account opening form - dcb bank

For Individuals

M026 / Nov 16 / 2.1481-Ver 1.1-March 2014

Account Opening Form

DCB Bank Limited

Instruction for filling Account Opening Form

ABC

Description of Document Can be obtained for

AddressIdentity

*Accepted only for Low Risk Customers

Please Note: 1. Customer must sign the Account Opening Form (AOF) in the presence of Bank Officials 2. The cheque provided as the initial Account Opening Amount (AOA) must be signed by the prospective customer and this signature should match with the signature on the AOF.

PAN Card

Passport

Voter's Id issued by Election Commission of India

Driving Licence

Letter issued by UIDAI containing details of name , address and Aadhaar number or any other document as notified by the Central Govt in consultation with RBI or ‘Aadhaar’ Letter or ‘Aadhaar Card

Job card issued by NREGA duly signed by officer of the State Government

*Identity card with applicant's photograph issued by Central/ State Government Departments, Statutory / Regulatory, Public Sector Undertakings, Scheduled Commercial Banks and Public Financial Institutions (Low Risk customers)

*Letter issued by a gazetted officer with a duly attested photograph of the person.

*Senior Citizen Card issued by any State Government

*Letter with attested photograph issued by recognized public authority such as Collector / Tehsildar / Magistrate

Legal Guardianship Certificate issued by the Local Level Committees set up under the National Trust for the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Mental Disabilities Act, 1999 and under the Mental Act, 1887 appointing Legal Guardians for persons with disability can be accepted to open an account (for accounts of people with disability)

Passbook with attested photograph from any Scheduled Commercial Bank with latest completed 3 months account statement *

Letter from Block Development Officer/ Revenue Official *

Letter from Scheduled Bank as per Annexure K *

Social security card issued by State Govt.*

Certificate issued by Gram Panchayat *

Passport

Voter's Id issued by Election Commission of India

Driving License

Letter issued by UIDAI containing details of name , address and Aadhaar number or any other document as notified by the Central Govt in consultation with RBI or ‘Aadhaar’ Letter or ‘Aadhaar Card

Job card issued by NREGA duly signed by officer of the State Government

Passbook with attested photograph from any Scheduled Commercial Bank, Post Office (latest 2 months)*

Address card issued by India Post *

Letter from Block Development Officer/ Revenue Official*

Letter from scheduled bank as per Annexure K *

Social security card issued by State Govt. *

Certificate issued by Gram Panchayat *

Declaration from joint holder to consider the address as proof of address along with proof of relationship*

Property or Municipal tax receipt (not more than one year old)*

Utility bill which is not more than two months old of any service provider (electricity , telephone, postpaid mobile phone, piped gas, water)*

Letter of allotment of accommodation from employer issued by State or Central Government departments, statutory or regulatory bodies, public sector undertakings, scheduled commercial banks, financial institutions and listed companies. Leave and license agreements with such employers allotting official accommodation can also be obtained.*

Documents issued by Government departments of foreign jurisdictions and letter issued by Foreign Embassy or Mission in India.*

Please write your NAME as it appears in all your support documents

Hint boxes give tips and highlight important points across the form

Please fill the form preferably in ‘BLACK’ ink only

Please countersign in full for any overwriting / alteration

Specify the addresses along with City, State and PIN Code

Please tick the appropriate boxes

Please use in CAPITAL LETTERS only

ALL PHOTOCOPIES of documents to be SELF-ATTESTED by the applicant

Indicative List of Documents that can be provided to open a Bank Account

SOL Code:

Relationship Form

3

Savings

Classic BSBDA Privilege Elite Corporate Payroll (Basic) Corporate Payroll (Plus)

Others (please specify including Personal Current A/c.)Fixed Deposit

Shubh-Labh

Cash Back

“I / We hereby apply for a relationship with your Bank under which I / we wish to open an account.”

Bank Use only (* Fields are Mandatory) Application No.: IND

Customer ID:

Account No.:

Funding: Txn. / ID No.: YYYYMMDDDate: YYYMMDDValue Date: Y

Current Address:

City: Pin:

*Preferred Mobile No.:Telephone:(with STD Code)

*Preferred Email Id:

*Landmark:

State: Country:

All alerts will besent to thepreferred

Mobile Numberand E-mail ID.

Mobile Numberwill be used forSMS Bankingregistration for

eligibleaccounts.

Permanent Address:

City: Pin:

*Landmark:

Same as Current Address

State:Telephone:(with STD Code)

Personal Details: Primary Applicant (* Fields are Mandatory)

(First Name) (Middle Name) (Last Name)

*Date of Birth: YYYYMMDD

*Nationality: Indian Other (pl. specify)

*Short Name:Maximum

19 characters.This name

wouldappear on the

Debit Card

*Status: Minor Sr. Citizen Pensioner Staff, if yes, Employee No.Other General

Maximum 32 characters.

*Name: Existing Customer ID:(If applicable)

Mr. Mrs. Ms. Dr. Prof. Capt. Others

*Gender: Male Female Third Gender

Marital Status: Single Married *Mother’s Maiden Name:

Category: General OBC SC ST Others

*Permanent Account Number (PAN): Form 60 If PAN number is not available

please fill in Form 60Your 12 digit unique identification numberAadhaar Number:

*Card: Debit Card required

ATM Card required

Yes

Yes

No

NoType of card & cheque book issuance would be based upon the product.

