Annexure2

Back Office:
Date:__/__/____
Dear Madam/Sir

Reg: Your Saving A/c No. …………………………. with Cust. Id …………….. opened dated ………….
with Branch Office: ……………..Dist. No.

We thankfully recognize your patronage for starting relationship with Punjab National Bank family.

The details of accounts basic information provided by you are given hereunder for your kind information
and record. Discrepancy, if any, be kindly brought to the notice of concerned branch by quoting the
Account No. within three days.
Sl. Details First Second
No applicant applicant

*1. Full Name

*2. Spouse Name
*3. Father’s Name
*4. Mother’s Name
5. Guardian Name, if minor
*6. Date of birth
*7. Place of Birth
*8. Residential Address
*9. Address Proof Type/No
*10. Identity Proof Details
Type/No
*11. Aadhar No
*12. PAN No
13. Passport No.
14. Tax Residency
15. TIN/other equivalent
(for tax residency other
than India)
*16. i) Nature of account

*ii) Mode of operation

*17. Nomination Details

*18. Mobile No.

Email ID
*19. Service Requested $IFRVF#PPL O Internet Banking O Debit Card O
SMS Alerts O Mobile Banking O E-Statement O

Assuring you of our best services, We are confident that our relationship will grow further in times to come.

With regards!
For Punjab National Bank
This is a computer generate statement, Customer Signature
URN No.

FATCA/ CRS SELF CERTIFICATION / DECLARATION FOR INDIVIDUALS:

Are you a tax resident of any country other than India? Yes No

If yes, please fill the details below & Sign:

If No, please sign the declaration Certification below:
(Please indicate all countries in which you are resident for tax purposes and associated details)

1.Country/ .ISO 3166 Tax Identification Residence Address Type:

(ies) of Tax Country Identification Type (TIN or Address for Tax
residency # code of Number (TIN)% Other%, purpose 1- Residential
jurisdiction or Equivalent please or
(including City,
of residence* specify) Business,
State, Country
1st
Applicant

2nd
Applicant
Place/City of Birth* ISO 3166 Country
code of birth
1st
Applicant
2nd
Applicant

# To also include USA, where the individual is a citizen/ green card holder of USA
% In case Tax Identification Number is not available, kindly provide functional equivalent$

Certification:
Under penalty of perjury, I/we certify that: I understand that Punjab National Bank is relying on this information for the
purpose of determining the status of the account holder named above in compliance with FATCA/CRS. Punjab National
Bank is not able to offer any tax advice on FATCA or CRS or its impact on the account holder. I shall seek advice from
professional tax advisor for any tax questions.
I agree to submit a new form within 30 days if any information or certification on this form becomes incorrect.
I agree that as may be required by domestic regulators/tax authorities, Punjab National Bank may also be required to
report, reportable details to CBDT or other authorities/agencies or close or suspend my account, as appropriate.
I have understood the information requirements of this Form (read along with the FATCA/CRS Instructions) and hereby
confirm that the information provided by me on this Form including the taxpayer identification number is true, correct,
and complete. I also confirm that I have read and understood the FATCA/CRS Terms and Conditions and hereby accept
the same.

Signatures 1. …………………………. 2. …………………………

(Ist Applicant) (IInd Applicant)

Account Number
Name 1st applicant 2nd applicant

Cust ID
Specimen
Signature

Mode of operation

For Office 1. Signature Verified Name:

Use only 2. In person verification done & KYC Date: Signature with
verified from original document GBPA/PF No
3.Account opening authorized
Annexure-I

TERMS & CONDITIONS

I/we confirm that details entered in the tablet for opening my account have been seen by me & found correct. I have given
following KYC documents as a proof of identity and address:

1. PAN No. 2. Passport No/Driving licence No

3. Any other (Please specify) i. ii.

I/we further confirm having received, read and understood (a)the accounts rules and hereby agree to be bound by the
terms & conditions outlined in these rules which governs the account(s) which I/we am/are opening/will open with
Punjab National Bank and (b) amendments to the rules made from time to time and those relating to various services
availed by me/us when displayed by the bank on its notice board or on its website and those relating to various services
offered by the Bank including but not limited to Debit card, Credit card, Internet banking, Mobile Banking, SMS alerts
and other facilities listed in this form. I/We are aware that the usage of these facilities is governed by the terms and
conditions which are contained in the brochures of the Bank issued from time to time/ displayed on the website
www.pnbindia.in. the site maintained by Punjab National bank and I/we have reviewed the contents of the same. I/we
understand that the bank may at its absolute discretion discontinue any of the services completely or partially without
any notice to me/us. I/We agree that the bank may debit my account for service charges as applicable from time to time
.I/We declare that the transactions in the account will be made from legitimate sources only and the account will not be
used for any purpose contrary to law.

