1. 2. 3.

6.

SAVING AND TERM DEPOSIT ACCOUNT OPENING FORM (RESIDENT INDIVIDUALS)

also

Name of Applicants [Use separate KYC forms (Annexure 3) for providing information of each applicant]

2.1 1. 2. 3.

Same as AADHAAR / Current / Permanent / Overseas Address details (In case of multiple correspondence / local address please fill ‘Annexure A1’)

*Mobile registration will link to SMS alert facility (Refer conditions under para 13 of Declaration & Undertaking)

PAN NUMBER*

AADHAAR No.*

DMS Ref No.

Account/Wk No.

Branch Sol-Id

Scheme Code

Scheme Sub Type

L A S T N A M E

L A S T N A M E

L A S T N A M E

L A S T N A M E

M I D D L E N A M E

M I D D L E N A M E

M I D D L E N A M E

M I D D L E N A M E

F I R S T N A M E

F I R S T N A M E

F I R S T N A M E

F I R S T N A M E

PR EF IX

PR EF IX

PR EF IX

PR EF IX

Ÿ I hereby declare that the details furnished above and in attached “annexure 1” are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.

Ÿ I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email address.

FATCA / CRS / OTHER:(A) Under penalty of perjury, I/we certify that: 1. The applicant is (i) an applicant taxable as a US person under the laws of the United States of America (“U.S.”) or any state or political subdivision thereof or therein, including the District of Columbia or any other states of the U.S.,

(ii) an estate the income of which is subject to U.S. federal income tax regardless of the source thereof. (This clause is applicable only if the account holder is identified as a US person) 2. The applicant is an applicant taxable as a tax resident under the laws of country outside India. (This clause is applicable only if the account holder Is a tax resident outside of India) (B) 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/CRS. 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 . (C) I/We agree to submit a new form within 30 days if any information or certification on this form becomes incorrect. (D) 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 or close or suspend my account. (E) 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.DECLARATION(F) I/We confirm having received, read and understood the Most Important Terms and Conditions & BSBDA Terms & Conditions (enclosed) and hereby agree to be governed by them for the accounts which I/we am/are opening with Dena

Bank along with the amendments from time to time on various services). I/We accept and agree to the bound by the said terms and conditions stated above including those which are limiting the Banks liability.(G) I/We understand that the Banks as its sole descretion amend or discontinue any services completely or partially without any notice to me/us. (H) I/We agree that the Bank may debit my account for service charges as applicable from

time to time. (I) l/We also declare that the authorisations and declarations given by me/us to the Bank herein are out of my/our free will with full knowledge and awareness.(J) I/We hereby declare that the information furnished above and also in the personal information form is true and correct to my best of my/our knowledge. (K) I/We authorise the Bank/their representatives to verify the details given in

these forms for due diligence. (L) In case of jointly held accounts, communication will be sent to first holder of the account. (M) SMS alerts will be on chargable basis. (N) I/We confirm that l/We do not have any existing customer ID /customer IDs apart from the one mentioned. In case found otherwise, Bank reserves right to consolidate the customer IDs as it may decide, without any prior notice to me. (O) l/We understand that all alternate channels including but not limited to internet banking, mobile banking, debit card, etc will be provided only to 1st Applicant

AADHAAR CONSENT I submit copy of my aadhaar letter self attested and voluntarily give my consent to ; 1. Seed my Aadhaar Number issued by the UIDAI, Govt. of India in my name with my aforesaid account. 2. Map it at NPCI to enable me to receive Direct Benefit Transfer (DBT) from Govt. of India in my above account. I understand that if

more than one benefit is due to me, I will receive all Benefit Transfers in this account. 3.Use my Aadhaar details to authenticate me from UIDAI. 4. Use my registered mobile number for sending SMS alerts to me. I have been given to understand that my information submitted to the bank herewith shall not be used for any purpose other than mentioned above, or as per requirements of law. I/we confirm having received Welcome Kit in an untampered / sealed condition and confirm that these deliverables have been received by me.1) Chequebook 2) Insta Rupay Card 3) Insta Card Pin 4) Welcome letter

1st Applicant 2nd Applicant 3rd Applicant

Religion

Category GN SC ST OBC Oth

/

Disabled Y N

Source of Income

Estimated Annual Income

Net-Worth

Political Connected Person Y N

Country of Birth

Expected Level of Turnover p.a.

# Please fill from the following: (a) Illiterate, (b) Primary School, (c) Under Graduate, (d) Graduate, (e) Post Graduate

Page 2

Account sourced by Business Correspondent/Buiness Facilitator- Yes/No, if yes Code No. of BC/BF_________________________It is confirmed that information furnished by the applicants has been properly entered in the systemby us. Applicant has signed in my presence. Further confirmed that KYC verification has been doneby us as per Bank guidelines.

HRMS ID___________________ P.A. No.__________________ Date _________________

12. CKYC DECLARATION

11. PERSONAL INFORMATION

DOB

Relationship____________________ Address ______________________________________________________________________________________________________________________________________________________________________________________________________________

Self Certification: (To be filled only if Name of the Country of Birth / Citizenship / Residence for Tax Purpose is other than India and TIN of the functional equivalentis not available OR if US person status is mentioned as Yes and TIN is not available)

Page 3

ANNEXURE 1: TO BE FILLED ONLY FOR NON E-KYC CUSTOMER, RESIDENT OUTSIDE INDIA, MINOR OR ILLITERATE

Page 4

Verification

I/We, ______________________ do hereby declare that what is stated above is true to the best of my knowledge and belief. I further declare that I do not have a Permanent account number and my/our estimated total income(including income of spouse, minor child etc. as per section 64 of Income tax Act 1961) is computed in accordance with the provisions of Income-tax Act 1961 for the financial year.

