Application for Fixed Deposit

Sole/First Applicant Full Name

Guardian's Name (Incase of Minor)

Mobile Number

Full Address (Attached Address Proof)

Pin Code

Date of Birth (First Applicant)

Name of Second Applicant

Name of Third Applicant

Nomination Details (Incase of Sole Depositor)

Name of Nominee

Relationship

Address

Deposit Amount

Deposit Amount Rs. (required)

Deposit Amount in Words Rs. (required)

Mode of Deposit

Fresh FDR

Cheque Number

Cheque Date

Bank Name and Place

Cheque Amount

Renewal of FDR

Cheque Number

Principal Amount

Choice of Scheme (required)

Non Cumulative (Interest Payable Quarterly)Cumulative (Interest Payable on Maturity)

Scheme Tenure (required)

1 Year2 Years3 Years

Bank Account Details

Account Number

Name of Bank

Branch

City

IFSC Code

Account Type

SavingsCurrent

Others (Please Specify)

Terms and Conditions

I/We, hereby declare that the amount shown is not being deposited out of the funds acquired by me/us by borrowing or by accepting deposit from other person. I/We have read terms and conditions printed in this form, and agree to abide by the same. I/We also declare that the first named depositor is the beneficial owner of the deposit and it to be treated as the payee for the purpose of deduction of tax under Section 194 - A of the Income Tax Act 1981. I am/we are resident(s) of India and am/are not placing this deposit as a Nominee(s) of any Non-Resident.

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