If1845 Eng Final
If1845 Eng Final
If1845 Eng Final
For Office use only (To be filled in by the branch’s officials): Account No._______________________
To: Date:
The Manager/ Senior Manager, CANARA BANK, Branch_____________________
Please note to enclose memorandum of association/ Article of Association and Certificate of incorporation in case of
Joint stock companies and partnership deed for partnership firms along with overseas auditor/ Chartered Accountant/
Certified Public Accountant certificate in FORM OAC where ownership/ beneficial interest is directly held by NRI and
OAC1 where it is held indirectly.
PERSONAL DETAILS
(Fill in Capital Letter) FIRST NAME MIDDLE NAME SURNAME
(In case the applicant is a Minor), Name of Parent/ Natural Guardian ______________________________________
Date of Birth ______________________ Relation: _______________________________ (Please Specify)
यह फार्म हहिं दी र्ें भी उपलब्ध है , हहिं दी प्रहि हे िू, कृपया शाखा प्रबिंधक से सम्पकम करें I 1
ADDRESS FOR CORRESPONDENCE: Indian Address Overseas Address (if not ticked, default address would be
Indian Address).
INDIAN ADDRESS:
First Applicant Second Applicant Third Applicant
Flat No./ Bldg.
Name
OVERSEAS ADDRESS:
First Applicant Second Applicant Third Applicant
Flat No./ Bldg
Name
* Occupation: Service Private Sector Public Sector Govt Sector Self –employed Retired
Business House wife Student Professional Not –category others
** Education: Non matric SSC/ HSC Graduate Post-Graduate Others
***Monthly Income Upto 5,000/- 5,001-10,000 10,001-20,000 20,001-50,000 50,001- 1 lac Above 1 lac
PASSPORT DETAILS:
Particulars Passport No. Place of Issue Date of issue Expiry Date Nationality
1ST APPLICANT
2ND APPLICANT
3RD APPLICANT
यह फार्म हहिं दी र्ें भी उपलब्ध है , हहिं दी प्रहि हे िू, कृपया शाखा प्रबिंधक से सम्पकम करें I 2
Atleast ONE of the following Officially Valid Documents (OVD) should be produced:
Particulars First Applicant Second Applicant Third Applicant
PAN No
Voter Id
Driving Licence
(with date of expiry)
Other
यह फार्म हहिं दी र्ें भी उपलब्ध है , हहिं दी प्रहि हे िू, कृपया शाखा प्रबिंधक से सम्पकम करें I 3
DETAILS OF REMITTANCE
1. Please keep Term Deposit Receipt in Safe Custody and renew for similar period on maturity
2. Please remit interest by draft to me
3. Credit interest to my SB / CA Account No……………………………… with Canara Bank………………….
4. Swift details (in case the interest amount is eligible for repatriation subject to compliance of RBI guidelines).
5. Please specify other instructions:
DECLARATION
1. I/we hereby declare that I/ we are a Non Resident Indian of India origin. I/we understand that the above account will be opened
on the basis of the statements / declarations made by me/us and I/we also agree that if any of the statements / declarations made
herein is found to be not correct in material particulars you are not bound to pay any interest on the deposit made by me/us.
2. I/we agree that no claim will be made by me/us for any interest on the deposit(s) for any period after the date(s) of maturity of
the deposit(s). I/we agree to abide by the provisions of the Foreign Currency Non-Resident Account (Banks) Scheme/Non
Resident (External) Account / Non Resident (Ordinary) Account Schemes. I/we hereby undertake to intimate you about my
return to India for permanent residence immediately on arrival.
3. I/we agree that if the premature withdrawal is permitted of my/our request, the payment of interest on the deposit may be allowed
in accordance with the prevailing stipulations laid down by the Bank in this regard.
4. I/we request and authorize you to honour all cheques or other orders drawn by me/us on the said account and I/we request you
to debit such cheques to the said account whether such account be for the time being in credit / overdrawn.
5. I/we in the matter of cheques lodged by me/us with you from time to time for collection or negotiation where the cheques payable
at place where you have not established branches, I/we request you to collect them through any bank entirely at my /our risk and
responsibility. Where such drafts / cheques are negotiated by and the same are lost in transit or otherwise, I/we hereby agree to
reimburse to you the full amount of such drafts, cheques on demand.
6. I/we agree to comply with and to be bound by the Banks for the time being in force for the conduct of such accounts. I/we declare
that the rules in force have been read by me/us.
7. I/we authorise the Bank to automatically renew the deposit on the due date for identical period unless the instruction to the
contrary from me/us is received by the Bank before maturity, I/we understand that the renewal will be in accordance with
provisions of the Reserve Bank of India guidelines / directives in force at the time of renewal.
8. I/we further understand that the rate of interest applicable on the deposit renewed shall be at the appropriate rate of interest for
the period of renewal as prevailing on the date of maturity or on the date of renewal whichever is lower and that the renewal will
be noted on the deposit receipt on my/our presenting the same on the maturity date or later for renewal/payment, I/we also
understand that the overdue deposit or a portion thereof can be renewed from the date of maturity provided the overdue period
does not exceed 14 days.
9. I/we hereby declare that all forex transactions, as may be entrusted by us to the Bank from time to time will be in strict conformity
with the prevailing provision of FEMA 1999 at the time of transactions are put through.
