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    Dasarath 1

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    s9632636718
    Bank account

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    © All Rights Reserved
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    Dasarath 1

    Uploaded by

    s9632636718
    19 views3 pages
    Bank account

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    dasarath1

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    Bank account

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    19 views3 pages

    Dasarath 1

    Uploaded by

    s9632636718
    Bank account

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    SB - BARODA ADVANTAGE SAVING ACCOUNT (SB160)

    eKYC ACCOUNT OPENING FORM (BC POINT - System Generated)


    Ref.No. SB415917671943 Date: 07-JUN-2024

    Name of the Branch BASAVAKALYAN SOLID 6328


    Village/Town/City GULBARGA Sub District/Block Name BIDAR
    District BIDAR State KARNATAKA
    SSA Code/Ward No.
    Village Code/Town Code [as per Name of Village/Town [as
    803057 BASAVAKALYANCMC
    census 2011] per census 2011]
    Applicant Details:
    A/C Number 63280100025222 CUST ID XXXXX8985
    SB-BARODA ADVANTAGE SAVING
    A/C Type Scheme Code SB160
    ACCOUNT
    Full Name MR.Dasarath
    Marital Status MARRIED Gender MALE
    Name of Father MR DEVINDRAPPA SINGE
    Name of Mother MRS KAMALAMMA SINGE
    Name of Spouse
    Permanent Address
    Mogha Chincholi Gulbarga Karnataka Mogha Chincholi Gulbarga Karnataka BIDAR KARNATAKA IN 585324
    (As per Aadhaar)
    Declaration for Local Address when Address as per Aadhaar is different from current address: Declare that I submitted below Aadhaar as proof of
    Identity & Address for the purpose of account opening. However, I hereby declare that my current address is as under
    Mogha Chincholi Gulbarga Karnataka Mogha
    Current Address
    Chincholi Gulbarga Karnataka BIDAR Residing Since 01-01-1992
    (self-declared)
    KARNATAKA IN 585324
    Pin Code 585324
    Telephone No. XXXXXX1274 Date Of Birth 01-01-1992
    Mobile No. XXXXXX1274
    Aadhaar (masked) XXXXXXXXXX9849 PAN No. XXXXXXX36F
    Nationality IN Religion HINDU
    Category SC
    Disability No If Yes
    Education HSC
    Occupation/
    SELF EMPLOYED
    Profession
    Annual Turnover Rs.51000.00 Gross Income Rs.50000
    No. of Dependents
    Owning House Y No. of Animals owned
    Detail of Assets:
    Owning Farm N Any other
    Existing Bank A/c. of family
    NO If yes, No. of A/cs
    members/ household
    Kisan Credit Card N

    I request you to issue me a RuPay Card (Classic) in my name given above

    I request you to enroll me under Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY)
    I request you to enroll me under Pradhan Mantri Suraksha Bima Yojana (PMSBY)

    I request you to enroll me under Internet Banking - Baroda Connect

    I request you to enroll me under Mobile Banking - Bobworld

    I request you to enroll for under SMS Alerts


    Declaration cum undertaking

    I hereby apply for opening of a NON-BSBD Bank Account. The terms and conditions applicable have been read over and explained to me and
    have understood the same. I shall abide by all the terms and conditions as may be in force from time to time.
    I hereby declare that I have submitted the Aadhaar Card issued by UIDAI voluntarily for identification and address proof towards the
    compliance of KYC norms under the PMLA, 2002. I hereby consent that the Bank may verify the same with UIDAI and authorise the UIDAI
    expressly to release the identity and address through biometric authentication.
    I hereby consent that my Aadhaar number shall be seeded in my Bank Account for receipt of DBT benefits & AEPS Transactions/ AEPS
    alone/No Transactions.
    I declare that my Aadhaar is not seeded with any other Bank for receiving DBT benefits (I understand that NPCI will reject mapping request,
    if my Aadhaar number is already mapped to any other Bank). OR my Aadhaar is currently seeded with BANK OF BARODA and request you
    to change DBT mapping at NPCI from my account with that bank to my account with Bank of Baroda. (I understand that my NPCI mapping
    for receiving DBT benefit will not be changed from previous bank in the event of my PMJDY overdraft continuing to be outstanding in that
    bank)
    I declare that at the time of account opening, I have requested for

    a). issue of RuPay card (classic) and the Debit card to be issued in the name of MR.Dasarath

    b). Internet Banking- Baroda Connect

    c). Mobile Banking-BOBWORLD

    d). SMS Alert facility


    e). sEnrolment under the following micro insurance schemes

    i). PMJJBY (Pradhan Mantri Jeevan Jyoti Bima Yojana ii). PMSBY (Pradhan Mantri Suraksha Bima Yojana
    FATCA Declaration: I declare that I am a citizen of India by birth and resident in India as well as resident for tax
    purposes in India and not of any other country other than India
    I declare that the details furnished above are true and correct to the best of my knowledge and belief and I
    undertake to inform the Bank of any charges 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.
    I agree that my personal KYC details may be shared with Central KYC registry or any other competent authority. I
    hereby give consent to receive information from the Bank / Central KYC Registry / GOI / RBI or any other
    authority through SMS / e-mail on my registered mobile number / e-mail address. I also agree that the non-receipt
    of any such SMS / e-mail shall not make the Bank liable for any loss or damage whatsoever in nature.

    Form No 60 (If PAN is not provided)


    a) Agricultural Income NA
    b) Other than agricultural income NA

    I 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 estimated total income (including income of spouse, minor child etc., as per section 64 of Income Tax Act, 1961) computed in
    accordance with the provisions of Income Tax Act, 1961 for the financial year will be less than the maximum amount not chargeable to tax.
    Place:BASAVAKALYANCMC
    Date: 07-JUN-2024
    (Signature / LTI of applicant)
    Nomination From-DA1: (Under Section 45ZA of Banking Regulation Act, 1949 and rules 1985 in respect of Bank Deposits)
    I do not want to nominate anybody in this account
    I want to nominate the following person to whom in the event of my death the amount of this deposit particulars of which given above may be
    returned by Bank of Baroda
    I want the name of the nominee to be printed on the passbook

    Name of Nominee Relationship Address Pincode Age Gender Date of Birth in case of minor
    MOGHA
    KALBURGI
    KALBURGI
    KAMALAMMA SINGE MOTHER 585324 50 F 01-06-1974
    BIDAR
    KARNATAKA
    INDIA
    Person authorised to receive the amount on behalf of the nominee in the event of my /minor(s) death.

    Name of Guardian Relationship Address Pincode Age Gender

    Obtain latest
    photograph not
    older than six
    month

    Place:BASAVAKALYANCMC
    Date:07-JUN-2024 (Signature/LTI of Applicant)
    Witnessed by - Name of BC agent:SAGAR NA KOID:11273709
    Address of BC agent:PANDARI GALLI, TIRPURANTH BASAVAKALYAN
    Signature of BC agent

    Enclosed: (1) Self attested copy of Aadhaar; (2) Self attested copy of PAN (if PAN is submitted).
    For office use At BC/CSP level

    Name of Primary
    SAGAR NA KOID 11273709
    BC agent:

    Date of submission
    Date of enrolment: 07-JUN-2024
    to link branch:

    Date: Signature of BC agent

    For office use at link Branch


    Particulars of a/c
    Received on: opened tallied with
    a/c opening form:
    Account No: 63280100025222 CUSTID: XXXXX8985
    A/c unfreeze in Photo & Signature
    FREEREC on: uploaded on:

    Date: Signature of BM at Link Branch

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