account opening form - dcb bank must sign the account opening form (aof) in the presence of bank...
TRANSCRIPT
Account Opening Form
For Individuals
DCB Bank Limited M026 / Nov 15 / 1.9481-Ver 1.1-March 2014
Instruction for filling Account Opening Form
ABC
Description of Document Can be obtained for
AddressIdentity
Micro Finance Customers Additional Documents that can be Obtained
*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.
Letter / Certificate issued by the Village Sarpanch / Mukhiya / Village Administrative Officer / Village Panchayat / Panchayat Secretary / Block DevelopmentOfficer / Panchayat President / Panchayat Council Officer / Gazetted Officer / Revenue Officer / Mandal Officer, containing the name, recent photograph and address of the applicant
Copy of Farmer Passbook issued by Public Sector / Co-operative Banks
Extracts of Land Records or Land ‘Khata’ maintained by a Government authority at the local level
Caste Certificate issued by an authorized Government entity
Letter / Certificate issued by the Village Sarpanch / Mukhiya / Village Administrative Officer / Village Panchayat / Panchayat Secretary / Block DevelopmentOfficer / Panchayat President / Panchayat Council Officer / Gazetted Officer / Revenue Officer / Mandal Officer, containing the name, recent photograph and address of the applicant
Copy of Farmer Passbook issued by Public Sector / Co-operative Banks
Extracts of Land Records or Land ‘Khata’ maintained by a Government authority at the local level
Caste Certificate issued by an authorized Government entity
Certificate from the Post Office / Postal Authorities
Certificate from the Ward Officer or, from an Officer of equivalent rank, maintaining Election Rolls
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*
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 *
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
Relationship Form
Savings
Branch: SOL Code:
“I / We hereby apply for a relationship with your Bank under which I / we wish to open an account.”
Date: YYYYMMDD
Classic Premium BSBDA Privilege Banking (HNI) Elite Corporate Payroll (Basic) Corporate Payroll (Plus)
Others (please specify including Personal Current A/c.)Fixed Deposit
Personal Details : Applicant 1 (* Fields are Mandatory)
(First Name) (Middle Name) (Last Name)
*Date of Birth: YYYYMMDD
*Nationality:
*Gender: Male Female
Marital Status: Single Married *Mother’s Maiden Name:
Mailing Address: Residential Office Permanent (You must tick mark one option)3
Category:
Indian
General
Other (pl. specify)
OBC SC ST Others
Bank Use only (* Fields are Mandatory) Application No.: IND
RM / CSE / RO / CBE (Code):*Segment Code
Customer ID:
Account No.:
Funding: Txn. / ID No.: YYYYMMDDDate: YYYMMDDValue Date: Y
Cash Back
*Short Name: Maximum 19 characters.
This namewould
appear on theDebit Card
*Status: Minor Sr. Citizen Pensioner Staff, if yes, Employee No.Other General
*Permanent Account Number (PAN): Form 60 Form 61
Current Residential Address:
Permanent Address:
City: Pin:
*Preferred Mobile No.:Telephone:(with STD Code)
City: Pin:
*Preferred Email Id:
Landmark:
State:Telephone:(with STD Code)
Landmark:
Office Address:
Address proofof mailingaddress ismandatory.Otherwise,
default addresspicked would be
CurrentResidential
Address
If PAN number is not available
please fill in Form 60 or
Form 61 (incase of agricultural income and if
one enters into any transaction
specified in rule 114B)
State: Country:
Same as Current Residential Address
City: Pin:
Landmark:
Extn.: Fax:(with STD Code)
State: Telephone:(with STD Code)
All alerts will besent to thepreferred
Mobile Numberand E-mail ID.
Mobile Numberwill be used forSMS Bankingregistration for
eligibleaccounts.
Your 12 digit unique identification numberAadhaar Number:
Maximum 32 characters.