International Debit Card required Yes No

*Country of Birth: *Place of Birth:

Type of card would be

based upon the product

Please fill FATCA

Declaration Form if you are U.S.A. or other country citizen

/ resident

*Citizenship: *Residence for Tax Purposes:

U.S. Person: Yes No

Office Address:

City: Pin:

Visa

Rupay Yes

Yes

No

No

*Occupation Code: Applicant 1: Joint Applicant 1:

Joint Applicant 2: *Segment Code RM / CSE / RO / CBE (Code):

Branch: Date: YYYYMMDD

Please specify the occupation code as mentioned by customer in the form.

*Mother’s Full Name:

Mailing Address: Office Permanent (You must tick mark one option)

Address proofof mailingaddress ismandatory.Otherwise,

default addresspicked would be

CurrentAddress

4

*Landmark:

Extn.: Fax:(with STD Code)

State: Telephone:(with STD Code)

Customer Profile

*Occupation:

Gross Annual Income (`): Less than 50K 50K - < 1.5 Lakhs 1.5 Lakhs - < 3 Lakhs 3 Lakhs - < 5 Lakhs

5 Lakhs - < 10 Lakhs 10 Lakhs - < 50 Lakhs 50 Lakhs and above

Residence: Self Owned Family Owned Rented Company Lease

Existing Credit Facility: House Loan Vehicle Loan Consumer Loan Education Loan Business Loan Credit Card

Education: Graduate Post Graduate Professional Others

Two WheelerVehicle: Four Wheeler Both None

*Permanent Account Number (PAN): Form 60

*Short Name: Maximum 19 characters.This name would appear on the Debit Card

Your 12 digit unique identification numberAadhaar Number:

*Status: Sr. Citizen Pensioner Staff, if yes, Employee No.Other General


ATM Card required

Yes

Yes

No

No

International Debit Card required Yes NoType of card

would be based upon the product

##(Guardian to fill a Minor Declaration Form separately) If applicable, please attach age proof * Fields are Mandatory

*Gender: Male Female *Nationality: Indian Other (pl. specify)



Marital Status: Single MarriedRelationship with Primary Applicant:

Joint Applicant 1 (* Fields are Mandatory)


Maximum32 characters



Third Gender


*Occupation:

Please fill FATCA


/ resident

*Citizenship: *Residence for Tax Purposes: U.S. Person: Yes No

If PAN number is not available

please fill in Form 60

Type of card & cheque book issuance would be based upon the product.

Visa

Rupay Yes

Yes

No

No


State: Country:

City: Pin:

Current Address:


*Landmark:

Permanent Address:

City: Pin:

*Landmark:



*Mother’s Maiden Name:

Current Address

5

Please note: Allcheques shouldbe CROSSED

and in favour of‘DCB Bank

Limited’ A/c

(Your Name)’

Initial Payment Details

(Bank)Drawn on: Amount `:

Debit to DCB Bank A/c No.:

Amount in words:

Cheque No.: Cheque Dated: YYYYMMDD

Payment By Cash (To be deposited by the customer at teller counter only) Cash Deposited on: YYYYMMDD

Mode of Operation

Self Either or SurvivorJointly

Others:(Please Specify)

Former or Survivor Guardian Anyone or Survivor

Joint Applicant 2 (* Fields are Mandatory)

*Permanent Account Number (PAN): Form 60

*Short Name: Maximum 19 characters.This name would appear on the Debit Card

Your 12 digit unique identification numberAadhaar Number:

*Status: Sr. Citizen Pensioner Staff, if yes, Employee No.Other General


ATM Card required

Yes

Yes

No

No

International Debit Card required Yes NoType of card

would be based upon the product

*Gender: Male Female *Nationality: Indian Other (pl. specify)



Marital Status: Single MarriedRelationship with Primary Applicant:


Maximum32 characters



Third Gender


*Occupation:

Please fill FATCA


/ resident

*Citizenship: *Residence for Tax Purposes: U.S. Person: Yes No

If PAN number is not available

please fill in Form 60

Type of card & cheque book issuance would be based upon the product.

Visa

Rupay Yes

Yes

No

No


State: Country:

City: Pin:

Current Address:


*Landmark:

Permanent Address:

City: Pin:

*Landmark:



*Mother’s Maiden Name:

6

Tax Deduction at Source

If No, TDS Exemption Reference No.

TDS to be deducted if applicable: Yes No TDS Exemption submission date : YYYYMMDD

Enclose TDS Certificate for exemption.

Form 15G / 15H,etc. to be

submitted at thebeginning of

every financialyear and whilemaking fresh

deposits duringthe year.

Services

SMS Banking & Alert Facility:Alerts facility enables you to receive alerts on your Email and / or Mobile regarding large debit, large credits, Standing Instruction failure, balance below Account Quarterly Balance and balance update. New alerts may be added from time to time.

Internet BankingEmail Account Statement Utility Bills

Phone Banking Preferred Language Options: English Hindi Marathi Gujarati Tamil Telugu

Facility required: Yes No (please tick appropriate options)2-Way Sweep Deposit Details:

Please Note: Reverse Sweep to Fixed Deposit account shall happen only, if the balance in the account exceeds threshold limit and Sweep shall happen if the balance in the account goes below the threshold limit. All deposits will be under Re-investment scheme with Auto Renewal Facility, this facility may differ from product to product and from time to time.

