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PMJDY Small Account BSBDA

(Same as ID Proof)

Divorce/Widow
VER. 3/BAN/INDIV ACC FORM/WPC/05-19

(Please fill Form 60 on Annexure 4, if you don’t have PAN)


(Same as ID Proof)

Divorce/Widow
VER. 3/BAN/INDIV ACC FORM/WPC/05-19

(Please fill Form 60 on Annexure 4, if you don’t have PAN)

2
*International transactions under Liberalized Remittance Scheme (LRS) are allowed only if a valid PAN has been submitted.

Cash Withdrawals (in `L) Cash Deposits (in `L)


Transaction Type 0-5L 5-7.5L 7.5-10L 10-15L >15L Transaction Type 0-5L 5-7.5L 7.5-10L 10-15L >15L

Cash Cash
Cheques / Drafts Cheques / Drafts
Funds Transfer Funds Transfer
Forex Forex

Expected Number of Withdrawals Per Month Expected Number of Deposits Per Month
0-15 16-30 31-50 51-100 >100 0-15 16-30 31-50 51-100 >100
Cash Cash
Cheques / Drafts Cheques / Drafts
Funds Transfer Funds Transfer
Forex Forex
VER. 3/BAN/INDIV ACC FORM/WPC/05-19
OTHER DETAILS

Will there be cross-border wire transfer into/from this account


If yes, please mention the countries from which you will receive inward wires (up to 5 countries)

If yes, please mention the countries to which you will send outward wires (up to 5 countries)

Do you expect to deposit money orders, cash letters or travelers’ checks with combined value greater than INR 6.75L per month in this account
VER. 3/BAN/INDIV ACC FORM/WPC/05-19
VER. 3/BAN/INDIV ACC FORM/WPC/05-19
VER. 3/BAN/INDIV ACC FORM/WPC/05-19

Citibank India does not market any product or service to individuals resident in the European Union, European Economic Area, Switzerland, Guernsey and Jersey.
This application form is not, and should not be construed as, an offer, invitation or solicitation to buy or sell any of the products and services mentioned herein to individuals
resident in the European Union, European Economic Area, Switzerland, Guernsey and Jersey.
VER. 3/BAN/INDIV ACC FORM/WPC/05-19

By submitting a copy of your Aadhaar Card to Citibank, you confirm and agree that the Bank has duly explained to you that submission of Aadhaar Card is no longer mandatory and you
have the option to submit any one of the above documents towards submission of KYC / proof of address document. You are providing your Aadhaar card as an officially valid document
proof to Citibank voluntarily and hereby authorize Citibank to use your Aadhaar as proof of address/KYC document in accordance with extant rules and regulations. In case you are
submitting/uploading copy of your Aadhaar card, please ensure to blacken out the Aadhaar number on the Aadhaar card before submitting/uploading so that it is not visible

2019

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