Branch Office………………………………

FORM DA-1: NOMINATION

Nomination under Section 45 ZA of Banking Regulation Act, 1949 and Rule 2(1) of the Banking Companies (Nomination) Rules 1985 in respect of Bank Deposits,
I/ We ( Name(s)) ________________________________________________________________________________________________
R/o_____________________________________________________________________________________________________________
nominate the following person to whom in the event of my/our/ minor’s death, the amount of deposit in the account may be returned by Swabhiman Bank, Branch
Office______________
DEPOSIT NOMINEE
Nature
of
Account
Account No. Additional
Details, if
any
Name Address Relationship with
depositor, if any
Age Date of birth
* As the nominee is minor on this date, I/we appoint Mr./Ms._______________________________________________________
Age________ 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.
Place:_________________________________
Date:__________________________________ @ Signature(s) / #Thumb impression(s) of depositors
@Where the deposit is made in the name of minor, the nomination is to be signed by natural/legal guardian of the minor to act on behalf of the minor.
*Strike out if nominee is not a minor
WITNESSES
Name & Signature of the first witnesses Name & Signature of second witnesses
Name___________________________
Signature:________________________
Address:_________________________
Place:___________________________
Date:____________________________
Telephone No._____________________
Name___________________________
Signature:________________________
Address:_________________________
Place:___________________________
Date:____________________________
Telephone No._____________________
#Thumb impression(s) shall be attested by two witnesses; otherwise it shall be attested by one
witness.………………………………………………………………………………………………………………
NOMINATION REGISTERED
The above mentioned nomination is registered at serial no ____________________________________ in respect of (Type of Account.) _________________ Deposit
Account No.________________ ___________________________.
Date_____________________. For Indian Bank, _____________________ Branch.
(Authorised Official)
SS No.____________