorrect/invalid, etc. and to provide fresh self-certification along with documentary evidence/s.

8. I/We also agree that my/our failure to disclose any material fact known to me/us, now or in future, may invalidate our application and the Bank

would be within its right to put restrictions on the operations of my/our account and/or any of the above mentioned facilities, or close it or report to

any regulator and/or any authority designated by the Government of India (GOI)/RBI for the purpose or take any other action as may be deemed

appropriate by the Bank if the deficiency is not remedied by me/us within the stipulated period.

9. I/We shall indemnify the Bank for any loss that may be suffered by the Bank on account of providing incorrect information.

10. I/We declare that I/we have the capacity to sign for the Entity as per CBDT rules/SEBI/RBI guidelines.

11. I/We hereby accept and acknowledge that the Bank shall have the right and authority to carry out investigations from the information available in

public domain for confirming the information provided by me/us to the Bank.

12. Debit Card Safety: - It is the sole responsibility of the cardholder to preserve the card in good condition. Always keep debit card safely in plastic

pouch to prevent any physical damage to the magnetic strip. Do not expose it to magnetic fields, heat, water and dust anytime.

13. If the card is broken or unreadable it will be considered as an invalid card and a new card will be issued on receiving application by cardholder

and handing over of such invalid card for cancellation to the Home Branch.

14. I/We have received the copy of declaration and undertaking from the Bank for my/our record.

Note: If the depositor is illiterate, thumb impression should be attested by two witnesses.

Signature of Witness 1. .................................................................... Signature of Witness 2. ...........................................................................

Name and Address: ......................................................................... Name and Address: ................................................................................

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

The declaration and undertaking have been explained to me/us in my/our mother tongue. I/We have acknowledged the declaration and

undertaking given by Bank.

Date: ........../........../.................... Signature: ..............................................................................................

Place: .......................................................................... Name: ....................................................................................................

(04)

ATTESTATION/FOR OFFICE USE ONLY KYC

Application type: New Update

Account Type: Normal Small

To be filled by Financial Institutions KYC No. .......................................................................................

Document received: Self-Certified True Copies Notary

Risk Category: High Medium Low

In Person Verification Carried Out By: .............................................................................................................

Identity Verification Date: dd mm yyyy

Employee's Name : ........................................................................................................

Designation : ........................................................................................................

Employee's Code : ........................................................................................................

Employee's Branch : ........................................................................................................

Employee's Signature : ........................................................................................................

Bank Details

Name: Pune Commercial Co-operative Bank

Manager's Signature and Seal