Kisan Application Form Nov 2021.cdr - DCB Bank

Kisan Application Form

DCB Bank LimitedDCB Bank LimitedDCB Bank Limited

Instruction for filling Account Opening Form

Please write your NAME as it appears in all your support documents

Hint boxes give tips and highlight important points across the form

Please fill the form preferably in ‘BLACK’ ink only

Please countersign in full for any overwriting / alteration

Specify the addresses along with City, State and PIN Code

Please tick the appropriate boxes

Please use in CAPITAL LETTERS only

ALL PHOTOCOPIES of documents to be SELF-ATTESTED by the applicant

Description of Document Can be obtained for

AddressIdentity

Indicative List of Documents that can be provided to open a Bank Account

Job Card issued by NREGA duly signed by Officer of the State Government

Passport

Letter issued by National Population Register containing details of name and address

Proof of Possession of Aadhar Number

Driving License

Voter's Identity Card

Proof of Possession of Aadhar Number

Utility bills – Electricity, Telephone, Water Bill, Piped Gas, Postpaid Mobile (not more than 2 months old), Property or Municipal Tax receipts, Pension or Family Pension Payment Orders issued to retired employees by Govt. Departments or PSU, Letter of allotment of accommodation from employer issued by State / Central Govt, Statutory or Regulatory bodies, Public Sector Undertakings, Scheduled Commercial Banks, Financial Institutions and Listed companies and Leave and Licence agreements with such employers allotting official accommodation.(Provided that customer must submit Official Valid Document with updated current address within a period of 3 months of submitting these documents)

Driving License

Passport

Letter issued by National Population Register containing details of name and address

Voter's Identity Card

Job Card issued by NREGA duly signed by Officer of the State Government

Please Note: 1. Customer must sign the Account Opening Form (AOF) in the presence of Bank officials.

Relationship Form

Savings

Classic Premium Value Saver Kisan Mitra A/c Others (please specify)

SOL Code:

Bank Use only (* Fields are Mandatory) Application No.: IND

Customer ID:

Account No.:

Funding: Txn. / ID No.: YYYYMMDDDate: YYYMMDDValue Date: Y

* Occupation Code: Applicant 1: Joint Applicant 1:

Joint Applicant 2: *Segment Code RM / CSE / RO / CBE (Code):

Branch: Date: YYYYMMDD

Please specify the occupation code as mentioned by customer in the form.

Employee Code:

Personal Details of Primary Applicant (* Fields are Mandatory)

(First Name) (Middle Name) (Last Name)

*Date of Birth: YYYYMMDD

*Nationality: Indian Other (pl. specify)

*Short Name:Maximum

19 characters.This name

wouldappear on the

Debit Card

*Status: Minor Sr. Citizen Pensioner Staff, if yes, Employee No.Other General

Maximum 32 characters.

*Name: Existing Customer ID:(If applicable)

Mr. Mrs. Ms. Dr. Prof. Capt. Others

*Gender: Male Female Third Gender

Marital Status: Single Married

*Country of Birth: *Place of Birth:

Please fill FATCA

Declaration Form if you are U.S.A. or other country citizen

/ resident

*Citizenship: *Residence for Tax Purposes:

U.S. Person: Yes No

*Mother’s Full Name:

*Father / Spouse Full Name:

*Mother’s Maiden Name:

*Residential Status: Resident Individual Non Resident Indian Foreign National Person of Indian Origin

Religion: Hindu Muslim Christian Sikh Buddhist Jain Parsi Others

*Account Type: NormalSimplified (for low risk customers)

SmallOTP based KYC

KYC Number:

Category: General OBC SC ST OthersMBC

*Occupation:

*Permanent Account Number (PAN): Form 60 If PAN is not available please fill in

Form 60

*Card: Debit Card required

Online Banking:

Yes No

Type of card & cheque book

issuance would be

based upon the product.

Passport Number: YYYMMDDExpiry Date: Y

Driving Licence: YYYMMDDExpiry Date: Y

Required if Passport or

Driving licence provide as Identity /

Address proof

Passport

NREGA Job Card:

Others:(any document notified by the central government)

Identification Number:

*Proof of Address: Driving Licence UID (Aadhaar) Voter Identity Card

NREGA Job Card Others

Simplified Measures Account Document Type Code

Voter Identity Card:

Your unique identification number *Aadhaar Number:

Internet BankingDCB � On The Go (Mobile Banking)

Current Address:

City: PIN:

*Landmark:

Office Address:

City: PIN:

Permanent Address:

City: Pin:

*Landmark:

Same as Current Address

State:Telephone:(with STD Code)

*Preferred Mobile No.:Telephone:(with STD Code)

State: Country:

Additional Contact No.:

*Preferred Email Id:

All alerts will besent to thepreferred

Mobile Numberand E-mail ID.

Mobile Numberwill be used forSMS Bankingregistration for

eligibleaccounts.

