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VIJAYA BANK Branch :

DEPOSIT ACCOUNT OPENING FORM

Open Photo [to be stapled] Branch Manager

To VIJAYA BANK Branch :

Date :

Account No :

I / We remit herewith a sum of Rs. _________and request you to open ________account in the name/s furnished herein below : Name/s Occupation and address of the first depositor with Specimen nationality Signature/s

PAN No : Tel No :

Scheme under which the deposit is made Date of birth (in case of minor): Period of deposit Daily / Monthly deposit shall be ___________ days / months Rs .

Debit the instalments / credit interest and / or principal, as and when fall due, to my/our______A/c No:_____ with you. On maturity, please renew the deposit automatically for the same period until I revoke this instruction in writing. I shall abide by the rate of interest and other terms and conditions of this deposit scheme prevailing at that time. I/We hereby instruct you to send / not to send me / us the due notice in respect of this term deposit. Mode of operation / repayment shall be `Either or Survivor / `Jointly / No: 1 or Survivor / _____________. I/We agree to abide by the Bank s rules relating to this deposit scheme and maintain a minimum balance of Rs._____in Current Account / Savings Bank Account.

I/We nominate the following person: Name : _________________ Age: _____ Years. Relation : Address : Date of birth of the minor : ___________________ . As the nominee is a minor on this date, Sri / Smt. Address : is appointed to receive the amount of deposit of the nominee, in the event of my/our/minor s death during period of minority of the nominee. Signature of witness: Name & address : Introduction Yours faithfully,

I know the applicant/s personally for a period of years and confirm his / her / their occupation.

____________________________

____________________________ SIGNATURE ____________________________ Name : A/c No : Address :

____________________________

____________________________

Verified
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Other Required Particulars 1. Two passport size photographs, duly signed on the reverse, by the applicant and the introducer. 2. Declaration in Form No: 60 or 61 as the case may be. 3. Address proof.

4.

Two witnesses, In case of thumb impression.

For Office Use Only Account No Printed No Amount (Rs) Rate of interest (%) Period Date of maturity Amount payable (Rs) Initial of Clerk Officer