*Card: Debit Card required
ATM Card required
Yes
Yes
No
No Cheque Book required
International Debit Card required Yes
Yes
No
No Visa
Rupay Yes
Yes
No
No
Type of card would be
based upon the product
*Name: Existing Customer ID:(If applicable)
Mr. Mrs. Ms. Dr. Prof. Capt. Others
Third Gender
4
Customer Profile
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
*Occupation: Salaried PoliticianBusiness Agri AlliedSelf Employed House Wife StudentRetired /Pensioner
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
To be filled ifthe occupation
is salaried
Salaried: Proprietorship Partnership Pvt. Ltd. Public Ltd. Public Sector Central / State Government
Multinational Others (Please specify):
To be filled if the occupationis self employed
Nature of Self Employment: Doctor CA / CS Lawyer Architect Consultant Engineer
Others (Please specify):Banking / Financial Services
To be filled ifthe occupation
is business
Nature of Business: Manufacturing
Jewellers
Trading Services Retailing Agriculture Stock Broker Real Estate
Others (Please specify):
*Preferred Mobile No.:Telephone:(with STD Code)
State: Country:
City: Pin:
##(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)
*Date of Birth: YYYYMMDD *Mother’s Maiden Name:
*Permanent Account Number (PAN): Form 60 Form 61
*Occupation: Salaried Self-employed Self-employed Professional Housewife Retired
Student Others (please specify):
Marital Status: Single MarriedRelationship with 1st Applicant:
*Short Name:
Joint Applicant 1
Current Residential Address:
Joint Applicant (* Fields are Mandatory)
Maximum 19 characters.This name would appear on the Debit Card
If PAN number is not available
please fill in Form 60 or
Form 61 (incase of agricultural income and if
one enters into any transaction
specified in rule 114B)
(First Name) (Middle Name) (Last Name)
Maximum32 characters
Your 12 digit unique identification numberAadhaar Number:
*Status: Minor Sr. Citizen Pensioner Staff, if yes, Employee No.Other General
*Preferred Email Id:
Landmark:
To be filled ifthe occupation
is business
Nature of Business: Manufacturing
Jewellers
Trading Services Retailing Agriculture Stock Broker Real Estate
Others (Please specify):
*Card: Debit Card required
ATM Card required
Yes
Yes
No
No Cheque Book required
International Debit Card required Yes
Yes
No
No Visa
Rupay Yes
Yes
No
No
Type of card would be
based upon the product
*Name: Existing Customer ID:(If applicable)
Mr. Mrs. Ms. Dr. Prof. Capt. Others
Third Gender
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 SurvivorJointlyOthers:(Please Specify)
Former or Survivor Guardian
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
Reverse Sweep (Transfer of funds from Savings Account to Term Deposit Account)
Facility required: Yes No (please tick appropriate options)2-Way Sweep Deposit Details:
BothSweep (Transfer of funds from Term Deposit Account to Saving Account)
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.
*Gender: Male Female
*Nationality: Indian Other (pl. specify)
*Date of Birth: YYYYMMDD *Mother’s Maiden Name:
*Permanent Account Number (PAN): Form 60 Form 61
*Occupation: Salaried Self-employed Self-employed Professional Housewife Retired
Student Others (please specify):
Marital Status: Single MarriedRelationship with 1st Applicant:
*Short Name:
Joint Applicant 2
Current Residential Address:
Maximum 19 characters.This name would appear on the Debit Card
If PAN number is not available
please fill in Form 60 or
Form 61 (incase of agricultural income and if
one enters into any transaction
specified in rule 114B)
(First Name) (Middle Name) (Last Name)
Maximum32 characters
Your 12 digit unique identification numberAadhaar Number:
*Status: Minor Sr. Citizen Pensioner Staff, if yes, Employee No.Other General
*Preferred Mobile No.:Telephone:(with STD Code)
State: Country:
City: Pin:
*Preferred Email Id:
Landmark:
To be filled ifthe occupation
is business
Nature of Business: Manufacturing
Jewellers
Trading Services Retailing Agriculture Stock Broker Real Estate
Others (Please specify):
*Card: Debit Card required
ATM Card required
Yes
Yes
No
No Cheque Book required
International Debit Card required Yes
Yes
No
No Visa
Rupay Yes
Yes
No
No
Type of card would be
based upon the product
*Name: Existing Customer ID:(If applicable)
Mr. Mrs. Ms. Dr. Prof. Capt. Others
Third Gender
6
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.