##(In case of minor, the Guardian to fill a Minor Declaration Form separately) If applicable, please attach age proof * Fields are Mandatory

Joint Applicant 1 (* Fields are Mandatory)

*Short Name:Maximum

wouldappear on the

Debit Card

Please fill FATCA

/ resident

U.S. Person: Yes No

SmallOTP based KYC

KYC Number:

Profile of Primary Applicant

Gross Annual Income (`): Less than 50K 50K - < 1.5 Lakhs 1.5 Lakhs - < 3 Lakhs 3 Lakhs - < 5 Lakhs

5 Lakhs - < 10 Lakhs 10 Lakhs - < 50 Lakhs 50 Lakhs and above

Existing Credit Facility: Home Loan Vehicle Loan Consumer Loan Education Loan Business Loan Credit Card

Agri Based Loan

Two WheelerVehicle: Four Wheeler Both None

*Occupation:To be filled if

the occupationis businessNature of Business: Others (Please specify):

Nature of Self Employment: Agri Others (Please specify): To be filled if the occupationis self employed

Education: Graduate Post Graduate Professional Others

Constitution of Applicant: Individual HUF Partnership Proprietor Company

Residence: Self-owned Rented Company Provided

if rented, monthly rent `:

Residence Type: Pucca Kachha / Temporary Shed Others

Tax Liability: YesLegal Litigation: No

No. of years at above residence

Agri Allied

issuance would be

Permanent Address:

City: PIN:

*Landmark:

State: Country:

City: PIN:

Current Address:

*Landmark:

*Occupation:

Form 60

*Card: Debit Card required

Online Banking:

Yes No

issuance would be

Address proof

Passport

NREGA Job Card:

Joint Applicant 2 (* Fields are Mandatory)

*Short Name:Maximum

wouldappear on the

Debit Card

Please fill FATCA

/ resident

U.S. Person: Yes No

SmallOTP based KYC

KYC Number:

*Card: Debit Card required Yes No

State: Country:

City: Pin:

Current Address:

*Landmark:

Permanent Address:

City: PIN:

*Landmark:

*Occupation:

Form 60

Online Banking:

Address proof

Passport

NREGA Job Card:

Others:

Details of Applicant’s Income and Employment

Self employed:

Turnover: Annual income `:

Name of proprietary / partnership concern:

Nature of Business: No. of years in current business:

Total no. of years in business: Office / Shop address:

Agricultural activity:

Land Owned by Self (Acres): Owned in Family: Lease Land:

Total Years in Agricultural activity: years

Crop Yield / Income Data for the Year: YYYY / YYYY

Land Area Under Irrigation (Acres):

Mode of Operation

Self Either or SurvivorJointly

Others:(Please Specify)

Former or Survivor Guardian Anyone or Survivor

Please note: Allcheques shouldbe CROSSED

and in favour of�DCB Bank

Limited� A/c

(Your Name)�

Initial Payment Details

(Bank)Drawn on: Amount `:

Debit to Applicant's DCB Bank A/c No.:

Amount in words:

Cheque, then Cheque No.: Cheque Dated: YYYYMMDD

Payment By Cash (To be deposited by the Applicant at teller counter only) Cash Deposited on: YYYYMMDD

Constitution:

Crop Planted No. of Acres Cultivated Sowing Month Harvest Month Yield Per Acre Total Value `Price Received Per Quintal (last year) `

Cost of Cultivation Per Acre

A B C D E

Allied Activity: Commercial Dairy Fishing Fish Farming Poultry / Hatchery Sericulture

Others (please specify)

Irrigation source: Bore Well Open Well Tube Well Talab / Tank River Canal

Unirrigated

F G H (B X E X F)

Name of the Firm:

Date of Incorporation / Registration:

Permanent Account Number (PAN):

GST Number:

Proprietorship Partnership Pvt. Ltd. Public Ltd. Trust / Soc. / Clubs

Others

Value of Plant and Machinery / Equipment: Annual Turnover:

Registered Address: Same as Office Address

State: Country:

City: Pin:

*Landmark:

Please Note: Reverse Sweep to Fixed Deposit account shall happen only, if the balance in the account exceeds threshold limit and Sweep shall happen if the balance in the account goes below the threshold limit. All deposits will be under Re-investment scheme with Auto Renewal Facility. This facility may differ from product to product and from time to time. Authorised signatory/ies of the Firm / Company / Trust / Association / Society are eligible for free Mobile alert facility subject to compliance of terms and conditions as stipulated by the Bank from time to time.

Account Statement: Frequency of statement would be as per the product feature.

Facility required: Yes No (please tick appropriate options)2-Way Sweep Deposit Details:

Investment: Life Insurance Mutual Fund Wealth Management General InsurancePassbook

Services

SMS Banking and Alert Facility:Alerts facility enables you to receive alerts on your Preferred Email Id and / or your Preferred Mobile No. regarding large debit, large credits, Standing Instruction failure, balance below Account Quarterly Balance and balance update. New alerts may be added from time to time.

Email Account Statement Utility Bills

Phone Banking Preferred Language Options: English Hindi Marathi Gujarati Tamil Telugu

Please fill a separate Mobile

Banking Registration

Form for Joint Account

Holder

I / We don�t wish to receive any Bank related promotional calls, SMS alerts or emails.

I / We don�t wish to link my/our Aadhaar Number to this account.(Please Note: Any 1 Aadhaar Number is linked to 1 Account Number to receive subsidy on the account)

Applicant’s Bank Details

Name of Bank Branch Account Status (Sole / Joint account) Account Number

Loan / Limit with Other Banks and Financial Institutions:

Bank / Financial Institution Name and Branch Account Number Purpose Facility Type Limit (`) Outstanding (`) Security

Name Address Contact Nos.

Purpose of Loan: DCB Agri Term Loan KCC (CC) KCC (CC + T.C.) Other Loan

Details (please specify)

DCB Tractor Loan

Details of security offered and facility required

For DCB Tractor Loan:

Product Description:(as per invoice / proforma invoice / quotation)

Manufacturer:

Dealer Name and Address:

Product condition (please select): New Used If used, year of manufacture: YYYY

Product is (please select): To be purchased Already owned by the Applicant

Quotation amount: ` Loan requested: ` Nature of Facility: Rupee Loan

Tenure of the Facility: months Purpose of the Facility:

Registration / Vehical Details:

Area of landholding: acres

Address of land as per Encumbrance Certificate 7/12:

Residential Property Commercial / Industrial property Gold Farm Equipment Tractor Two Wheeler

Car TV Refrigerator AC Microwave Washing Machine PCOthers (please specify)

Financial Assets:

PPF `:

RBI Bonds `:

Life Insurance `:

KVPs (Kisan Vikas Patra) `:

DCB / Other Banks Fixed Deposits `: Mutual Funds `:

Bonds and Debentures `:

NSCs (National Saving Certificate) `:

Signature and Stamp of the Organisation / Guarantor

Communication Address:

City: PIN:

Mobile No.:

State:

Country:

Authorised Signatories

are by default eligible for free SMS facility, if mobile no. is mentioned

Your 12 digit unique identification numberAadhaar Number: Designation:

Authorised Signatory / Guarantor - 1

Please affix

a recent

photograph

Sign across the photo

Existing Customer ID: Yes No (Please fill the below details)

*Name: Mr. Mrs. Ms. Dr. Prof.