Account Statement: Frequency of statement would be as per the product feature.

Investment: Life Insurance Mutual Fund Wealth Management General Insurance

I / We don’t wish to receive any Bank related promotional calls, SMS alerts or emails.

DCB – On The Go (Mobile Banking)

Passbook

Please fill a separate Mobile

Banking Registration

Form for Joint Account

Holder

Please Note: Authorised signatory/ies of the Firm / Company / Trust / Association / Society are eligible for free Mobile alert facility subject to compliance of terms and conditions as stipulated by the Bank from time to time.

I / We don’t wish to link my/our Aadhaar Number to this account.(Please Note: Any 1 Aadhaar Number is linked to 1 Account Number to receive subsidy on the account)

Term Deposit Details (* Fields are Mandatory)

*Maturity Instructions(Tick any one)

Auto Renew Principal and Interest Auto Renew Principal and Pay Interest

Repay Principal and Interest

ONLY Simple Interest

payable for deposits of less than 6 months

tenor

Type of Deposit Monthly Interest Payout (MIC)

Half Yearly Interest Payout

Quarterly Interest Payout (QIC) Quarterly Compounded (RIC)

Tax SaverSimple Interest (for deposits less than 6 months)

Amount of Deposit Please issue Fixed Deposit in the name(s) of

by Cash / Debit to Account No.:

Amount `

(Rupees only)

Date of Birth (DOB) proof required to

avail benefits for Senior Citizens.

Deposit Period

*Payment Instructions(upon closure)

Mode of Operation

Please tick if you wish to receive hard copy of the Deposit Confirmation Advice (DCA) otherwise the DCA will be sent at your registered email ID with the Bank.

Days Months Years (Minimum 7 days maximum 10 years)

Senior Citizen Yes No Interest Rate . % per annum

Transfer to DCB Bank A/c. No.:

Issue Demand Draft Payable at

Through NEFT

Transfer to DCB Bank A/c. No.:

Issue Demand Draft Payable at

Through NEFT

JointlyFormer or SurvivorSelf

Guardian

Either or Survivor

By anyone or Survivor

Interest PaymentInstructions

1. Mandatory to attach a cancelled cheque of the bank account mentioned below2. Beneficiary Name (As per Beneficiary’s Bank record - should be same as applicant name):

Bank Name: Branch Name:

Instructions for payment of interest & maturity proceeds through NEFTThis facility is not available

for fixed deposits with

maturity instruction as “Auto Renew Principal &

Pay Interest”

Others (please specify)

Account Type: Savings Current

Overdraft

Account Number:

IFS Code:

Terms and conditions: I/We abide by the following terms and conditions: 1. It is being understood that the remittance is to be sent at my/our own risk and responsibility and on the distinct understanding that no liability whatsoever is to be attached to the Bank for any loss or damages arising or resulting from delay in transmission, delivery or non-delivery of the message or for any mistake, exchange or error in transmission or delivery thereof or in deciphering the message for whatsoever cause or from its misinterpretation when received or the action of the destination Bank or due to RBI (Reserve Bank of India) RTGS / NEFT system not being available or failure of internal communication system at the recipient bank/branch or incorrect information provided by me/us or any incorrect credit accorded by the recipient bank/branch due to information provided by me/us or any act or event beyond control or from failure to properly identify the person’s name. 2. I/We understand that the RTGS / NEFT request is subject to the RBI regulations and guidelines governing the same. 3. I / We agree that the credit will be effected solely on the beneficiary account number information and beneficiary name particulars will not be used for the same.

7

Name of Father / Mother / Guardian Signature of Father / Mother / Guardian

Minor's Name

Declaration where Applicant is Minor

I hereby declare that I am the natural guardian / lawful guardian appointed by the Court order dated (copy enclosed) of YYYYMMDD

Master / Miss

I shall represent the said minor in operating the Bank Account till he / she attains majority. I agree to indemnify the Bank against any claims for any transactions made in the account(s).I undertake and confirm that I shall avail various services of the Bank (wherever applicable) like Phone Banking, Mobile Banking, Internet Banking, Bill Pay only for the benefit of the minor and I shall abide by all terms and conditions governing the various services and shall intimate the Bank in writing immediately upon the Minor attaining majority.

*Customer id:

* Incase Father / Mother / Guardian is an existing customer

Name :

Signature :

Address :

Place : Date:

Name :

Signature :

Address :

Place : Date:

Nomination Details (Form DA 1)

Yes, I want to nominate the following person No, I do not want to nominate anyone

Address:

Nominee Name:

YRelationship with Applicant, if any YYYMMDDDate of Birth:YearsAge:

* As the nominee is a minor on this date, I / we appoint (Name & Address)

*Strike out if nominee is not a minor. ** Where deposit is made / account is held in the name of the minor the nomination should be signed by a person lawfully entitled to act on behalf of the minor.

Witness(es):

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

In case you have specified a nominee above, please indicate if you wish to make mention of the nominee name on the passbook, statement & DCA issued in respect of your account and / or the passbook issued to you

I / We do hereby declare that what is stated above is true to the best of my / our knowledge and belief.