Name of Father / Mother / Guardian Signature of Father / Mother / Guardian
*Customer id:
* Incase Father / Mother / Guardian is an existing customer
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.
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
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
Payment Instructions(upon closure)
Transfer to DCB Bank A/c No.:
Issue Demand Draft Payable at
ONLY Simple Interest
payable for deposits of less than 6 months
tenor
Interest PaymentInstructions
Transfer to DCB Bank A/c No.:
Issue Demand Draft Payable at
Type of Deposit Monthly Interest Payout (MIC) Quarterly Interest Payout (QIC) Quarterly Compounded (RIC)
Tax SaverSimple Interest (for deposits less than 6 months)
Amount of Deposit Please issue Term Deposit in the Name(s) of Account Holder
by Cash/Debit to Account No.:
for an amount of `
(Rupees only)
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
Please tick here if you wish to receive physical Deposit Confirmatin Advice (DCA) otherwise your DCA will be sent at your registered email ID with the Bank.
Form 60 / 61 for Primary Applicant (to be filled by those who do not have either PAN or GIR) In case of Agriculture Income, please fill up form 61 separately.
Form 60 Form 61 [See provision to clause (a) of rule 114C(1)]
1. Full name and address of the Declarant:
2. Particulars of transaction:
3. Amount of the transaction:
4. Are you assessed to tax: Yes No
5. If Yes,
a) Details of Ward / Circle / Range where the last return of income was filed:
b) Reason for not having PAN / GIR No.:
6. Details of the document being produced in support of address in column (1):
Verification
I, hereby declare that what
is stated above is true to the best of my knowledge and belief. Verified today,
the day of 20
Date:
Place: Signature of the Declarant
Form of declaration to be filed by a person who has agricultural income and is not in receipt of any other income chargeable to income-tax in respect of transactions specified in clauses (a) to (h) of rule 114B.
1. Full name and address of the Declarant:
2. Particulars of transaction:
3. Details of documents being produced in support of address in column (1):
Yes No
I, hereby declare that my source of income is from agriculture and I am not required to pay income-tax on any other income if any.
Date :
Place : Signature of the Declarant
Verification
I, hereby declare that what
is stated above is true to the best of my knowledge and belief. Verified today,
the day of 20
Date:
Place: Signature of the Declarant
Form 60 / 61 for Joint Applicant 1 (to be filled by those who do not have either PAN or GIR) In case of Agriculture Income, please fill up form 61 separately.
Form 60 Form 61 [See provision to clause (a) of rule 114C(1)]
1. Full name and address of the Declarant:
2. Particulars of transaction:
3. Amount of the transaction:
4. Are you assessed to tax: Yes No
5. If Yes,
a) Details of Ward / Circle / Range where the last return of income was filed:
b) Reason for not having PAN / GIR No.:
6. Details of the document being produced in support of address in column (1):
Verification
I, hereby declare that what
is stated above is true to the best of my knowledge and belief. Verified today,
the day of 20
Date:
Place: Signature of the Declarant
Form of declaration to be filed by a person who has agricultural income and is not in receipt of any other income chargeable to income-tax in respect of transactions specified in clauses (a) to (h) of rule 114B.
1. Full name and address of the Declarant:
2. Particulars of transaction:
3. Details of documents being produced in support of address in column (1):
Yes No
I, hereby declare that my source of income is from agriculture and I am not required to pay income-tax on any other income if any.
Date :
Place : Signature of the Declarant
Verification
I, hereby declare that what
is stated above is true to the best of my knowledge and belief. Verified today,
the day of 20
Date:
Place: Signature of the Declarant
Form 60 / 61 for Joint Applicant 2 (to be filled by those who do not have either PAN or GIR) In case of Agriculture Income, please fill up form 61 separately.