*Date of Birth: YYYYMMDD *Gender: Male Female

*Permanent Account Number (PAN): Form 60

Third Gender

Form 60 for Primary Applicant (See second provison to rule 114B)

Form for declaration to be filed by an individual or a person (not being a company or firm) who does not have a permanent account number and who enters into any transaction specified in rule 114B

Date of Birth / Incorporation of Declarant: YYYYMMDDName: Mr. Mrs. Ms. Dr. Prof. Capt. Others

Father's Name (in case of individual)

Current Address:

City: PIN:

Preferred Mobile No.:Telephone:(with STD Code)

Landmark:

State: Country:

Amount of Transaction (`): Date of Transaction: YYYYMMDD

In case of Transaction in joint names, number of persons involved in the Transaction:

Mode of Transaction: Cash Cheque Card Draft / Banker's Cheque Online Transfer Other

If applied for PAN and it is not yet generated enter date of application and acknowledgement number YYYYMMDD

If PAN not applied, fill estimated total income (including income of spouse, minor child etc. as per section 64 of Income-tax Act, 1961) for the financial yearin which the above transaction is held

Aadhaar Number issued by UIDAI (if available):

Collateral Address:

City: PIN:

Mobile No.:

State: Country:

For DCB Crop / Term Loan

Purpose of CC Loan: Loan Amount `:

Purpose of Term Loan: Loan Amount `:

Collateral:

Estimated Collateral Value `: Description of Collateral:

Place: ____________ (Signature of Declarant)

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/ our 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 in which the above transaction is held will be less than maximum amount not chargeable to tax.

Verified today, on this ______________ day of ______________ 20_____

Verification

2. The person accepting the declaration shall not accept the declaration where the amount of income of the nature referred to in item 22b exceeds the maximum amount which is not chargeable to tax, unless PAN is applied for and column 21 is duly filled.

(i) in a case where tax sought to be evaded exceeds twenty‐five lakh rupees, with rigorous imprisonment which shall not be less than six months but which may extend to seven years and with fine;

(ii) in any other case, with rigorous imprisonment which shall not be less than three months but which may extend to two years and with fine.

Note: 1. Before signing the declaration, the Declarant should satisfy himself / herself / itself that the information furnished in this form is true, correct and complete in all respects. Any person making a false statement in the declaration shall be liable to prosecution under section 277 of the Income‐tax Act, 1961 and on conviction be punishable:

Form 60 for Joint Applicant 1 (See second provison to rule 114B)

Current Address:

City: Pin:

Landmark:

State: Country:

Agricultural income (`): Other than agricultural income (`)

Details of document being produced in support of identify in Column 1

Document code Document identification number Name and address of the authority issuing the document

Details of document being produced in support of address in Columns 4 to 13

Verification

Place: ____________ (Signature of Declarant) Note: 1. Before signing the declaration, the declarant should satisfy himself / herself that the information furnished in this form is true, correct and complete in all respects. Any person making a false statement in the declaration shall be liable to prosecution under section 277 of the Income‐tax Act, 1961 and on conviction be punishable,

(i) in a case where tax sought to be evaded exceeds twenty‐five lakh rupees, with rigorous imprisonment which shall not be less than six months but which may extend to seven

years and with fine; (ii) in any other case, with rigorous imprisonment which shall not be less than three months but which may extend to two years and with fine. 2. The person accepting the declaration shall not accept the declaration where the amount of income of the nature referred to in item 22b exceeds the maximum amount which is not chargeable to tax, unless PAN is applied for and column 21 is duly filled.

Landmark:

State: Country:

Form 60 for Joint Applicant 2 (See second proviso to rule 114B)

Current Address:

City: Pin:

Verification

Place: ____________ (Signature of Declarant)

Note: 1. Before signing the declaration, the declarant should satisfy himself / herself that the information furnished in this form is true, correct and complete in all respects. Any person making a false statement in the declaration shall be liable to prosecution under section 277 of the Income‐tax Act, 1961 and on conviction be punishable,

(i) in a case where tax sought to be evaded exceeds twenty‐five lakh rupees, with rigorous imprisonment which shall not be less than six months but which may extend to seven years and with fine;

(ii) in any other case, with rigorous imprisonment which shall not be less than three months but which may extend to two years and with fine. 2. The person accepting the declaration shall not accept the declaration where the amount of income of the nature referred to in item 22b exceeds the maximum amount which is not chargeable to tax, unless PAN is applied for and column 21 is duly filled.

Place : Date:

Name :

Address :

Signature :

Address :

Place : Date:

Signature :

Name :

*Strike out if nominee is not a minor. ** Where deposit is made / account is held in the name of the minor the nomination should be signed by a person lawfully entitled to act on behalf of the minor.

