PUNJAB NATIONAL BANK

PHOTOGRAPH IF NOT AVAILABLE ON BANK RECORD
Branch Office…………………………..
Dist. No…….……………….……………

ANNEXURE TO ACCOUNT OPENING FORM FOR INDIVIDUAL/JOINT ACCOUNTS
(TO BE FILLED IN BY EACH INDIVIDUAL)
Customer ID
Account No.
1.Name of Account Holder (In block letters)
First Name
Middle Name
Last Name
2. Gender
Male
Female
3. Date of birth
(DD/MM/YYYY)
4. Nationality
5. Religion
HINDU/MUSLIM/ SIKH/CHRISTIAN/ OTHER
6.
Category
GENERAL/ OBC / SC / ST
7. ADDRESS
(a) Present
Residence
Owned
Parental
Rental
Employer
provided
Address
City(State)
PIN
Telephone No. (with STD
Office
Code)
Residence
E-mail
Mobile
No.
(a) Permanent
Residence
Owned
Parental
Rental
Employer
provided
Address
City(State)
PIN
8. OCCUPATION
Salaried-Govt./PSU sector
Salaried-others
Retired -Govt./PSU sector
Retired-Others
Student
Housewife
Self employed
Others –Not working
Medical
Legal
CA/CS
Business-Trading
Business-Industry/Mfg.
Agriculture
Any other*
9. MARITAL STATUS Married Single
10. EDUCATIONAL QUALIFICATION
Up to SSC Graduate Post Graduate Others (Specify)_______________
11. TOTAL ANNUAL INCOME (INDIVIDUAL)
Up to Rs.50000
Rs. 50000 Rs. 1.5lakh
Rs.1.5 lakh –Rs 5 lakh
Above Rs.5 lakh
12. Annual Turnover (in case of occupation is any business) __________________________
Nature of business, if applicable __________________________________________________________________________
Page 2 of 4
Whether documentary proof in support of item No. 11 & 12 provided : provided
Y
N
If yes, type of Proof : Balance Sheet Income –tax Return
Sales Tax Return Excise Return Other (specify) _________________
13. WHETHER INCOME TAX ASSESSEE?
IF YES, FURNISH PAN/GIR NUMBER(If PAN/GIR No. is not applicable, submit Form No. 60/61)
PAN/GIR Number
Y
N
14. PROOF OF IDENTITY
Passport PAN Card Voter ID Card Govt. /Defence ID Card
Driving license Other (specify) _________________
15. PROOF OF ADDRESS
Electricity Bill Telephone Bill Passport Ration Card
Driving Licence Govt / Defence ID Card Other (Specify) _______________
16. NAME OF SPOUSE (In block letters)
Mr./Ms.
First Name
Middle Name
Last Name
Telephone No. (with STD Code)
E-mail
Mobile No.
Customer ID No.(if any)
Whether employed/ self employed
Y
N
If yes, furnish office/ Business address
Office/Business Address
Telephone No.(with STD Code)
Pin Code
17. WHETHER DEALING WITH ANY OTHER BANK, IF YES, PLEASE GIVE DETAILS
NAME OF THE BANK AND BRANCH
Facilities/services being availed
SF
CA
OD
TL
OTH
18. Whether already dealing with PNB, if yes, please give details
Nature of Account
Account No.
Branch Office
19. Loans availed: (tick whichever is applicable, if yes, mention name of the financing institution/bank with amount)
Sl. No.
Type of Loan
YES
NO
NAME OF THE INSTITUTION
AMOUNT
1.
CAR LOAN
2.
CONSUMER LOAN
3.
HOUSING LOAN
4.
MORTGAGE LOAN
5.
EDUCATION LOAN
6.
ANY OTHER
7.
8.
9.
20. ASSETS (approximate value) Rs._________________
Details (*) :
Page 3 of 4
Vehicle owned : Car Two wheeler Others None
Life policy for : Upto Rs.1 lac Upto Rs.2 lacs Upto Rs. 5 lacs Above Rs.5 lacs
Pension policy : Yes No If yes, give details ____________
Medical Insurance : Yes No If yes, give details ____________
Other Assets : ___________________________________________________________________________________________
21. INVESTMENTS Rs.___________________
Details(*) (Stocks & Shares/NSCs/ PPF, other deposits etc) (tick appropriately)
Nationalized Banks
Pvt. Banks
Foreign
Others
Company Deposits
Mutual Funds
Shares
Bank Deposits
Investments
Property
Gold
PPF
Others
Amount
Upto Rs. 1 lac Upto Rs. 2 lacs Upto Rs. 5 lacs Above Rs.5 lacs
22(*). Spouse’s qualification :
UptoSSC Graduate Post Graduate Other (Specify) ___________
23(*). Details of your family members :
Age Group Up to 10 Yrs 11 to 20 Yrs 21 to 45 Yrs 46 to 60 Yrs Above 60 Yrs Total
No. of Males + + + + =
No. of Females + + + + =
24(*). Any relative settled abroad? Yes No If yes, please mention their names and addresses
Name
Address
1.
2.
3.
How many times have you been abroad in the last three years?
Never
1 to 5 times
Above 5 times
25. Whether ATM / Debit Card issued. If yes, please write the Card Number
(*) Optional
DECLARATION:
I/We give our consent to receive information by usual means of communication, including phone Banking about PNB’s Product 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 available with the Bank for marketing purposes.
Page 4 of 4
Date __________________
Place__________________
SIGNATURE/THUMB IMPRESSION
FOR BRANCH USE
Sl.No
Name of the Official/ Retired Staff
Signature
PF No./ Identity No.
DATE
Bank Official who got the form filled up
1
Retired Bank Official who got the form filled up
2
Information entered in the system by
3
Collected/ Entered Information Verified by
4
Risk Category: High risk Medium Risk Low Risk Negligible risk
Name
SIGNATURE
GPA / SPA / PF NUMBER
DATE
1. Risk Category confirmed by