Yes No

Signature(s) / Thumb Impression(s) of depositor(s)

I / we nominate the following person to whom in the event of my / our / minor’s death the amount of the deposit / in the account may be returned by DCB Bank Limited

Preferable forSingle & Joint

Account holders

Nominationunder Section45ZA of the

BankingRegulation Act, 1949

and Rule 2(1) of the Banking Companies (Nomination) Rules 1985 in

respect of bankdeposits.

Thumb impression isrequired to be

attested by2 witnesses.

In case of signature, no

witness isrequired.

DKD can be created in the name of the

Primary Applicant only

DCB Diamond Khushiyali Deposit Details

Monthly InstalmentAmount

`

Monthly Instalments tobe collected through

Debit to Account No.

on DD of every month

Maturity Instructions Transfer to DCB A/c No.:

Date of Birth (DOB) proof required to

avail benefits for Senior Citizens.

Deposit Period Days Months Years (Deposit period is minimum 14 days and maximum 10 years)

Interest Rate . %Senior Citizen Yes No

Mode of Operation Self Either or SurvivorJointly

Others:(Please Specify)

Former or Survivor Guardian

List of hazardous occupation which are not covered in GPA: in hazardous performances, Aerial crop sprayer, Bookmaker (for gambling), Demolition contractor, Explosives users, Fisherman (seagoing), Jockey, Marine salvager, Miner and other occupations underground, Off-shore oil or gas rig worker, Policeman (Full time), Pop Musicians, Professional sports person, Roofing contractors and all construction, maintenance and repair workers at heights in excess of 50ft / 15m, Saw miller, Scaffolder, Scrap metal merchant, Security guard (armed), Steeplejack, Stevedore, Structural steelworker, Tower crane operator, Tree feller, Ship crew, Travel agency business, Air coupon & ticket business.

Aircraft pilots and crew, Armed Forces personnel, Artistes engaged

Group Personal Accident Insurance

Yesfor Group Personal Accident Insurance

, I wish to enroll Yes, I wish to enroll for the auto renewal of Group Personal Accident Insurance for additional

Group Personal Accident (GPA) Plan (Please tick any one of the below 7 options)

*Nominee:

*Nominee Gender: Male Female

*Relationship of Nominee with Applicant:

Signature of the Applicant

The maximum Sum Insured

allowed for any one customer, across one or more policies,

should not exceed

` 30 Lakhs (standard

variant only).

Double benefit VariantDeath + Permanent Total Disability + Double benefit for salaried person for accident on duty by Rail / Road / Air

Standard VariantDeath + Permanent Total Disability

500000 (AIB only)

1000000

1500000

2500000

3000000

5000000

1000000

1500000

2500000

444

868

1602

2670

3204

6087

1184

1780

2937

Sum Insured ` Net Premium* Option Chosen (þ)Coverage Options

3 years 5 years 10 years

Sourcing Staff Name: HRMS Number:

*Mention Guardian / Appointee Name in case Nominee is a minor:

*PLEASE TICK (ü) AGAINST THE APPLICABLE DESCRIPTION, IF YOU FALL UNDER ANY OF THE BELOW LISTED CATEGORIES. IF YOU FALL UNDER MORE THAN ONE OF THE LISTED TITLES BELOW, PLEASE TICK AGAINST ALL THE APPLICABLE HEADS.

Head of Stateor Central Government

Senior Executive of State or Central-Owned Corporation

Senior Politician

Important Political Party Official

Senior Government / Judicial / Military Officer

Any other Politically Exposed Person (PEP) / Related to PEP

Third Gender

8

*Exclusive of Service Tax.

ACKNOWLEDGMENT

(Note: Certificate of Insurance will be couriered at your mailing address / emailed on your registered Email ID post issuance of the policy. Insurance cover will start on 1st day of succeeding month of the premium amount debit from your Account with DCB Bank Limited)

Name of the Applicant:

DCB Bank Account Number:

YYYYMMDD

Instruction received to debit ` ______________ from DCB Bank Account towards Group Personal Accident Insurance Premium.

Date: DCB Bank Account Opening Form Number:

This application is for Group Personal Accident Cover only. It is not a cover for Life Insurance or Mediclaim.Insurance

Applicant’s Signature: ____________________________________ Authorized signatory for DCB Bank Limited: ____________________________________

List of hazardous occupation which are not covered in GPA:

Aircraft pilots and crew, Armed Forces personnel, Artistes engaged in hazardous performances, Aerial crop sprayer, Bookmaker (for gambling), Demolition contractor, Explosives users, Fisherman (seagoing), Jockey, Marine salvager, Miner and other occupations underground, Off-shore oil or gas rig worker, Policeman (Full time), Pop Musicians, Professional sports person, Roofing contractors and all construction, maintenance and repair workers at heights in excess of 50ft / 15m, Saw miller, Scaffolder, Scrap metal merchant, Security guard (armed), Steeplejack, Stevedore, Structural steelworker, Tower crane operator, Tree feller, Ship crew, Travel agency business, Air coupon & ticket business.

Key Features: • Worldwide Cover • No Waiting Period

Key Benefits:

Death Benefit: In the unfortunate event of a fatal accident, the Sum Insured shall be paid to the nominee of the Insured Person.