Witness(es):

Nomination Details (Form DA 1)

Yes, I want to nominate the following person No, I do not want to nominate anyone on my behalf

Address:

Nominee Name:

YRelationship with Applicant, if any YYYMMDDDate of Birth:YearsAge:

* As the nominee is a minor on this date, I / we appoint (Name & Address)

I / We nominate the following person to whom in the event of my / our / minor�s death the amount of the deposit / in the account may be returned by DCB Bank Limited

Preferable forSingle and Joint Account holders

Nominationunder Section45ZA of the

BankingRegulation Act, 1949

and Rule 2(1) of the Banking Companies (Nomination) Rules 1985 in

respect of bankdeposits.

In case you have specified a nominee above, please indicate if you wish to make mention of the nominee name on the passbook, statement and DCA issued in respect of your account and / or the passbook issued to you

I / We do hereby declare that what is stated above is true to the best of my / our knowledge and belief.

to receive the amount of the deposit / in the account on behalf of the nominee in the event of my /our / minor�s death during the minority of the nominee.

Yes No

Signature(s) / Thumb Impression(s) of Depositor(s)

Thumb impression isrequired to be

attested by2 witnesses.

In case of signature, no

witness isrequired.

Customer Information & Due Diligence (CIDD) Form - For Primary Applicant

Information Type Details

Countries where business associates located (for Businessmen, only)

Source of Funds for Credits in the Account

Other (please specify)

Investments

Savings Sale of PropertySalary

Inheritance

Business Proceeds

Professional fee

Wire Transfers Expected Yes

Into the Account No

Value `

Yes No Approximate Value `

Value `From the Account

Foreign Inward Remittances Expected

Country where the Individual / Entity based

Nature of business / Line of activity (in detail)

Expected number of transactions in a month Up to 20 21 to 50 More than 50

Signature of Primary Applicant

Financial Status (Net Worth) More than `10 lakhs upto `25 lakhsUpto `10 lakhs

More than `50 lakhs upto `2 croresMore than `25 lakhs upto `50 lakhs

More than `2 crores

Customer Information & Due Diligence (CIDD) Form - For Joint Applicant 1

Investments

Inheritance

Business Proceeds

Professional fee

Into the Account No

Value `

More than `2 crores

Customer Information & Due Diligence (CIDD) Form - For Joint Applicant 2

Investments

Inheritance

Business Proceeds

Professional fee

Into the Account No

Value `

More than `2 crores

* Kindly fill the following details:

Risk Classification for Joint Applicant 1

Basis of Categorisation: Politically Exposed Person Domiciled in Risk Country Trust Sleeping Partner

High Risk Profession Others (Please specify):

Information: Politically Exposed Person due to position / status as:

If Domiciled in Risk Country - Country Name:

Nature of Business / Occupation:

*Details of Customer’s Source of Funds & Estimated Net Worth:

Income from Employment Income from Business Income from Investments Inherited Funds

Others (Please specify):

Risk Classification of Account (L / M / H):

Expected Annual Turnover (`): Upto ` 1 Lakh Upto ` 10 Lakhs Upto ` 50 Lakhs Upto ` 1 Crore

Upto ` 5 Crores Upto ` 10 Crores Upto ` 25 Crores More than ` 25 Crores

Risk Classification for Primary Applicant

Risk Classification for Joint Applicant 2

Signatures and Photographs

YYYYMMDDDate:

Please affixa recent

photograph.

Please signin “Black Ink”

withinthe box.

“Signatureshall be

consideredfor all Cheque

clearancesand

any futurecommunicationwith the Bank”

YYYYMMDDDate:

Thumb Impression

Signature

Please affix

a recent photograph

of Primary Applicant

Please affix

a recent photograph

of Joint Applicant 1

Primary Applicant

Joint Applicant 1

Date :_____________ Place :_____________

Name and signatures of Applicants / Name and signature of the Declarant

I, Mr./Ms._________________________________________________________________ (the Declarant - either Bank Official or Applicant of Bank) have read out and

explained the contents of this Account Opening Form of DCB Bank Limited ('Bank') to the Applicant(s) Mr. / Ms. ____________________________________________ in

_____________________________ language and he / she / they have confirmed that he / she / they has / have understood the same and have agreed to abide by all the

terms and conditions of the said Account Opening Form. Pursuant to the same the aforesaid Applicant(s) is / are affixing his / her / their signature(s)/thumb

impression(s) as given herein below:

___________ ___________ ___________ _____________________________

Declaration Regarding Signing in Vernacular Language / By Illiterate / Blind Person

Approved by BM / BSOM (Name, signature with signature code) with seal*Incase of Thumb Impression, �Sign in BM/BSOM presence�

Please do notforget to collect

yourAcknowledgment

YYYYMMDDDate:Thumb Impression Signature

Please affix

a recent photograph

of Joint Applicant 2

Joint Applicant 2

x _______________________________Name of the Authorised Signatory:

Designation:

Place:

In case of Company / Society / Trust:

For and on behalf of

Passed / Issued by:1. Date: YYYYMMDD

Date and details of the authority letters or Board Resolutions, if any, authorising the borrowing and/or execution of this Application Form:

x _______________________________Name of the Authorised Signatory:

Designation:

Place:

For and on behalf of [ _________________________________________________ ] and each of the following partners / members of the firm / HUF / association:

**Signature

[*Names of all partners / members to be specified. **Signature by all the Partners /members is required unless a letter of authority is executed by all partners/members in favour of the signatories]

In case of Partnership / HUF / Association of Persons

For OfficeUse Only

Signature of Bank Official

Name of Bank Official: Mr. Mrs. Ms. Employee Code:

I confirm having met Mr. / Ms. ______________________________________________________________________________________________ ("Applicant"), in person at

c DCB Bank Limited, ____________________________________ Branch, c Current Residential Address, c Permanent Address, c Office Address (anyone address

as mentioned in the application form) and hereby confirm the identity and address as provided in this account opening form and also confirm having verified the copy

of the documents (as applicable) against originals as produced by the applicant/s.

