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  Form DA-1 (Nomination Form) Nomination under section 45ZA of the Banking Regulation Act, 1949 and Rule 2(1) of the Banking Companies (Nomination) Rules, 1985 in respect of bank depositsI/ We ANUSHKA DINESH PANDITnominate the following person to whom in the event of my/our/minor's death the amount of the deposit, particulars whereof are given below, may be returned byState Bank of India,Nomination Serial No.(Name and address of branch/ office in which the deposit is held) Details of Deposits Type of deposit: SAVING Account number Additional details, if any: Details of the Nominee Name: DINESH VAMAN PANDIT Relationship with the depositor: FATHER Age: 42 Date of birth of nominee: 01/06/1973Address:NR. BUDDHA VIHAR, AT PARIVALI, POST ANGAON, TAL BHIWANDI City: BHIWANDI PIN: 421302 State: MAHARASHTRA CIF No. of Nominee (to be filled byLCPC): As the nominee is a minor on this date, I/We appoint Shri/Smt./ age: years Address: to receive the amount of the deposit on behalf of the nominee in the event of my / our / minor's death during the minority of the nominee.Date: Place: BHIWANDI Signature(s) / Thumb impressions(s) of depositor(s) Please Sign in black ink only. Signature(s) / Thumb impressions(s) of 1st witness ** Name: Address: Signature(s) / Thumb impressions(s) of 1st witness ** Name: Address: * Where deposit is made in the name of a minor, the nomination should be signed by a person lawfully entitled to act on entitled to act on behalf of the minor.** Thumb impression(s) shall be attested by two persons. Page No. 1 of 7  Mobile no. will be used for sending SMS alertsBranch Teller: in CBS, go to - Customer Management -> Create Personal Customer (tocreate new CIF) / Amend -> Customer Details (to issue Welcome Kit, put the printed a/cnumber here and transmit); Input TCRN in Reference No. field and click Get Details Account Opening Form: Part-I To be separately filled by each applicant (new customersonly)   TCRN : AC84073954 (For office use only)CIF No. Account No.Date: Branch to affix rubber stamp ofname and code no. Sole/First Applicant 1. Please fill up in BLOCK letters only and use black ink for signature. Please leave one box blank between two words. Tick ( ✓ ) the appropriate boxes.2. Fields marked asterix (*) are not mandatory3. Please affix a passport size photograph in the box provided. Also enclose another photograph for affixing in the pass book4. For opening account of minors, where proof of identity/address is not available, the same will be provided by Father/Mother and Natural Guardian5. In case of illiterate customers, Left Thumb Impression (LTI) to be affixed and verified. Personal DetailsCustomer Type:  Public Staff Senior Citizen:  Yes Minor:  Yes PF No. Name:  Mr Ms MrsOther ANUSHKA DINESH PANDIT Name of Father/ Husband/Guardian:  Mr Ms MrsOther DINESH VAMAN PANDIT Date of Birth: 23/01/2008 Gender: Male Female Nationality: INDIAN Mother's Maiden Name: ANITA Marital Status:  Married Unmarried Others UID:  806871747428 UID of Father/Mother (in case applicant is a minor) : 514435211240Unique Identification Number Correspondence Address (Current Residential/Office) AT PARIVALI, POST ANGAON,NR. BUDDHA VIHAR,Landmark/ Street: TAL BHIWANDIDistrict: THANECity: BHIWANDI PIN: 421302 State: MAHARASHTRATelephone no. Mobile no. 9850271530 Permanent Address Same as Correspondence Address AT PARIVALI, POST ANGAON,NR. BUDDHA VIHAR,Landmark/ Street: TAL BHIWANDIDistrict: THANECity: BHIWANDI PIN: 421302 State: MAHARASHTRATelephone no. Fax no. Email Address:  E-mail address is required for alerts and e-statements Additional Details (wherever applicable)Income: Upto INR 20,000 Monthly Annually Assets (approximate value):  0  *Religion:  Hindu Muslim Christian Sikh Others BUDDHIST  *Category:  General OBC SC ST  EducationalQualification:  Non-Graduate Graduate Post-Graduate Others OccupationType:  Salaried Self-employed Business Retired Student Others Organization's Name:   *Designation/Profession:  STUDENT Passport no.   *Others  Voters ID/ Driving Licence/ Govt. / Defence ID Card No. I.T. PAN: OR Form 60/61  CITPP7661MIf PAN is not available please fill-up form 60/61 Vehicle:  Car Two-wheeler Other Life Insurance Value:  Upto 2 lakhs Upto 5 lakhs Above 5 lakhs  Life Insurance:  SBI Life Other Existing Loans:  Car Loan House Loan Personal Loan Education Loan Business/Agriculture House:  Ancestral Owned Rented Employers  Mutual Funds:  SBIMF Other No investments  Credit Card:  SBI Card Others Page No. 2 of 7  TCRN : AC84073954Identification Details Aadhar Card where the address on the Aadhar Card is the same as the Correspondence Address mentioned on the first page of this form.No.: 806871747428 Issued at: MUMBAI Issue Date 01-Oct-2013ORAny one document from each of the undernoted two columns for a photo-identity and proof of address (Please tick the appropriate box and give details below): Proof of identity A)PassportB)Voter ID CardC)PAN CardD)Government/ Defence ID CardE)ID Card