In the unfortunate event of an accident resulting in Permanent Total Disability, the Insured Person shall be paid the following % of Sum Insured.

a) 100% sum insured in case of loss of sight of both eyes, or of the actual loss by physical separation of two entire hands or two entire feet, or of one entire hand and one entire foot, of such loss of sight of one eye and such loss of one entire hand or one entire foot.

b) 100% sum insured in case of loss of use of two hands or two feet or of one hand and one foot, or of such loss of sight of one eye and such loss of use of one hand or one foot.

c) 50% sum insured in case of loss of sight of one eye, or of the actual loss by physical separation of one entire hand or of one entire foot.

d) 50% sum insured in case of total and irrecoverable loss of use of a hand or a foot without physical separation.

e) 100% sum insured in case of permanent and total disability which absolutely disables insured person from engaging in any employment or occupation.

For those opting for Double benefit for Death & Permanent Total Disability cover: Claim will be paid for salaried persons who are involved in an accident on duty while traveling by Rail / Road / Air.

Who can be Insured Person?

This insurance is available to persons who are aged between 18 and 70 years at the commencement date of the Policy and are Account holders of DCB Bank Limited (DCB Bank).

This is an insurance plan underwritten by Royal Sundaram General Insurance Co. Limited (IRDAI Registration No. 102, CIN-U67200TN2000PLC045611) for customers of DCB Bank. Your participation in this insurance product is purely on a voluntary basis. DCB Bank will be the Group Manager for this insurance product and will only be responsible for distributing the insurance product to all members of this group. All Claims under the policy will be solely decided upon by Royal Sundaram General Insurance Co. Ltd.

This application shall be processed and the premium amount as per option chosen by you shall be debited if it is found acceptable by Royal Sundaram General Insurance Co. Ltd. The insurance cover shall start on 1st day of succeeding month of the premium amount debit in your DCB Bank Account (“commencement date”). This insurance cover will be valid for a period of 1 (one) year from the commencement date, provided you continue to remain a DCB Bank account holder during this period. This insurance cover will cease to exist in case the DCB Bank Account is dormant, freezed or lien marked for any reason whatsoever. The application will not be accepted till the time such account related disputes are resolved and the said DCB Bank Account is reactivated. Renewal reminders for this policy will be conveyed through SMS alerts and Email by DCB Bank on the Mobile No. and Email respectively as indicated by the Applicant in this Application.

If for any reason you need to communicate with Royal Sundaram General Insurance Co. Ltd., it is adequate that you mention the Master Policy number, DCB Bank account number and the branch details. Claim intimation can also be made to Royal Sundaram General Insurance Co. Ltd., by contacting them on 1860 425 0000.

This is only a brief summary of the insurance product. Please refer to Master Policy No. PADCB00001 (available on DCB Bank’s website www.dcbbank.com) issued to DCB Bank by Royal Sundaram General Insurance Co. Ltd. for complete information on terms, conditions and exclusions.

Royal Sundaram General Insurance Co. Limited, Vishranthi Melaram Towers 2/319, Rajiv Gandhi Salai, Old Mahabalipuram Road, Karapakkam, Chennai - 600097.

Sum Insured Options:

The maximum Sum Insured

allowed for any one customer, across one or more policies,

should not exceed

` 30 Lakhs (standard

variant only).

A worldwide personal accident cover plan that is specially designed to give comprehensive protection to help you / your family against finance crises due to Accidental Death or Permanent Total Disablement.

Royal Sundaram General Insurance Co. Ltd.

Call 1860 425 0000

Write [email protected]

Visit www.royalsundaram.in

DCB 24-Hour Customer Care

Call Toll Free: 1800 209 5363

Email: [email protected]

Web: www.dcbbank.com

Double benefit VariantDeath + Permanent Total Disability + Double benefit for salaried person for accident on duty by Rail / Road / Air

Standard VariantDeath + Permanent Total Disability

5,00,000 (AIB only)

10,00,000

15,00,000

25,00,000

30,00,000

50,00,000

10,00,000

15,00,000

25,00,000

444

868

1602

2670

3204

6087

1184

1780

2937

Sum Insured ` Net Premium* Option Chosen (þ)Coverage Options

*Exclusive of Service Tax.

Experience banking like never before

DCB Business Loan

Your property can now fund your business expansion. Avail of term loans for your business against the security of your residential or commercial property.

DCB Diamond Khushiyali Deposit

A small deposit every month leads to a large assured amount for the future. You can deposit as low as ` 1000 per month.

DCB Gold Loan

Avail instant loan against your gold jewellery / ornaments. The loan amount can be as high as 80% of the appraised gold value.

Free access to Visa ATMsin IndiaUse your DCB Debit Card for cash withdrawals and balance enquiries atany Visa ATM in India at no cost.

DCB Investment Services

Experience state-of-the-art personalised financial planning along with the best investment products that suit your risk appetite.

DCB CashBack AccountA unique savings account that pays you cash every time you spendusing your Debit Card.

DCB NRI Services

DCB Bank offers a bouquet of productsand services ranging from DCB NRE / NRO Accounts and Term Deposits to DCB Wealth Management Solutions.