I also confirm that the form has been signed by the applicant is in my presence. I have also verified the Mobile Number _________________________________ by calling

the no. mentioned in this account opening form.

YYYYMMDDDate:

Is any of the Signatories / Beneficial Owners of the entity, a Political /Public Figure or related to a Political / Public Figure?

Yes No if yes, please give position

Does it seem that the initial Deposit and/or the declared transaction profile is in line with the status/occupation declared?

Yes No

For Bank Use Only

MEMBER ENROLLMENT FORM – SMQ

REGULATED ENTITY

[IMPORTANT NOTE: Any cancellation and alteration must be countersigned by Life to be Insured.Please do not sign blank Proposal form]

Plan: HDFC Group Term Insurance Plan HDFC Life Group Credit Protect HDFC Life Group Credit Protect Plus

Option: N.A. N.A. Life Option Extra Life Option Terminal Life Option

Critical Life Option 1 Critical Life Option 2 Life Disability Option

Sum Assured (INR) _________________________ Premium (INR)________________________ Policy Term (yrs) Moratorium Period (yrs)

Main benefit:_______________________________ Interest Rate: % level / decreasing for decreasing option

Particulars of Life Assured: Mr/Mrs.

F I R S T M I D D L E L A S T

Address:

Date of Birth (dd/mm/yyyy) Age

D D M M y y y y ______ (yrs)

Gender

M F Tg

Loan Account No.

_____________________________

Loan Type

_____________________________

Nominee / Appointee Details:

Name Date of Birth Gender Contact No. Relationship to

Nominee: dd/mm/yyyy Life Assured

Appointee: dd/mm/yyyy Nominee if nominee is below 18 yrs of age

HEALTH DETAILS OF LIFE TO BE ASSURED:

Yes No

1 Have you ever suffered or are currently suffering from: (a) Chest Pain or heart attack or any other heart disease (b) Cancer, tumor, growth or cyst of any kind (c) Stroke, paralysis, Epilepsy, any psychiatric / mental disorder, disorder of brain/nervous system or any kind of physical disabilities (d)Asthma, Tuberculosis or other lung disorder (e) Diseases or disorder of muscles, bones or joints, arthritis or blood disorder (anemia) or any endocrine disorder (f) Diseases of the kidney, digestive system(stomach, pancreas, gall bladder, intestine), liver, Hepatitis B or C or HIV/AIDS infection (g) Diabetes, high blood pressure.

6 Are you taking any medication or has a doctor ever attended to you for any conditions, diseases or impairment not mentioned above (except for cough or cold)?

2 During the last 5 years have you undergone any major surgery or been hospitalized for more than one week?

4 Do you smoke more than 10 cigarettes a day?

9 Do you have any history of conviction under any criminal proceedings in India or abroad?

8 Have you ever been declined, deferred, and accepted at special terms, had cover reduced or had exclusion imposed for any life, health or accident insurance cover?

5 Has more than one of your parents and siblings died before the age of 60 years as a result of heart attack, stroke, cancer, diabetes, HIV?

7 For Female Lives: (a) Are you presently pregnant? (b) Do you have a history in the past of an abortion, miscarriage or caesarian section due to complications during pregnancy or due to any other cause? (c) Have you given birth to a child with any congenital disorder such as Down Syndrome, congenital heart disease, etc? (d) Have you ever had any disease of breast, uterus, cervix, ovaries or any other part of the reproductive system?

3 Do you take part in any adventurous sports or hobbies? (like paragliding, mountaineering, deep sea diving , motor racing, bungee jumping, etc.)

Signature/Thumb impression of life to be assured

Name & Address______________________________________________________________________________________________________________________

Declaration to be made by a 3rd person where: a) The insured member has affixed his/her thumb impression; OR b) The insured member has signed in vernacular; OR c) The insured member has not filled the application.I hereby declare that I have explained the contents of this application form to the insured member in ________________language and have truthfully recorded the answers provided to me. I further declare that the insured member has signed/affixed his/ her thumb impression in my presence.

significance of the proposed contract.Declaration made by life to be assured: I hereby declare that the content of the form and document has been fully explained to me and I have fully understood the

I confirm that I have read and understood, the rules and any additional rules of the plan, the standard Policy provisions and any additional provisions that govern the policy to be issued by insurer in the name of the policyholder and on my life, and I agree and confirm that the same shall be binding on me. I authorise the policyholder to disclose to the insurer such particulars as they may require including the details given above and any changes to the same, pay the premium payable on my behalf /collected from me to the Insurer. I understand that any statutory levy or charges including any indirect tax may be charged to me either now or in future by the insurer and I agree to pay the same. I understand that HDFC SLIC has the right to reject a proposal without giving reasons thereto and client to give an undertaking thereof that he shall not raise any claims thereof. I understand the significance of the contract and the contract will be governed by the provisions of the Insurance Act 1938 as amended from time to time and that the same will not commence until written acceptance of this application by Insurer issue on its normal terms and conditions is received.

PAYMENT AUTHORISATION

__________________________________________________Occupation_____________________________ Date & Place: ________________

I do hereby declare that I have received a loan from M/s ______________________________________________________ (�Master Policyholder�). In order to secure the said loan I have taken the above referenced policy from HDFC Standard Life Insurance Company Limited (�HDFC Life�). In consideration of receiving the said loan I hereby authorize HDFC Life to make payment of Outstanding Loan Balance amount to Master Policyholder by deducting from the claim proceeds payable on happening of the contingent event covered by the Group Life Insurance Scheme/ Policy referenced above.