of Reputed EmployerF)Driving LicenseG)Pension Payment Order*H)Photo ID Card Issued by Post OfficeI)Photo ID Card Issued by University*J)Photo ID Card Issued by Public Authority*K)Aadhaar Letter / CardL)NREGA Card Proof of address (of Correspondence Address) A)Credit Card Statement (not more than 3 months old)B)Salary SlipC)Income/ Wealth Tax Assessment OrderD)Electricity Bill (not more than 6 months old)E)Telephone Bill (not more than 3 months old)F)Bank Account StatementG)Letter from Reputed EmployerH)Letter from Public Authority*I)Ration CardJ)Voter ID Card (only if it contains the current address)K)Pension Payment Order*L)Lease Deed/Sale Deed*M)Proof of Residence Issued by University*N)Address Proof of Relatives (for students)*O)Address Proof of Close Relatives*P)Address Proof of Gazetted/ Senior PSU Officers* No.:   Issued at:   Issue date:   No.:   Issued at:   Issue date:  Please attachone self-attestedphotocopy ofIdentity proofand Addressproof each.Originalsthereof willhave to beproduced forverification* Refer to the Savings Bank rules Introduction Details I having CIF no. confirm that I aman holder of account number of State Bank of India for the past months andpersonally know the applicant(s) for more than months and confirm his/her/their identity and address as statedabove.Required for smallaccount only. Notrequired if complete KYCrequirements are fulfilledDate Signature of the IntroducerSign verified by (Sign, SS No. & stamp)With State Bank of India agreeing to open my Small Deposit account under liberalized KYC norms specified by RBI, I undertake to submit the requiredKYC documents as and when the balance or total annual transaction in my account exceed the stipulated limits in this regard. In the event of noncompliance the Bank is within its rights to stop operations in account after advance notification as per RBI instructionsSignature of the Applicant Detail of other Accounts Please give the details of your other accounts in our # /other Bank # mandatoryBankBranchType of Account/Facility(ies)Account Number Date Signature/ Thumb impressions of depositorPlease Signin black inkonly.Place BHIWANDI  FOR OFFICE USE Details of one or two identification marks, if any, such as a mole or scar (mandatory for illiterate applicant) Verifying Officer/Open CIF Signature: Name:SS No.:Designation:Date:  Generated CIF  (Authorised signatory) Date:SS No.: Page No. 3 of 7  Account Opening Form: Part-II  Branch to affix rubberstamp of name and code no.Date: (For office use only) Account No. Type of Account   Savings Bank Account (with cheque book)   Savings Bank Account (without cheque book)   No-frills Account Savings   Saving Plus Account   Premium Savings Account   Current Account   Recurring Deposit   Term Deposit   Special Term Deposit   Multi Option Deposit Scheme linked with Savings Bank Current Account Others  (please specify) Please tick the typeof account to beopened. To knowmore about variousschemes pleasecontact Bankofficials. Details of Applicant(s)Sole/First Holder Name: CIF no. (to be filledin by branch/LCPC):ANUSHKA DINESH PANDIT Second Holder Name: CIF no. (to be filledin by branch/LCPC): Third Holder Name: CIF no. (to be filledin by branch/LCPC):  Account Name Account name as would appear on passbook/account statement Services Required1. ATM-CUM-DEBIT CARD :(for International card and its variants, separate application is to be submitted)Applicant no.Card TypeName as would appear on the card1st2nd3rd Domestic Gold International Domestic Gold International Domestic Gold International Please mention any other account desired to be linked Account TypeAccount NumberName Account TypeAccount NumberName 2. INTERNET BANKING:Viewing rights 1st 2nd 3rd applicant Limited Transaction rights :  1st 2nd 3rd applicant Full Transaction rights :  1st 2nd 3rd applicant 3. MOBILE BANKING: Mobile Banking Service to be enabled on this no. 4. SMS ALERTS:SMS Alerts at mobile number as mentioned in Part-I:  Required Not required 5. CHEQUE BOOK:Type of Cheque Book:  Ordinary Multicity* Both * Charges applicable for Multicity cheques 6. STATEMENT FREQUENCY:  Monthly Quarterly Half-yearly(for current account) e-Statement to be sent to e-mail id as mentioned in Part-I:  Required Not required Mode of Operation  Self only Either or Survivor Former or Survivor Any one or Survivor Jointly Other Specimen Signature(s)  Paste a passport size photograph inside this box1st Applicant Paste a passport size photograph inside this box2nd Applicant Paste a passport size photograph inside this box3rd Applicant Signature(s) / Thumb impressions(s) Sole/First HolderSignature(s) / Thumb impressions(s) Sole/First HolderSignature(s) / Thumb impressions(s) Sole/First HolderSignature, SS No and name of verifying officerSignature, SS No and name of verifying officerSignature, SS No and name of verifying officerPleaseSign inblackinkonly. Page No. 4 of 7

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Jul 23, 2017
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