DCB Elite Account

Now choose your lucky number as your savings or current account number along with a host of free benefits and services.

DCB Bank launches India's First Aadhaar ATM

Easy to use with Aadhaar Number &

your Finger Print

ATM Card & your Finger Print

ATM Card & PIN

DCB Bank Limited

* Kindly fill the following details:

Risk Classification for Joint Applicant 1

Basis of Categorisation: Politically Exposed Person Domiciled in Risk Country Trust Sleeping Partner

High Risk Profession Others (Please specify):

Information: Politically Exposed Person due to position / status as:

If Domiciled in Risk Country - Country Name:

Nature of Business / Occupation:

*Details of Customer’s Source of Funds & Estimated Net Worth:

Income from Employment Income from Business Income from Investments Inherited Funds

Others (Please specify):

Expected number of transactions in a month: Up to 20 21 to 50 More than 50

Risk Classification of Account (L / M / H):

Expected Annual Turnover (`): Upto ` 1 Lakh Upto ` 10 Lakhs Upto ` 50 Lakhs Upto ` 1 Crore

Upto ` 5 Crores Upto ` 10 Crores Upto ` 25 Crores More than ` 25 Crores


Risk Classification for Joint Applicant 2













11


Risk Classification for Primary Applicant













12

Letter From Customer – Opening of “NO FRILL” Accounts in “VALUE SAVINGS SCHEME” under relaxed KYC Norms

The Branch Manager

DCB Bank Limited

____________________ Branch

Sir / Madam,

I / We am / are aware and agree that if the balance in my / our account and / or the aggregate credits in my / our account exceed/s the limits specified by Reserve Bank of India, I/we agree to be subjected to full KYC norms applicable at that point of time and affirm that I/we shall comply with the same as per requirements of the Bank failing which, the Bank has the right to suspend the operations or close the account by giving a notice of 15 days.

Yours faithfully,

___________________________________

(Signature of the Customer)

Letter From Customer – Opening of Corporate Payroll Account with Mailing Address as Office Address

The Branch Manager

DCB Bank Limited

____________________ Branch

Sir / Madam,

I am / We are aware of the risks that would arise due to receipt of customer deliverables at the corporate address by any unauthorised person and I / we shall not hold the Bank responsible and liable for any loss or damage that I / we may suffer, due to the Bank recording and treating the corporate address of my / our company as my / our mailing address.

Yours faithfully,

___________________________________

(Signature/s of the Customer/s) DCB Bank Limited

Letter From Customer - Recording A Different Signature(When Signature recorded on any of the document provided for Signature Proof is different from the one recorded on the AOF)

To be signed by the Customer in the presence of the Bank Official attesting the Signature

The Branch Manager

DCB Bank Limited

____________________ Branch

Sir / Madam, With reference to the ____________________________________________________________________ (name of the document on which the signature differs) provided by me as proof of my signature along with the Account Opening Form, I request you to please record with yourselves my specimen signature as below, as the signature on the above referred document differs from the one provided on the Account Opening Form :

_________________________________________________________________________________________________ (Signature as per document submitted)

_________________________________________________________________________________________________ (Signature now requested to be admitted)

This difference in the signature is because ________________________________________________________________________________________________

Yours faithfully,

___________________________________(Signature of the Customer) Signed in my presence

Name & Signatures of the Officer(Name of the Customer) along with Signature Code Number

YYYYMMDDDate:

Declaration Regarding Signingin Vernacular Language / By Illiterate / Blind Person

I, Mr./Ms._________________________________________________________________ (the Declarant - either Bank Official or customer of Bank) have read out and

explained the contents of this Account Opening Form of DCB Bank Limited (the Bank) to the Applicant(s) Mr. / Ms. ____________________________________________

in _____________________________ language and he / she / they have confirmed that he / she / they has / have understood the same and have agreed to abide by all

the terms and conditions of the said Account Opening Form. Pursuant to the same the aforesaid Applicant(s) is / are affixing his / her / their signature(s)/thumb

impression(s) as given herein below:

___________ ___________ ___________ ___________Name and signatures of Applicants Name and signature of the Declarant

Date :_____________ Place :_____________

Declaration

Signature of Primary Applicant Signature of Joint Applicant 2Signature of Joint Applicant 1

I / We have read, understood and hereby agree to the “Terms and conditions as applicable to my / our account” set forth on DCB Bank Limited (“DCB Bank”, “the Bank”) website at www.dcbbank.com. I / We understand that access to any changes / updates in terms and conditions applicable to this relationship shall be available on the Bank’s website only. I / We do hereby declare that information furnished in this Form is true and correct to the best of my / our knowledge and belief. I / We hereby authorize issuance of ATM / Debit Card and provision of Phone Banking, Mobile Banking Services, Internet Banking and Bill Payment Services. I / We am / are aware of Charges Applicable for various services offered and I / we affirm, confirm and undertake that I / we have read and understood the “Terms and Conditions” for usage of the Phone Banking, Mobile Banking Services, Internet Banking and Bill Payment Services of DCB Bank as set forth in the Bank's website www.dcbbank.com and I / We will adhere to all the terms and conditions as applicable from time to time. I / We further authorize the Bank to debit my / our Account(s) towards any applicable charges for any / various service / services provided as applicable from time to time.