Name and address of Declarant________________________________________________________ Signature of the Declarant

I understand, agree and confirm that these statements and this declaration are basis of the contract between the insurer and the policyholder. If any untrue statement are contained herein or there has been any non disclosure of any material fact, the policy to be issued by the insurer in the name of the policyholder may be treated as void as far as I am concerned.

Date & Place: ________________________ Signature/Thumb impression of the Insured Member __________________________________

Signature/Thumb impression of Witness* Signature / Thumb Impression of the Insured Member

* Witness Signature, Address and Occupation is along with signature of Insured Member

Declaration

9. I/We undertake to inform the Bank regarding the change in my/our occupation/employment and to provide any further information and documents that the Bank may require from time to time.

2. I/We confirm that there are no insolvency or bankruptcy proceedings or suits for recovery of outstanding dues or monies whatsoever or for attachment of my/our assets or properties and/or any criminal proceedings have been initiated and/or are pending against me/us nor I/we have never been adjudicated insolvent or bankrupt by any Court or other authority.

1. I/We, the undersigned, hereby declare that all the particulars and information and details given / filled-in in this application form are true, correct, complete and up-to-date in all respects and that I/we have not withheld any information whatsoever. I/We understand and accept that they shall form the basis of any facility DCB Bank Limited ("Bank") may decide to grant me/us.

13. It will be in order for the Bank to disqualify / deny me/us from receiving any credit facility/ies from the Bank in case it is proved that the declaration of my/our existing credit facility/ies made above contains misrepresentation of facts.

I agree that my personal Know Your Customer (KYC) information may be shared with Central KYC (CKYC) registry or any other competent authority. I hereby give consent to receive information from the Bank / CKYC registry / the Government / Reserve Bank of India or any authority through SMS /email on my registered mobile number / email address. I also agree that non receipt of any such SMS / email shall not make the Bank liable for any nature of loss or damage.

my/our Accounts. I/We confirm that all the details provided are correct and I/We agree to the terms and conditions of the Bank. I/We also understand that all my/our accounts can be accessed from the

3. No action or other steps have been taken or legal proceedings started by or against me/us in any court of law / other authorities for winding up, dissolution, administration or re-organisation or for the appointment of a receiver, administrator, administrative receiver, trustee or similar officer or for my/our assets.

8. I/We confirm that I/we have read the terms and conditions applicable to the facility and understood the contents.

unique Customer ID post consolidation of multiple Customer ID's if any.

consolidated and TDS shall now be applicable on the basis of the unique Customer ID in accordance with the provisions of the Income Tax Act, 1961 and the Bank will furnish one TDS Certificate for all

5. I/We understand, agree and acknowledge that the Bank shall have the absolute discretion, to reject my/our application without assigning any reasons and that I/we reserve no right to appeal against this decision of the Bank. I/We further agree that the Bank shall not be responsible/liable in any manner whatsoever to me/us for such rejection or any delay in notifying me/us of such rejection and any costs, losses, damages or expenses, or other consequences, caused by reason of such rejection, or any delay in notifying me/us of such rejection, of this application.