Form 60 Form 61 [See provision to clause (a) of rule 114C(1)]
1. Full name and address of the Declarant:
2. Particulars of transaction:
3. Amount of the transaction:
4. Are you assessed to tax: Yes No
5. If Yes,
a) Details of Ward / Circle / Range where the last return of income was filed:
b) Reason for not having PAN / GIR No.:
6. Details of the document being produced in support of address in column (1):
Verification
I, hereby declare that what
is stated above is true to the best of my knowledge and belief. Verified today,
the day of 20
Date:
Place: Signature of the Declarant
Form of declaration to be filed by a person who has agricultural income and is not in receipt of any other income chargeable to income-tax in respect of transactions specified in clauses (a) to (h) of rule 114B.
1. Full name and address of the Declarant:
2. Particulars of transaction:
3. Details of documents being produced in support of address in column (1):
Yes No
I, hereby declare that my source of income is from agriculture and I am not required to pay income-tax on any other income if any.
Date :
Place : Signature of the Declarant
Verification
I, hereby declare that what
is stated above is true to the best of my knowledge and belief. Verified today,
the day of 20
Date:
Place: Signature of the Declarant7
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.
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 8 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).
Deathfor accident on duty by Rail / Road / Air
+ Permanent Total Disability + Double benefit for salaried person
Death + Permanent Total Disability
5,00,000
10,00,000
15,00,000
25,00,000
30,00,000
10,00,000
15,00,000
25,00,000
510
994
1,834
3,057
3,669
1,356
2,038
3,363
Sum Insured `Plan Premium ` Option Chosen (þ)Coverage
8
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
Plan A
Plan G
Plan B
Plan C
Plan F
Plan H
Plan D
Plan E
9
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 Alliance Insurance Co Ltd. 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 Alliance Insurance Company 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 Alliance Insurance Company Limited. 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 your registered Mobile No. and Email ID respectively.
If for any reason you need to communicate with Royal Sundaram Alliance Insurance Company Limited, 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 Alliance Insurance Company 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 Alliance Insurance Company Limited for complete information on terms, conditions and exclusions.
Royal Sundaram Alliance Insurance Company Limited, Sundaram Towers, 45 & 46, Whites Road, Chennai - 600014
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.
Deathfor accident on duty by Rail / Road / Air
+ Permanent Total Disability + Double benefit for salaried person
Death + Permanent Total Disability
5,00,000
10,00,000
15,00,000
25,00,000
30,00,000
10,00,000
15,00,000
25,00,000
510
994
1,834
3,057
3,669
1,356
2,038
3,363
Sum Insured `Plan Premium ` Option Chosen (þ)Coverage
Plan A
Plan G
Plan B
Plan C
Plan F
Plan H
Plan D
Plan E
Royal Sundaram Alliance 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
10
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.
* Kindly fill the following details:
Risk Classification for Primary Applicant
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 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
Expected number of transactions in a month: Up to 20 21 to 50 More than 50
Risk Classification of Account (L / M / H):
* 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):
* Kindly fill the following details:
Risk Classification for Joint Applicant 2
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
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
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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 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. (o) That the Bank may at its absolute discretion, discontinue any of the services completely or partially without any notice to me / us. (p) 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. (q) That DCB – On The Go facility will be offered to customers whose account is an individually operated resident account. (r) That DCB mobile Banking will also not be available to Non Resident Accounts.
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 Alliance Insurance Company Limited (“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.
13
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 15 / 1.9481-Ver 1.1-March 2014
14
Please call DCB 24-Hour Customer Care to enquire about your account application status
DCB Bank Limited
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
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 Joint Applicant 1
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 Joint Applicant 2
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
DCB 24-Hour Customer Care
Call Toll Free: 1800 209 5363
Email: [email protected]
Web: www.dcbbank.com
Signatures and Photographs
Approved by BM / BOM (Name, signature with signature code) with seal*Incase of Thumb Impression, “Sign in BM/BOM 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
Sign across the photo
Please affix
a recent
photograph
Sign across the photo
For OfficeUse Only
Signature of Bank Official
Confirmation “I confirm having met the Applicant/s in person.”
Name of OfficialBank : Mr. Mrs. Ms.
Employee No.:
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.
YYYYMMDDDate:
15
*Terms & conditions apply. DCB Bank Limited
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