10. I/we undertake to utilize the debit card strictly in accordance with the exchange control regulations and understand that in the
event of my failure to do so, would be liable for action under FEMA guidelines issues from time to time and will also be debarred
from international Card facility at the instant of Reserve Bank of India or Canara Bank.
11. I/we declare that I/we have read and understood the document containing the terms and conditions and disclaimer governing
Canara Bank’s Internet and Mobile Banking Services as provided in the Bank’s Internet Banking Website www.canarabank.in
and I/we accept the same. Further, I also agree that the transactions and requests executed in the above mentioned accounts
through internet, Mobile Banking under my user ID and password will be legally binding on me and I am responsible for
maintenance of secrecy and confidentiality of the information passed on to me by the Bank through internet/ mobile/ email. I
have the mandate from the other joint holders to view/ enquire/ operate the joint accounts mentioned above.
12. No interest will be paid on premature closure of NR-TD & FCNR, closed before one year.
यह फार्म हहिं दी र्ें भी उपलब्ध है , हहिं दी प्रहि हे िू, कृपया शाखा प्रबिंधक से सम्पकम करें I 4
Under Penalty of Perjury, I certify that CERTIFICATION
Under penalty of perjury, I certify that;
1. I/we understand that Canara Bank is relying on this information for the purpose of determining the status of the account holder
named above in compliance with FATCA/ CRS. Canara Bank is not able to offer any tax advice on FATCA or CRS or its impact
on the account holder.
2. I/we agree to submit a new detail/ form within 30 days if any information or certification on this form becomes incorrect.
3. I/we agree that as may be required by domestic regulators/tax authorities, Canara Bank may also be required to report, reportable
details to CBDT or other authorities/agencies or close or suspend my account, as appropriate.
4. I/we have understood the information requirements of this Form (read along with the FATCA/ CRS Instructions) and hereby
confirm that the information provided by me/us on this Form including the taxpayer identification number is true, correct and
complete. I/we also confirm that I/we have read and understood the FATCA/ CRS Terms and Conditions and hereby accept the
same
5. I/we hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I/we
undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue
or misleading or misrepresenting, I/we are aware that I/we may be held liable for it.
6. My/our personal/ KYC details may be shared with Central KYC Registry
7. I/we hereby consent to receiving information from Central KYC Registry through SMS/email on the above registered
number/email address.
PHOTO & SIGNATURE:
Place:
Date:
Signature of 1st Applicant Signature of 2nd Applicant Signature of 3rd Applicant
INTRODUCTION
I know the applicant personally for a period of ………. Years and confirm his/ her/ their address/ occupation as stated above
SIGNATURE OF INTRODUCER
VERIFICATION OF SIGNATURES
& Countersigned
For Canara Bank
SUPERVISOR MANAGER
FOR OFFICE USE ONLY
Documents received: Self Certified True copies Notary Risk Category: High Medium Low
यह फार्म हहिं दी र्ें भी उपलब्ध है , हहिं दी प्रहि हे िू, कृपया शाखा प्रबिंधक से सम्पकम करें I 5
ANNEXURE: NOMINATION TO BE FILLED IN ONLY IF THE FACILITY IS REQUIRED BY THE DEPOSITOR
SUPERVISOR MANAGER
* strike out if nominee is not a minor & LTI, if any to be attested by 2 witnesses.
FATCA & CRS Indicia Documentation required for Cure of FATCA/ CRS indicia
observed (ticked)
U.S. place of birth If customer does not agree to be specified US person / reportable person status
1. Self-certification that the account holder is neither a citizen of United States of America nor a
resident for tax purposes;
2. Non-US passport or any non-US government issued document evidencing nationality or
citizenship (refer list below); AND
3. Any one of the following documents: a. Certified Copy of “Certificate of Loss of Nationality or
b. reasonable explanation of why the customer does not have such a certificate despite renouncing US
citizenship; or Reason the customer did not obtain U.S. citizenship at birth
Residence/mailing address in a 1. Self-certification that the account holder is neither a citizen of United States of America nor a tax
country other than India resident of any country other than India; and 2. Documentary evidence (refer list below)
Telephone number in a country 1. Self-certification that the account holder is neither a citizen of United States of America nor a tax
other than India If no Indian resident of any country other than India; and 2. Documentary evidence (refer list below)
telephone number is provided
Standing instructions to transfer 1. Self-certification in the attached format that the account holder is not resident for tax purpose in that
funds to an account maintained country
in a country other than India 2. Documentary evidence (refer list below)
List of acceptable documentary evidence needed to establish the residence(s) for tax purpose;
1. Certificate of residence issued by an authorized government body.
2. Valid identification issued by an authorized government body (e.g. Passport, National Identity card, etc.)
* Government or agency thereof or a municipality of the country or territory in which the applicant claims to be a resident.
यह फार्म हहिं दी र्ें भी उपलब्ध है , हहिं दी प्रहि हे िू, कृपया शाखा प्रबिंधक से सम्पकम करें I 6
Specimen Signature Card* (in case the application is downloaded from website/ when no separate card is available)
1 ………………………………….……………………
2 ……………………………….……………………….
Date: Countersigned by
Countersigned/ Authentication of signature by a Bank/ Indian Embassy/ High Commission/ Consulate etc.
* Each Individual applicant should provide separate card for him/ her.
यह फार्म हहिं दी र्ें भी उपलब्ध है , हहिं दी प्रहि हे िू, कृपया शाखा प्रबिंधक से सम्पकम करें I 7