Savings Account Declaration: I / We have read, understood and hereby agree to the terms and conditions as applicable to my / our account� set forth on DCB Bank Limited (�the Bank�) website at www.dcbbank.com. I / We understand that access to any changes / updates in terms and conditions applicable to this relationship shall be available on the Bank's website only. I / We do hereby declare that information furnished in this Form is true and correct to the best of my / our knowledge and belief. I / We hereby authorize issuance of ATM / Debit Card and provision of Phone Banking, MobileBanking Services, Internet Banking and Bill Payment Services. I / We am / are aware of charges applicable for various services offered and I / we affirm, confirm and undertake that I / we have read andunderstood the �Terms and Conditions� for usage of the Phone Banking, Mobile Banking Services, Internet Banking and Bill Payment Services of DCB Bank as set forth in the Bank's websitewww.dcbbank.com and I / We will adhere to all the terms and conditions as applicable from time to time. I / We further authorize the Bank to debit my / our Account(s) towards any applicable charges forany / various service / services provided as applicable from time to time. I / We understand and agree that the consent given for updation / registration / requests for free Mobile alert facility shall be validtill such time I / we withdraw the same in writing. Unless specifically advised, the Bank will continue to send SMS alerts on the number requested by the authorised signatory/ies of the Firm / Company /Trust / Association / Society. The Bank shall not be responsible and liable for any consequences which may arise owing to change in name/s, address, mobile number of individual, authorizedsignatory/ies or partners or directors or trustees or members of the Firm / Company / Trust / Association / Society. I / We declare, confirm, understand, accept, acknowledge and agree: (a)That all theparticulars and information given in this application form (and all documents referred or provided therewith) are true, correct, complete and up-to-date in all respects and I / We have not withheld anyinformation. I / We understand certain particulars given by me / us are required by the operational guidelines governing banking companies. I / We agree and undertake to provide any further informationas and when the Bank may require. (b) That I / we have had no insolvency proceedings initiated against me / us nor I / we have ever been adjudicated insolvent. (c) That I / we have read the applicationform and brochures and am aware of all the terms and conditions of availing finance or service or products from the Bank. (d) That the Bank reserves the right to reject any application without providingany reason and reference to me / us. I / We agree and understand that the Bank reserves the right to retain the application forms, and the documents provided therewith, including photographs, and shall not return the same to me / us. (e) To inform the Bank regarding change in my residence /employment and to provide any further information as and when the Bank may require from time to time. (f)That if the Account is under corporate salary scheme: I / We have also read and understood �Terms and Conditions� under which Salary Scheme is offered to my / our organization and employees. I / Weagree that my / our employer has full right to reserve any instruction given by them to credit my account for any amount within a period of three working days and I / we will not dispute or hold the Bankresponsible for such debits in my / our account. I / We understand that it is my / our responsibility to inform (in writing) the Bank immediately on termination of my / our employment with my / our currentemployer, whereupon I / we will cease to enjoy any or all benefits under Salary account scheme. I / We understand that the Bank reserves the right to convert my / our account into a regular savings bankaccount and further ceasing to be categorised as a account under corporate salary scheme. Accordingly there will be a change in minimum balance requirement and applicable charges per regularsavings bank account. (g) That I / we shall not hold the Bank liable and responsible for furnishing of the processed information / data / products thereof to other Banks / Financial Institutions / CreditProviders / Users registered as above. (h) That I / we have to complete further application for specific liability products / services from the Bank as prescribed from time to time, and that such furtherapplications shall be regarded as an integral part of this application (and vice versa), and that unless otherwise disclosed in such further forms as prescribed, the particulars and information set forthherein as well as the documents referred or provided herewith are true, correct, complete and up-to-date in all respects. (i) That such further applications will require incorporation of the application formnumber, and / or such details as the Bank may prescribe, to facilitate data management. (j) That I / we authorize the Bank to issue a Debit cum ATM Card to me / us. (k) That the issue and usage of theDebit cum ATM Card is governed by the terms and conditions as in force from time to time and I / we agree to be bound by the same. (l) That the terms and conditions of Debit cum ATM Card are liable tobe amended by the Bank from time to time. (m) That I / we unconditionally and irrevocably authorize the Bank, to debit my / our Account annually with an amount equivalent to the fee and charges for useof the Debit cum ATM Card. (n) I/We, the joint holder(s),agree that in case of death of any one or more of the joint depositor(s), the proceeds may be paid to the survivor(s), on request before due date asper the mode of operation. The Bank can levy penal charges, if any, as may be permissible by either regulatory guidelines, applicable as on the date of request. (o)That continuation of the account with the Bank is at the sole discretion of the Bank and in case the Bank is dissatisfied with the conduct of the account / account holder, the Bank has the right to close the account after giving me / us one month's notice or withdraw the concessions in to or any service granted to me / us or charge the Bank's applicable rates/charges for such services. (p) That the Bank may at its absolute discretion, discontinue any of the services completely or partially without any notice to me / us. (q) That in case of return of Account Opening Amount (AOA) cheque, for any reasonwhatsoever, the Bank would close the account without any reference to me / us. (r) That on receipt of written application from any of the Authorised Signatory(ies) and / or survivor or survivors of us, theBank at its sole discretion and subject to such terms and conditions, grant a loan / advance / renew / enhance against the security / collateral issued in joint names. (s) That DCB � On The Go facility willbe offered to customers whose account is an individually operated resident account. (t) That DCB mobile Banking will not be available to Non Resident Accounts. (u) I / We hereby understand thatamong all other things, minimum balance requirement for variants of savings bank account under various scheme codes would be applicable and is in line with such updated information as available onthe Bank's website www.dcbbank.com from time to time. (v) I/We agree that the DCB Bank shall deduct applicable TDS (Tax Deducted at Source) as per the Income Tax Provisions. I/We understand that the Bank is relying on this information for the purpose of determining the status of the applicant named above in compliance with FATCA (Foreign Account Tax Compliance Act) / CRS (Common Reporting Standards). The Bank is not able to offer any tax advice on CRS or FATCA orits impact on the applicant. I/we shall seek advice from professional tax advisor for any tax questions. I/We agree to submit a new form within 30 days if any information or certification on this formbecomes incorrect. I/We agree that as may be required by domestic regulators/tax authorities the Bank may also be required to report, reportable details to CBDT (Central Board of Direct Taxes) orclose or suspend my / our account. I/We confirm that, I/We will intimate / notify in writing to the Bank and update operating instructions and / or any other change(s) on Bank's record immediately in theevent of any change in the operating instructions and/or any other change(s) with respect to the account/s held with the Bank. I/We hereby agree and authorize Bank to mark freeze to my account if I/Wefail to submit the updated / refresh KYC documents as per Bank's KYC policy and/or operating instructions for my / our account periodically to the Bank. I/We certify that I/we provide the information onthis form and to the best of my/our knowledge and belief the certification is true, correct, and complete including the taxpayer identification number of the applicant.

6. I/We hereby unconditionally authorise the Bank to make any enquiries with any other finance company / bank / registered credit bureau / Reserve Bank of India (RBI) / agency/ies appointed by RBI regarding my / our credit history with them and also authorise the Bank to provide details of my / our credit history with any other finance company / bank / registered credit bureau / RBI / agency/ies appointed by RBI.

Aadhaar Consent: I/We have voluntarily submitted my/our Aadhaar/UID Number mentioned above and consent to: § Seed my/our Aadhaar/UID Number issued by UIDAI, Government of India inmy/our name with my/our aforesaid account. Map it at NPCI (National Payments Corporation of India) to enable me/us to receive Direct Benefit Transfer (DBT) from Government of India in my/our above mentioned account. I/We understand that if more than one Benefit Transfer is due to me/us, I/we will receive all Benefit Transfers in this account. Use my/our Aadhaar details to authenticate me/us from UIDAI. § Use my/our mobile number mentioned in my/our account for sending SMS alerts to me/us Consent for Authentication: I/We, the holder of the above stated Aadhaar number, hereby give my/our consent to the Bank to obtain my/our Aadhaar number, Name andFingerprint/Iris for authentication with UIDAI. The Bank has informed me/us that my/our identity information wouldonly be used for demographic authentication / validation / e- KYC purpose and also informed that my/our biometrics will not be stored / shared and will be submitted to CIDR (Central Identities Data Repository) only for the purpose of authentication. I/We have been given to understand that my/our information submitted to the Bank herewith shall not be used for any purpose other than mentionedabove, or as per requirements of law.