Verified today, the__________________ day of______________ 20____ Place_______________

ANNEXURE 2: TO BE FILLED ONLY IF INDIVIDUAL DOES NOT HAVE PAN

L A S T N A M E

L A S T N A M E

L A S T N A M E

L A S T N A M E

M I D D L E N A M E

M I D D L E N A M E

M I D D L E N A M E

M I D D L E N A M E

F I R S T N A M E

F I R S T N A M E

F I R S T N A M E

F I R S T N A M E

PR EF IX

PR EF IX

PR EF IX

PR EF IX

*

ANNEXURE 3: TO BE FILLED ONLY FOR JOINT HOLDER (C-KYC DETAILS FOR ADDITIONAL PERSON)

DETAILS FOR TERM DEPOSIT

It is in interest of the Term Deposit account holders to also maintain Savings/Current account with the Bank to facilitate smooth disbursement of interest or payment of proceeds on term deposits.

Whether nominee name should be printed in Passbook/Term Deposit Receipt?

Declaration: All other information provided by me in the account opening form submitted to Bank remain unchanged and binding on me/us.

Mandate for account operation

Account sourced by Business Correspondent/Buiness Facilitator- Yes/No, if yes Code No. of BC/BF_________________________It is confirmed that information furnished by the applicants has been properly entered in the systemby us. Applicant has signed in my presence. Further confirmed that KYC verification has been doneby us as per Bank guidelines.HRMS ID___________________ P.A. No.__________________ Date _________________

Acknowledgment of Nomination

From: ____________________________________________________

P.A. No.

Acknowledgment of Account Opening Form

Place: _________________________

From: ____________________________________________________

P.A. No.

Place: _________________________

Received Application Form for Customer ID Received Nomination for Customer ID

15. In case of any unauthorized electronic banking transactions if the time taken to report the fraudulent transaction is within 3 working days from the date of receiving the communication then the customer liability would be nil. In case the time is between 4 to 7 working days then the maximum liability in BSBD Account would be Rs. 5,000 or transaction value whichever is lower and Rs. 10,000 or transaction value whichever is lower, for all other savings account. In case the time of reporting is beyond 7 working days, the customer liability shall be unlimited / to the extent of the transaction.

Stop Payment Charges Rs 100/- per cheque leaf (Max 500/- per request)

*At the end of each quarter the calculation of QAB will be calculated by system and wherever the shortfall will be observed, an SMS will be sent on registered mobile number. After expiry of 30 days (i.e. at the end of next month of the preceding quarter), system will calculated the average balance of 4 months and verify whether minimum QAB is restored. If min. QAB is not restored the following charges will be levied proportionate to shortfall in minimum QAB.

25% of Rs 150/-

50% of Rs 150/-

75% of Rs 150/-

100% of Rs 150/-

(20 leaves per calender year free)

Savings Rs.150/- Rs100/- per cheque book of 20 leaves.

Rs.2.00 per entry (min Rs150/- , Max Rs5000/-)

Personalised Cheques Non-Personalised Cheques Beyond that Rs. 3.00 per leaf

Rs 100/- (one time charge) For Execution of SI Rs 100/- + Remittance charge if applicable

Rs 100/- per transaction

For Registration of Standing Instructions (SI)

For Non Execution of SI (due to insufficient fund)

Within 14 days of first credit NIL From 15 days to 1 year from first credit in the account Rs 200/-

CHARGES FOR CLOSURE OF SAVINGS ACCOUNT

Withdrawal either by Cheque or other (except Digital Banking transaction)exceeding 40 per half year.

Rs. 5/- per withdrawal. In Savings Account, cheque Book upto 20 leaves will be issued free every year.

Charges for Confirmation / Verification of specimen Signature/Photo Rs100/- per reference.

Charge for Addition / Deletion of Name / Change in address /Mobile No. / email address etc.

Rs100/- per occasion. No charge for deletion of name of deceased customer.

Intersol charges for Cash Deposit at local / outstation non base branches UptoRs 25,000/- per day : NIL; Above Rs 25,000/- uptoRs 50,000/- per day : Rs 25/-; Above Rs 50,000/- uptoRs. 1,00,000/- per day : Rs 50/-; Above Rs 1,00,000/- per day : Rs.100/-

Intersol charges for Cash Withdrawal at non base branch (local / outstation) Is restricted to Rs. 50,000/-.(Third party withdrawal not permitted); UptoRs 25,000/- per day : NIL; Above Rs 25,000/- per day : Rs 2 per thousand or part thereof (Min. Rs 50/-)

Rs 10/-

(For Rupay classic / Visa Silver Debit cards) Joining Charges : First Year Free. Second year onwards Rs.150/- per year

(For Platinum Debit cards) Joining Charges : First Year Free. Second year onwards Rs.200/- per year

(For Visa Gold Debit Card ) Joining charges: Rs.500/- every year.

Replacement of lost card : Classic / Silver / KCC/ Mudra / Stree Shakti - Rs.150/- per instance , Platinum - Rs.200/- per instance, Gold Card- Rs.500/- per instance

Regeneration of PIN : Rs.75/-

ATM Usage Charges on Dena Bank ATM: 5 free transactions per month post which

Financial Transactions Rs.25/- per transaction per month Non Financial Transaction Rs.10/- per transaction

ATM Usage Charges on Other Bank’s ATM: Free transactions per month Metro ATM – 3, Non Metro – 5, post which

Financial Transactions Rs.25/- per transaction per month Non Financial Transaction Rs.10/- per transaction

Outward Cheque/Bills return charges

Upto Rs10,000/-: Rs.150; Above Rs.10,000/-: Rs.250

Inward Cheque/Bills return charges

Upto Rs 100,000/-: Rs.150; Above Rs.100,000/-: Rs.250