FORM SSA-1 CEU re) i ‘Relationship Beyond banking ATION FOR OPENIN' ‘SUKANYA SAMRIDDHI ACCOUNT’ To, ‘The Manager — Sir, 1 {rama of pareigueran hereby ep for opening an account under ‘Sukany Sams ‘Account’ scheme conan In the name of Kumar 7 ‘of whom I am the guardian and tender herewith © (z ) in ‘cashicheque/DD. No, asinitial subscription. at 1. Name of Accountholder (git child) Ku, Daughter of father/mother'sname) 3. DateofBirth (oD MM 1 yyy) (inwords) i. 4. Details of Bith Certificate (copymay please be enclosed) a) Certiicat No. b) Dateofissue ©) Issuing authority 5. NameofParent/ Guardian (Operating the account on behalf ofthe minor gi child) 6. [Details ofparent/ guardian (copy may please be enclosed) a) IDProofNo. b) —Dateofissue ©) Issuing authority 7. Address (Present) (Permanent) 8 Deltas of other KYC documents attached | hereby undertake to abide by the provisions / rules of the ‘Sukanya Samriddhi Account’ and amendments issued thereto rom time totime, "hereby dectare that have not opened OR | am not maintaining any other account under the seme scheme in the name of i (Name of gir child) in any other Branch of Bank of India or any other Bank or Post Ofce ‘Signature or thumb impression of Parent / Guardian ‘Additional Specimen Signatures Be aozart has been opened nthe name of Ku is 7 [Under ‘Sukanya Samriddhi Account scheme, smc.co, 13900004088 Signature and seal of competent authority