I/we also agree to maintain the minimum/quarterly average balance which the Bank may prescribe as the
minimum/quarterly average balance to be maintained to avail the facilities and agree to pay the charges if
minimum/quarterly average balance not maintained and any other charges stipulated by the Bank. I/We understand that
any change in this respect will be notified by the Bank on its website www.pnbindia.in and also will be displayed on the
notice board of the branches one month in advance. I/We undertake to make good the losses to the bank, suffered
consequent to crediting in the account proceeds of cheque drawn on other customers' accounts in bank or make good any
overdraft created in our account on account of service charges or debit card withdrawal or through any other transaction.
I/we also undertake to update identity and address proof and submit latest photograph on the periodic interval.
I/We give our consent to receive information by usual means of communications including phone banking about PNB's
products and/or services or promotional offers introduced by the bank from time to time and also authorize the bank to
use my/our personal information for marketing purposes. All communications will be sent on provided registered mobile
no. & registered E-mail id/ by post.

My personal / KYC details may be shared with Central KYC Registry. I hereby consent to receiving information from
Central KYC Registry through SMS/Email on my registered number/email address

NOMINATION: (Please Tick)

Nomination required Yes No If YES……………please fill in the following

particulars

I/we, nominate the following person particulars whereof are given below to whom in the event of my /our death
the amount of the deposit in the account opened with this AOF may be returned by the bank.

Nominee
Name Address Relationship Age If nominee
with is a minor

As the nominee is a minor on this date, I/ we appoint Shri I Smt./…………………………………….

………………………………………………….. name, address and
age) 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.

Name of nominee to be printed on Passbook & Statement Y es No

Signatures 1. ..…………………………. 2. …………………………

(Ist Applicant) (IInd Applicant)

FORM 60
[See third provision to of Rule 114B]
Form of Declaration to be filled by a person who does no have either permanent account number of general index
Register Number and who makes payment in respect of transaction specified in clauses (c) to (f) of rule 114B of
the income Tax Act. 1962.

1. Full Name and Address of the declarant ..........................................................................................................................

..................................................................................................................................................................................................

..................................................................................................................................................................................................

..................................................................................................................................................................................................

2. Particulars of transaction

Account Type ..................................................... Number .............................................................................

3. Amount of the transaction Rs. ..................................................

4. Are you assessed to tax ? Yes / No

5. If yes,

i) Details of Ward / Circle / Range where the last return of income was filed.

ii) Reasons for not having permanent account number / General Index Register Number

6. Details of document being produced in support of address in column (1)

..................................................................................................................................................................................................

Verification

I, ........................................................................................................................... do hereby declare that what is stated

above is true to the best of my knowledge and belief.

Date ........................................

Place .......................................

...............................................
Signature of the declarant

Instructions: Documents which can be produced in support of the address are:

(a) Ration Card

(b) Passport
(c) Driving License
(d) Identity Card issued by any institution
(e) Copy of Electricity bill or Telephone bill showing residential address.
(f) Any document of communication issued by authority of Central Government or local bodies showing
residential address.
(g) Any other documentary evidence in support of his address given in the declaration.

Note: Amendment with effect from 1st November, 1998 as per Income Tax Act, 1962 Rule 114 B: para (c) A time
deposit exceeding Rs. 50,000/- with a banking company : para (f) opening an account with a Banking Company.
To Date………/………./……………….

The Branch Manager

Punjab National Bank

BO:………………………………………………….

Subject: Annual income undertaking for Account Opening at Punjab National Bank

Sir/Ma’am

I……………………………………………………….S/O, D/O, W/O ……………………………………………

having Aadhar Card/PAN Card/Voter ID/ Other ID No…………………………………..…………………..
undertake that my annual income from all sources is Rs. …………………………… and I authorize
Punjab National Bank to use this undertaking for the purpose of account opening and KYC
compliance procedure.

………………………………………….

Signature

Name:

Mobile: