MANIPUR RURAL BANK

HEAD OFFICE: KEISAMPAT, IMPHAL-795 001 (MANIPUR)

Form – 1 (Common Account Opening Form)
(Compulsory for all new account)
Branch Date

Account No. Cust ID

SAVINGS ACCOUNT CURRENT DEPOSIT ACCOUNT RECURRING DEPOSIT

With Cheque Book
Monthly Installment Rs
Without Cheque Book
REINVESTMENT PLAN OTHER TERM DEPOSIT Amount of Deposit Period of Deposit
(specify)
Rs
Days / Month / Year

FULL NAME OF DEPOSITORS IN BLOCK LETTERS DATE OF BIRTH

1.

2.

3.

60/61/PAN/GIR No. or FORM No. 60/61 UID No. NATIONALITY

1.
2.
3.

(Only first applicant) ID CARD No. ___________ MOTHER’S MAIDEN NAME*:

Complete address with telephone number, fax and email of all the depositors Residing at this
Office Address Residential Address address since

(Year)
1
email
mobile

2
email
mobile

3
email
mobile
Permanent residential address of first applicant (in case differs from present residential address) :

PIN

1
Address of communication first Depositor Second Depositor Third Depositor

MODE OF OPERATION :
By me By either, any one of us By Former or survivor of us
By Guardian on behalf of minor or survivor Other (Specify)

In respect of term deposit please: Send the renewal notice Do not send the renewal notice

In case of Bonanza Minimum balance to be maintaineed in the SB Account: `

Saving Account: Amount per unit of FD - `.

Period of Term Deposit - days

Standing instruction: Please debit monthly installment of RD account from my Savings Bank Account No …………………..

Please credit monthly/quarterly interest on fixed deposit to my Savings Bank Account No ……………

In case the operation is by Either / Any One or Survivor

Yes No
The bank may, on receipt of a written application from either/any one or survivor of us, in its absolute discretion and subject
to such term and conditions as the bank may stipulate, (a) grant loan/advance against the security of the term deposit receipt
to be issued in our joint names or (b) make premature payment of the proceeds of the term deposit or (c) close the account
without reference to the other depositors. The bank will be fully discharged while closing the account in this manner.

In case the operation is by Former or Survivor

Yes No
The bank may, on receipt of a written application from Former of us, in its absolute discretion and subject to such term and
conditions as the bank may stipulate, (a) grant loan/advance against the security of the term deposit receipt to be issued in our
joint names or (b) make premature payment of the proceeds of the term deposit or (c) close the account without reference to
the other depositors. The bank will be fully discharged while closing the account in this manner.

Date of birth (in case of minor) Name of the guardian & relationship Whether under Natural or Legal Guardian

Paste one Paste one Paste one

passport size passport size passport size
photograph and photograph and photograph and
sign across it in sign across it in sign across it in
presence of the presence of the presence of the
branch official branch official branch official

Signature

2
I/we agree to be bound by the Bank’s rules and regulations governing …………………………………..account from time to
time. I/we will maintain minimum balance in the account and on the event of fall in the minimum balance the bank may
realize the service charge.

I certify that I have known ____________________________ How do the depositors know the introducer?
____________________________ for past ________________
Months/years and confirm his/her/their occupation and Relation Colleague Neighbour
address. I also confirm that I know all the depositors.
Employer Friend
Signature ___________________________________________
Others (Please Specify) ________________________
Name ______________________________________________
If the account is to be open on self introduction, description of
Account No. ________________________________________ the papers furnished.

Address ____________________________________________

____________________________________________

____________________________________________

Additional Service Request:

I/we require the under mentioned services and agree to abide by the terms and conditions as governed by Manipur Rural
Bank from time to time.
(Please tick the services and options to view and / or transact)

Applicant
ATM cum debit card (international) Internet Banking Telebanking SMS/Mobile Banking

For Office Use:

Verified Introducer’s signature. Official’s Name: ____________________ Official Signature
Account opened on: DD/MM/YYYY
Letter of thanks sent to customer on: DD/MM/YYYY
Acknowledgement received from customer on: DD/MM/YYYY
Letter of patronage sent to the introducer on: DD/MM/YYYY
Reply received from the introducer on: DD/MM/YYYY

Additional Information:
Depositor First Second Third
Annual Income
Principal Economic Activity
Residence
Source of Wealth
Educational Qualification
Assets
Do you have Credit Card? If so, which Card?
How many times have you been abroad in last three years
Dealing with other Bank, if yes, give particulars
Signature

3
 MANIPUR RURAL BANK
CONFIDENTIAL
………………………………. Branch
CUSTOMER PROFILE
Name Name of
1) …………………………………………………………………… # F/M/H ……………………………………………….
2) …………………………………………………………………… # F/M/H ……………………………………………….
3) …………………………………………………………………… # F/M/H ……………………………………………….

