Andhra Bank Comp No: 8004

(A Government of India Undertaking) (For Individuals and Joint Applicants)

_________________________ Branch (Please tick (
) in the appropriate box)

Application Form for opening of

Account No: (For bank's use)
a Current Deposit Account
Please open the Type of Account indicated with a tick (
) in the following table.
Type of Account With Ordinary Cheque Book
/ Personalized Cheque Book

Current Deposit Account (Ordinary) / (NRO)
Corporate Salary Flexi Current Deposit Account 

Insured Current Deposit Account (ICD) 
AB Premium Current Account 

Current Deposit Flexi Account 


 Prescribed option letter should be submitted.
Name(s) of the applicant(s) in full and in capital letters
Sole/First Applicant:
1 Date of birth (DD-MM-YY) Customer ID (For bank's use)
If PAN is available PAN If PAN is not available Form 60
/ Form 61

(Enclose Copy of PAN) No: (Submit Form 60 or 61) Enclosed in duplicate.
Second Applicant:
2 Date of birth (DD-MM-YY) Customer ID (For bank's use)
If PAN is available PAN If PAN is not available Form 60
/ Form 61

(Enclose Copy of PAN) No: (Submit Form 60 or 61) Enclosed in duplicate.
Third Applicant:
3 Date of birth (DD-MM-YY) Customer ID (For bank's use)
If PAN is available PAN If PAN is not available Form 60
/ Form 61

(Enclose Copy of PAN) No: (Submit Form 60 or 61) Enclosed in duplicate.
Singly
, Either or Survivor
, Former or Survivor
, Latter or Survivor
Any One or
Mode operation.
Survivor
, Jointly
. Any other combination (Specify) ________________________.
Account of Minor. Operation by Guardian Customer ID of the Guardian:
If operation by others. Mandate Holder
GPA Holder
His/Her Customer ID
Mobile No
Address for
communication
Passbook/Statement? Passbook
Statement
- In Monthly, Quarterly, Half Yearly, Annual frequency
Nomination facility Required
Not Required
Submit Form DA1 if Nomination is required.
Source of Funds, Expected Source of Funds:
Turnover and Balance Expected Turnover Rs: Expected Balance Rs:
Other facilities Debit Card
, Mobile Alerts
Internet Banking
(Submit relative Application Form).
Borrowings from other banks: No borrowings from other banks
/Borrowings from other banks are as under

No Bank and Branch Name Type of facility Sanction Date Limit Rs Liability

(Applicant(s), Guardian, Mandate/GPA Holder should submit Personal Data Form if he/she is not an existing customer.)
I/We hereby declare that the information given above is true and correct to the best of my/our knowledge. I/We further
declare that I/We accept the Terms and Conditions of the deposit scheme, which are provided to me/us. I/We agree that
the Terms and Conditions may be modified by the bank from time to time, which will be binding on me/us for conduct of
the account.
Place:______________ (1) ____________________ (2)____________________ (3) ____________________
Date: ______________ [Signature(s) / Thumb Impression(s) of the Applicant(s)]
(Specimen Signature(s) / Thumb Impression(s) of persons authorized to operate the account)
S Customer ID Name of the Applicant / Guardian / Authorized Specimen Signature /
No (For bank's use) Signatory Thumb Impression
1

3
(Verification)
Application is filled in completely and is verified. Signature(s) /
Thumb Impression(s) is/are affixed in my presence. Signature of Verifying Officer and Signature No:
I.
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