I / We understand and agree the consent given for updation / registration / requests for free Mobile alert facility shall be valid till such time I / we withdraw the same in writing. Unless specifically advised, the Bank will continue to send SMS alerts on the number requested by the Authorised signatory/ies of the Firm / Company / Trust / Association / Society. The Bank shall not be responsible and liable for any consequences which may arise owing to change in name/s of authorized signatories or partners or directors or trustees or members of the Firm / Company / Trust / Association / Society.

I / We declare, confirm, understand, accept, acknowledge and agree:

(a)That all the particulars and information given in this application form (and all documents referred or provided therewith) are true, correct, complete and up-to-date in all respects and I / We have not withheld any information. I / We understand certain particulars given by me / us are required by the operational guidelines governing banking companies. I / We agree and undertake to provide any further information as and when the Bank may require. (b) That I / we have had no insolvency proceedings initiated against me / us nor I / we have ever been adjudicated insolvent. (c) That I / we have read the application form and brochures and am aware of all the terms and conditions of availing finance or service or products from the Bank. (d) That the Bank reserves the right to reject any application without providing any reason and reference to me / us. I / We agree and understand that the Bank reserves the right to retain the application forms, and the documents provided therewith, including photographs, and shall not return the same to me / us. (e) To inform the Bank regarding change in my residence /employment and to provide any further information as and when the Bank may require from time to time. (f) That if the Account is under Corporate salary Scheme: • I / We have also read and understood “Terms and Conditions” under which Salary Scheme is offered to my / our organization and employees. • I / We agree that my / our employer has full right to reserve any instruction given by them to credit my account for any amount within a period of three working days and I / we will not dispute or hold the Bank responsible for such debits in my / our account. • I / We understand that it is my / our responsibility to inform (in writing) the Bank immediately on termination of my / our employment with my / our current employer, whereupon I / we will cease to enjoy any or all benefits under Salary account scheme. (g) That I / we shall not hold the Bank liable for furnishing of the processed information / data / products thereof to other Banks /Financial Institutions / Credit Providers / Users registered as above. (h) That I / we have to complete further application for specific liability products / services from the Bank as prescribed from time to time, and that such further applications shall be regarded as an integral part of this application (and vice versa), and that unless otherwise disclosed in such further forms as prescribed, the particulars and information set forth herein as well as the documents referred or provided herewith are true, correct, complete and up-to-date in all respects. (i) That such further applications will require incorporation of the application form number, and / or such details as the Bank may prescribe, to facilitate data management. (j) That I / we authorize the Bank to issue a Debit cum ATM Card to me / us. (k) That the issue and usage of the Debit cum ATM Card is governed by the terms and conditions as in force from time to time and I / we agree to be bound by the same. (l) That the terms and conditions of Debit cum ATM Card are liable to be amended by the Bank from time to time. (m) That I / we unconditionally and irrevocably authorize the Bank, to debit my / our Account annually with an amount equivalent to the fee and charges for use of the Debit cum ATM Card. (n) That in case of death of any or more of the joint applicant(s), the proceeds would be paid to the survivor(s) at the Bank's discretion, on request before due date (subject to penal clause for premature payment as may be stipulated from time to time) as per mode of operations indicated above. (o) That continuation of the account with the Bank is at the sole discretion of the Bank and in case the Bank is dissatisfied with the conduct of the Account / accountholder, the Bank has the right to close the account after giving me / us one month's notice or withdraw the concessions in to or any service granted to me / us or charge the Bank's applicable rates for such services. (p) That the Bank may at its absolute discretion, discontinue any of the services completely or partially without any notice to me / us. (q) That in case of return of Account Opening Amount (AOA) cheque, for any reason whatsoever, the Bank would close the account without any reference to me / us. (r) that on receipt of written application from any of the Authorised Signatory(ies) and / or survivor or survivors of us, the Bank at its sole discretion and subject to such terms and conditions, grant a loan / advance / renew / enhance against the security / collateral issued in joint names. (s) That DCB – On The Go facility will be offered to customers whose account is an individually operated resident account. (t) That DCB mobile Banking will also not be available to Non Resident Accounts.

I/We understand that the Bank is relying on this information for the purpose of determining the status of the applicant named above in compliance with FATCA (Foreign Account Tax Compliance Act) / CRS (Common Reporting Standards).

The Bank is not able to offer any tax advice on CRS or FATCA or its impact on the applicant. I/we shall seek advice from professional tax advisor for any tax questions.

I/We agree to submit a new form within 30 days if any information or certification on this form becomes incorrect.

I/We agree that as may be required by domestic regulators/tax authorities the Bank may also be required to report, reportable details to CBDT (Central Board of Direct Taxes) or close or suspend my / our account.

I/We certify that I/we provide the information on this form and to the best of my/our knowledge and belief the certification is true, correct, and complete including the taxpayer identification number of the applicant.

