GENlkekU;

2- ?kks"k.kk@opu% Declaration:

eSa csfld cpr cSad tek [kkrk ¼ch,lchMh,½@csfld cpr cSad tek [kkrk & y?kq [kkrk ¼ch,lchMh,l½ [kksyus ds fy, vkosnu djrk gw¡- eSaus bl [kkrs gsrq ykxw fuca/kuksa ,oa 'krsZa isa le>k fn;k x;k gS rFkk mldh fo"k;oLrq dks eSaus le> fy;k gSa- eSa le; le; ij ykxw fuca/kuksa ,oa 'krksZa ds fy, Hkh lger gwa- ch,lchMh,l & y?kq [kkrksa ds fy, d½ bu [kkrksa esa ,d o"kZ esa dqy tek ` 1-00 yk[k ls vf/kd ugh gksuk pkfg,- [k½ bu [kkrksa esa vf/kdre 'ks"k jkf'k ` 50000/- ls vf/kd ugha gksuk pkfg,- x½ vkgj.k ,oa vUrj.k ds ek/;e ls bu [kkrksa esa dqy ukes ,d ekg esa ̀ 10000/- ls vf/kd ugh gksuk pkfg,- ?k½ dsokbZlh vkSipkfjdrkvksa dks iwjk fd, fcuk y?kq [kkrksa esa fons'kh eqnzk dks ugh tek djk;k tk ldrk gS- p½ izkjfEHkd :i ls y?kq [kkrs 12 ekg ds fy, oS/k gksrs gSa ftUgsa ;fn O;fDr vko';d oS/k nLrkostksa dks izLrqr dj nsrk gS rks vxys 12 ekg rd vkSj cs Kkr gS vkSj cSad dks vk'oklu nsrs gSa fd tc Hkh esjs [kkrs eas mijksfYyf[kr foÙkh; lhek ls vf/kd gksrk gS rks ge cSad ds dsokblh ekunaMkas dk ikyu djsaxs- eSa ;g Lohdkj djrk gwa fd cSad fdlh Hkh dkj.k dks crk, fcuk bl vkosnu dks vius foosd ls Lohdkj vFkok vLohdkj djus ds fy, gdnkj gksxk- eSa ?kks"k.kk djrk gwW fd bl vkosnu i= esa esjs }kjk nh x;h tkudkjh lR; ,oa lgh gS- —i;k eq>s :is; MsfcV dkMZ tkjh djsa-

I hereby apply for opening of a Basic Saving Bank Deposit Account (BSBDA)/Basic Saving Bank Deposit Account -

Small Account (BSBDS). I have read the terms and conditions applicable to BSBDA/BSBDS. Terms and conditions

applicable to BSBDA/BSBDS have been read over and translated into* ___________ and explained to me and having

understood the contents thereof subscribe to these presents. I agree to the terms and conditions as may be in force

from time to time. For BSBDA small accounts i) the aggregate of all credits in a financial year should not exceed

rupees one lakh; ii) the balance at any point of time should not exceed rupees fifty thousand; iii) the aggregate of

all withdrawals and transfers in a month should not exceed rupees ten thousand; iv) Foreign remittance cannot be

credited to Small Accounts without completing normal KYC formalities. v) Small accounts are valid for a period of

12 months initially which may be extended by another 12 months if the person submits proof of having applied for

an Officially Valid Document; and I am aware that and assure the Bank that whenever my account exceeds the

abovementioned financial limit I will comply and abide by the KYC norms of the Bank. I accept that bank is entitled

at its discretion to accept or reject this application without assigning any reason whatsoever. I declare that the

information provided by me in this application form is true and correct. Please issue Rupay Debit Card.

Mode of Opeation: Singleifjpkyu dh rjhdk% ,dy

Name of Applicantvkosnd dk uke

In case of small accountsself attestation to be done

on the photograph

NksVs [kkrksa ds ekeys esaQksVks ij Lo

vuqizek.ku djuk gS-

Signature/TI of Applicant

vkosnd ds gLrk{kj@vaxwBs dk fu'kku

Signature of Admitting Officer

LohdkjdrkZ vf/kdkjh ds gLrk{kj

* Name of Language * Hkk"kk dk uke

esjk vkils ;g Hkh fuosnu gS fd esjh ikfjokfjd vkdfLed vko';drkvksa fd iwfrZ ds fy, eq>s jkf'k `------------------------------------¼`-----------------------------------------------------------------------------------------½ dh vksojMªk¶V lhek eatwj djus dh —ik djsa- bl laca/k esa eSa cSad ds fu/kkZfjr fu;e o 'krkZsa dks ekuus ds fy, ck/; g¡w- esjh vk; dk eq[; lzksr-----------------------------------------------gS-eSa ;g Hkh ?kks"k.kk djrk gw fd eSus fdlh Hkh cSad@foÙkh; laLFkk ls dksbZ _.k ugh fy;k gS ,oa u gh esjs@esjs ifjokj ds lnL;ks ds uke dksbZ _.k cdk;k gSA

vkosnd ds gLrk{kjSignature of the applicant

I also request you to sanction me an overdraft limit of `_________________(`______________________________________) for meeting my emergency

family needs, I shall abide by the terms and conditions stipulated by the bank in this regard. My main source of income is___________________________.

I here by declare that, I have not availed any loan from any bank/financial institution and no loan

is outstanding in my/ my family members name.