Customer ID Merger: I/We understand andagree that all my/our Accounts will now be consolidated under a single DCB Bank Customer ID after merging the multiple Customer IDs. Post such merging, only one Customer ID will remain active.I/We, am/are aware that DCB Bank Personal Internet Banking or DCB Bank Business Internet Banking, if availed, will now be accessible only under the retained Customer ID and all the Accounts will beconsolidated to this Customer ID. I/We am/are aware that Tax Deducted at Source (TDS) on interest earned on DCB Bank Fixed Deposit Account(s) under erstwhile Customer IDs will also stand

I hereby give consent to the Bank to retrieve my information from CKYC registry for the purpose of this loan processing or any other relationship with DCB Bank.

4. I/We request you to kindly consider this application and inform me/us of the maximum loan amount which I/we may be able to avail of/borrow from the Bank on the basis of the security of the aforementioned.

12. I/We agree as a pre-condition of the facility given to me/us by the Bank and in that case, I/we commit default in the repayment of the facility or in the payment of interest thereon or any of the agreed instalment of the facility on the due date(s), the Bank and/or the Reserve Bank of India will have an unqualified right to disclose or publish my/our name (including my/our photograph) as defaulter/sin such manner and through such medium as the Bank or RBI in their absolute discretion may think fit.

7. I/We confirm that the funds will not be used for speculative or anti-social purpose.

10. I/We agree that my/our facility, if so granted shall be governed by the terms and conditions of the Bank that are in force and may be amended by the Bank at its absolute discretion from time to time.

11. I/We have understood, acknowledge and agree that a request and demand for any information and documents by any authority under the law will be mandatorily complied with by the Bank.

Signature of the Applicant:

Signature of the Co-applicant:

Acknowledgment

Received from:

application form for Loan facility of `

Applicant would be advised of the Bank�s decision on the application within two weeks from the receipt of complete information/documents.

Application received by:

Location:

Date: YYYYMMDD

For DCB Bank Limited

Authorised Signatory / Representative

Yours faithfully,

___________________________________

Name and Signatures of the Bank Officer(Name of the Applicant / Co-Applicant / Joint Applicant) along with Signature Code Number

This difference in the signature is because ________________________________________________________________________________________________

(Signature of the Applicant / Co-Applicant / Joint Applicant) Signed in my presence

(When Signature recorded on any of the document provided for Signature Proof is different from the one recorded on the AOF)Letter From Applicant /Co-Applicant / Joint Applicant - Recording A Different Signature

The Branch Manager

DCB Bank Limited

____________________ Branch

With reference to the ____________________________________________________________________ (name of the document on which the signature differs) provided by me as proof of my signature along with the Account Opening Form, I request you to please record with yourselves my specimen signature as below, as the signature on the above referred document differs from the one provided on the Account Opening Form :

Sir / Madam,

To be signed by the Applicant in the presence of the Bank Official attesting the Signature

_________________________________________________________________________________________________ (Signature as per document submitted)

_________________________________________________________________________________________________ (Signature now requested to be admitted)

YYYYMMDDDate:

Annexure – I

(Signature of the Applicant / Co-Applicant / Joint Applicant)

I/Weare aware of the scheme provisions and benefits of PMFBY / RWBCIS. I/We hereby, declare that I/We would like to continue with KCC loan scheme, however, I/We are opting out of

PMFBY / RWBCIS from ̈ Kharif / ̈ Rabi _______ (Year) season by choice. Therefore, requesting for non-enrolment under the scheme.

As I/We choose to Opt Out of PMFBY / RWBCIS, I/We declare that Bank will not be held responsible for any losses under PMFBY / RWBCIS scheme.

__________________________________

(Along with signature code number)

Name and Signature of Bank Officer

___________________________________

(Name of the Applicant / Co-Applicant / Joint Applicant)

Signed in my presence

_________________________________________________________

(PMFBY / RWBCIS Opt Out)

Please call DCB Customer Care to enquire about your account application status.

DCB Bank Limited

DCB Bank Limited61-Ver 1.0-Mar 2013 M030 / Nov 21 / 1.9

Annexure - II

I/We hereby declare that I/We would like to take benefit of coverage under PMFBY / RWBCIS. Therefore, requesting for enrolment under the scheme as per the scheme provisions. I/We

provide consent to deduct the premium amount from my/our crop loan account as per the declared crop.

___________________________________

(Signature of the Applicant / Co-Applicant / Joint Applicant)

_________________________________________________________

(Name of the Applicant / Co-Applicant / Joint Applicant)

Signed in my presence

__________________________________

Name and Signature of Bank Officer

(Along with signature code number)

(PMFBY / RWBCIS Opt In)

Kisan Application Form Nov 2021.cdr - DCB Bank

Documents

placement des-01.cdr - CollegeSearch

2019.cdr - GRANTH ABHIMAN

Value Chain Analysis - Mahila Kisan Sashaktikaran Pariyojana

CDR 999 DAB - ecg-electro.eu

CDR 500 autórádió

CDR Summaries - RANZCR

web profile 17.cdr - Palmadex

JOPATW~1.cdr 08.cdr - African Journals Online

UV_December, 2020.cdr - AIILSG

Anubhuti 2018.cdr

HEI 2_1.cdr - CCR

Raah Brochure 11.0.cdr

ÝæÇÕá 2015.cdr

Jivit - July 2021.cdr

final_Subzero Product Catalog11022019.cdr

MDAR 2016.cdr - AWS

Prospectus 2021-2022.pdf - DCB Girls' College

MANUAL DE QUÍMICA - DCB

KISAN MACHINERY INC - tradeKorea

May 2 2016.CDR - Subamuhurtham.in