Address of communication : …………………………………………………………………………………………

Telephone Number : (R) ………………………………………. (O) ………………………………………
(Mob.) ……………………………………
Type of Account and Account Number : ………………………………………………………………………………………...
Date of Opening the Account : …………………….
Residential Status : Resident / Non Resident
Sex : Male / Female
Age : ……………… Years
Educational Qualification : (a) School Final (b) Graduate
(c) Post Graduate (d) Professional (e) Others
Principal Economic Activity : ………………………………………………………………………………………….
Annual Income : ………………………………………………………………………………………….
@Annual Turnover Expected : ………………………………………………………………………………………….
*Purpose of opening the account : ……………………………………………………………………………………….....
Classification of the account as : Low risk / High risk
Observation of the official opening the account
(Briefly indicate reason for risk classification also)
______________________________
Date : Signature of the Bank official

BUSINESS PROFILE

Geographical Location of the Business : ……………………………………………………………………………………….

Nature / Activity of Business / Occupation : ……………………………………………………………………………………….
Estimated Income from the business : ……………………………………………………………………………………….
Any other source of income : ……………………………………………………………………………………….
Total Annual Income : ……………………………………………………………………………………….
Approximate value of movable and
immovable assets : ……………………………………………………………………………………….
Details of existing Bank Accounts : ……………………………………………………………………………………….
Details of foreign countries, if any, visited
during last three years : ……………………………………………………………………………………….

__________________________ ___________________________
Signature of the customer Signature of the Bank Official

# F-Father, M-mother, H-Husband

@ Should be based on Annual Income
*To be obtain through discussion
High Risk : Customer transactions crossing threshold limit
Low Risk : Pensioner’s Account, Priority Sector/Micro Credit Account, Accounts opened for disbursing funds under
Government Sponsored Schemes.

4
 Form No. DA-1 for nomination is executed below Do not require nomination
Please do not indicate the nomination on the passbook/ deposit receipt
FORM – DA 1
Nomination under Section 45 ZA of Banking Regulation Act, 1949 and Rule 2(1) Of the Banking (Nomination) Rules 1985 in
respect of Bank Deposits.
I/we _____________________________________________________________ nominate the following person to whom in the
event of my/our/minor’s death the amount of deposit in the above account may be returned by Manipur Rural Bank.
______________________ Branch (Name and Address of the Branch / Office in which deposit is held)
Particulars of Nominee
Name Address Relationship with Age If nominee is minor,
Depositor, if any his/her date of birth

# 2 As the nominee is a minor on this date, I/we appoint Shri/Smt/Kum _____________________________________________

__________________________________________________________________________________________________________
_____________________________________ (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.
Place :
Date : * Signature(s) / Thumb Impression(s)@ of the depositor(s)

Names, Signature and address of witnesses …………………………………………………………………………………………

…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………
# Strike out if the nominee is not a minor@ Thumb impression shall be witnessed by two witnesses
*Where deposit is made in the name of a minor, the nomination should be signed by a person lawfully entitled to act on behalf
of the minor.

MANIPUR RURAL BANK

5
 _____________________________________________Branch
Form No. 60
(See third provision to rule 114B)
Form of declaration to be filled by a person who does not have either a permanent account number or General
Index Register Number and who makes payment in cash in respect of transaction specified in causes (a) to (b)
of rule 114B.

1. Full name and address of the declarant :

2. Particulars of the transaction :
3. Amount of transaction :
4. Are you assessed to tax (Yes/No) :
5. If yes,
i) Details of ward/ Circle / Range where the last return of income was filled?
ii) Reasons for not having permanent account number / General Index Register Number?
6. Details of the 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.
Verified today, the ……………………. Day of ……………………. 20…………

Date ………………
Place …………….. …………………………….
Signature of the declarant

Proof of Identity Proof of address

A) Passport where the address differs A) Credit card statement
B) Voter ID card B) Salary slip with address
C) PAN card C) Income tax/ wealth tax assessment order
D) Govt./ Defence ID card D) Electricity bill
E) ID card of a reputed employer E) Telephone bill
F) Driving license F) Bank account statement
G) Photo ID card issued by Post Office G) Letter from a reputed employer
H) Photo-ID card issued by universities/ H) Letter from any recognized public authority
Institute approved by UGC / AICTE I) Ration card
I) Letter from a recognized public authority J) Copies of Registered Leave & License Agreement/Sale Deed/
or public servant verifying the identity and Lease Agreement
residence of the customer. K) Certificate issued by warden of hostel of University/Institute
J) UID card (approved by UGC/AICTE) where the student resides
L) For students residing with relatives, address proof of
relative along with their identity proof