Group Personal Accident Insurance Plan: Applicable only to Primary Applicant

(a) That I hereby opt to enroll under Group Personal Accident Insurance Plan (“Plan”). The terms and conditions of the Plan have been duly explained by DCB Bank and I have completely understood the same. (b) That I authorize DCB Bank to debit the above chosen premium amount from my DCB Bank Account towards the payment for this Plan. (c) That the insurance cover shall start on 1st day of the succeeding month of the premium amount debit in my DCB Bank Account (“commencement date”). (d) That this insurance cover will be valid for a period of 1 (one) year from the commencement date, provided I continue to remain a DCB Bank account holder during this period. (e) That in case auto renewal is chosen without specifying tenure, policy will be auto renewed for a tenure of 1 (one) year by default and applicable premium amount debited from my DCB Bank Account. (f) That in the event of an admissible claim due to my death, my nominee shall be receiving the claim amount. (g) That DCB Bank shall not have any role in the claim process and the claim shall be processed and settled by Royal Sundaram General Insurance Co. Ltd. (“Royal Sundaram”), as per the claim process stipulated by Royal Sundaram, from time to time. (h) That the claim shall be processed as per the terms and conditions of the Master Policy No. PADCB00001 issued to DCB Bank by Royal Sundaram.

Group Personal Accident Insurance: Applicable only to Primary Applicant

This application is for Group Personal Accident Insurance Cover only. It is not a cover for Life Insurance or Mediclaim.

Section 41 of the Insurance Act, 1938 – Prohibition of rebates -

1. No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer.

Provided that acceptance by an insurance agent of commission in connection with a policy of life insurance taken out by himself on his own life shall not be deemed to be acceptance of a rebate of premium within the meaning of this sub-section if at the time of such acceptance the insurance agent satisfies the prescribed conditions establishing that he is a bona fide insurance agent employed by the insurer.

2. Any person making default in complying with the provisions of this section shall be punishable with fine which may extend to five hundred rupees.

Please call DCB 24-Hour Customer Care to enquire about your account application status

DCB Bank Limited

DCB 24-Hour Customer Care

Call Toll Free: 1800 209 5363

Email: [email protected]

Web: www.dcbbank.com

Information Details

Countries where business associates located (for Businessmen, only)

Source of Funds for Credits in the Account

Other (please specify)

Investments

Savings Sale of PropertySalary

Inheritance

Business Proceeds

Professional fee

Wire Transfers Expected Yes

Yes

Into the Account No

No

Value `

Yes No Approximate Value `

Value `From the Account

Foreign Inward Remittances Expected

Customer Information & Due Diligence (CIDD) Form - For Primary Applicant

Information Details




Investments


Inheritance

Business Proceeds

Professional fee


Yes

Into the Account No

No

Value `




Customer Information & Due Diligence (CIDD) Form - For Joint Applicant 1

Acknowledgement 0159236Please provide this number for future reference

Nomination Form Received: Yes No

Date: YYYYMMDDSignature of Bank Official

Branch:Employee code:

1st Applicant’s Name:

Joint Applicant 1:

Joint Applicant 2:

Name of the Bank Official:

Name of the Nominee:

DCB Bank Limited M026 / Nov 16 / 2.1481-Ver 1.1-March 2014

Information Details




Investments


Inheritance

Business Proceeds

Professional fee


Yes

Into the Account No

No

Value `




Customer Information & Due Diligence (CIDD) Form - For Joint Applicant 2

For OfficeUse OnlyConfirmation “I confirm having met the Applicant/s in person.”

I confirm having met Mr. / Ms. __________________________________________________________________________________________________________, in person at

c DCB Bank Limited, ____________________________________ Branch, c Current Residential Address, c Permanent Address, c Office Address (anyone address

as mentioned in the application form) and hereby confirm the identity and address as provided in this account opening form and also confirm having verified the copy

of the documents (as applicable) against originals as produced by the applicant/s.

I also confirm that the form has been signed by the applicant is in my presence. I have also verified the Tel. No. _________________________________ by calling the no.

mentioned in this account opening form.

Name of OfficialBank : Mr. Mrs. Ms.

Employee No.: YYYYMMDDDate:Signature of Bank Official

For Bank Use Only

Any of the Signatories / Beneficial Owners of the entity a Political /Public Figure or related to a Political / Public Figure

Yes No if yes, please give position

Does it seem that the initial Deposit and/or the declared transaction profile is in line with the status/occupation declared?

Yes No

_______________________________________________Signed in my presence

Name & Signatures of the Officer along with Signature Code Number

15

Signatures and Photographs

Approved by BM / BSOM (Name, signature with signature code) with seal*Incase of Thumb Impression, “Sign in BM/BSOM presence”

Please do notforget to collect

yourAcknowledgment

slip

YYYYMMDDDate:

Please affixa recent

photograph.

Please signin “Black Ink”

withinthe box.

“Signatureshall be

consideredfor all Cheque

clearancesand

any futurecommunicationwith the Bank”

YYYYMMDDDate:

YYYYMMDDDate:

Thumb Impression

Thumb Impression

Thumb Impression

Signature

Signature

Signature

Please affix

a recent

photograph

Sign across the photo

Please affix

a recent

photograph


Please affix

a recent

photograph


Primary Applicant

Joint Applicant 1

Joint Applicant 2

DCB Family Savings Account

Link minimum 2 & maximum 5 family savings accounts in a group

Earn upto ` 20,000* p.a cash back on all debit card spends at merchant establishments with your DCB Debit Card, issued for each family member

DCB Bank LimitedDCB Bank Limited*Terms & conditions apply.*Terms & conditions apply.