Reference No: 201223054413-73528-QH2QA644RF-

For Office use only

1959804073140042
DSA ID : Branch :Chettikulangara
Sol ID :1863 Date :20-DEC-2023
Account Type:NRE/NRO Account Mode of operation :NA
Nomination Opted :Y CKYC No:
A/c No.
Customer ID 28130185
Scheme Name 35148

Welcome Kit Delivery Address Y

PERSONAL INFO
Name ABHI C Date of Birth 19-SEP-98
Gender M Nationality Indian
Mobile Number +919656605153 E-mail [email protected]
Father's Name NA Mother's Maiden Name JALAGA CHANDRAN
Senior Citizen N Indian Number +919947519677
Religion NA Category NA
Marital Status SING Spouse Name NA
Address Proof PassPort PassPort Number Z6286524
ID Proof PassPort PassPort Number Z6286524

Communication Address 9 ROSEVILLE COURT Permanent Address 9 ROSEVILLE COURT

EMPLOYMENT DETAILS
Occupation SELF EMPLOYED Employer's Type NA
Employer's Name NA Employer's Phone Number NA
Job Position NA Monthly Income 1000-20000
NRI STATUS DETAILS
Residence Status Resident Pan Number DODPA3410L
Passport Number Z6286524 Passport Place Of Issue NA
Passport Issue Date NA Passport Expiry Date NA
Visa Valid Upto NA
Account Activity
Purpose of Opening the Account NA Source of Fund NA
Expected Monthly Remittance NA Expected Monthly Withdrawals NA
CHANNEL FACILITIES
NA
Page | 1
 Declaration:
I/We hereby declare that ABHI C is /are Non-Resident Indian/s holding Indian Passport.
For Accounts in the name of Minors: I hereby certify that........................................................................... was born
on........................................and attains majority on .................................................and I am the natural guardian/legal guardian appointed by
the court order dated.............................................Name of the guardian...................................................................Relationship with
Minor.........................................Nature of Account...........................Account No...................
For Politically Exposed Persons:
I am a Politically Exposed Person who performs important functions for the State in the capacity as Senior Offcial of Govt. or Political
Parties etc. closely related to Politically Exposed Persons by Name ............................
Positions held Name of the Party/Organization Designation Period of Office
Political party
Government Organization
1. I/ We hereby undertake : (A) To inform the bank immediately on my/our coming back to India for permanent settlement/residence.(B) To
inform the bank immediately on any change occurring in my business/office/communication address/other contact details. (C) In respect of
NRO/ NRE A/C s, all the debits and credits will be carried out strictly as per FEMA regulations.
(D) To pay any overdraft created in my/our account inadvertently together with applicable interest and without demur. (E) To inform the
bank of the wrong credits in my/our account, pertaining toother customers and refund the same together with applicableinterestand without
demur.
2. I /We understand that : (A) 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 same made by me/us. (B) In the event of my NRI status is changed in future, my /our existing NRI account will be re-
designated to Resident/RFC account(s) (as applicable). (C) Rate of interest applicable, premature withdrawal of the deposit, premature
termination of the deposit in the event of death of the depositors and filing/ renewal / cancellation of the nomination will be as per /RBI/IBA/
Bank's rules in force from time to time.(D) I/We will not make available to any person resident in India any foreign exchange against
reimbursement in India in Rupees or otherwise. I/We hereby undertake to inform the Bank immediately on my/our coming back to India for
permanent settlement /residence. I/We understand that the bank may at any time and without notice to me/us combine and consolidate all or
any of my/our accounts and set off or transfer any sum or sums standing to the credit of anyone or more of such accounts in or towards the
satisfaction of any of my/our liabilities to the bank on any account or in any other respect whether such liabilities be actual or contingent,
primary or collateral and several or joint. Unless and until modified or cancelled by filing a fresh nomination form/request for cancellation ,
a nomination once filed will continue to be applicable to the deposit when renewed, whether in part or in full or with additional amount or
split up into different accounts, but without any change in the name and constitution of the account. If by error overdraft is created in my
account, I undertake to pay the same with applicable rates of interests. If by mistake, the bank credits cash/cheques pertaining to other
customers to my account(s),I undertake to inform the bank of the same and refund the same with interest and without any demur. (E) Term
Deposits will be automatically renewed on maturity for a similar Term at the rate of interest prevailing on the maturity date on same terms
and conditions unless instructed by me/us to the contrary or credit to my/our SB A/c No........................................... on maturity on receipt of
FD receipt duly discharged by me/us /facility for partial withdrawal in units/automatic loan facility. (F) I have read and understood the rules
governing internet banking services and agree to abide by the same. (G) I/We hereby unconditionally authorize the Bank to activate the
cheques issued to me/us in the account forthwith without insisting for my/our written/oral acknowledgment of having received the cheque
book. I/We shall not hold the Bank liable/responsible in any manner for any consequence(s) of whatsoever nature arising from activating the
cheque book facility as per this authorisation

Date :20-DEC-2023

Place :NA Applicant's Signature

Address Proof ___ KYC Norms complied with Customer Risk Rating
Yes __ No __
Principal
ID Proof ____ Signature of introducer verified Low ___ Clerk Asst Manager
Officer
Photos___ Medium ___
PAN Card Yes __ No __ High ___

Page | 2
 FORM DA 1

NOMINATION UNDER SECTION 45 'ZA' OF THE BANKING REGULATION ACT, 1949

AND RULE 2(1) OF THE BANKING COMPANIES (NOMINATION) RULES 1985 IN RESPECT
OF BANK DEPOSITS

I/We ABHI C nominate the following person to whom in the event of my/our/minor's death the amount
of the deposit, particulars whereof are given below, may be returned by The Federal Bank Ltd., Branch
Chettikulangara

Deposit Nominee
Additional Relationship If nominee is a
Nature of Distinguishing
Details , if Name Address with depositor , Age minor , Date
Deposit No.
Any if any Of Birth

chandran
NA FATHER NA NA
pillai

As the nominee is a minor on this date I/we appoint Shri/Smt/Kum NA to receive the amount of deposit
on behalf of the nominee in the event of my/our/minor's death during minority of the nominee

Date :20-DEC-2023 ABHI C

Place :NA Name Of Applicant Signature(s)/Thumb impression(s) of depositor(s)

Note: * Where deposit is made in the name of the minor, the nomination should be signed by a person
lawfully entitled to act on the behalf of the minor and strike out when the nominee is not a minor .
@ Thumb impression(s) should be attested by two witness(es)

.........................................................................................................................................................................................
ACKNOWLEDGMENT (NOMINATION)
Branch : Chettikulangara
Date : 20-DEC-2023
Appl. No : ............................
To,
Shri/Smt ABHI C
Dear Sir / Madam,
Reg : Nomination in respect of your deposit No................................... with us
Ref : Your Application Form DA1 /Letter No........... dated 20-DEC-2023
We acknowledge receipt of your letter of nomination dated 20-DEC-2023 authorizing Shri/Smt
chandran pillai to receive the amount of the aforesaid deposit kept in A/c No .........................................
with us.

Yours Faithfully

Manager
.........................................................................................................................................................................................
Page | 3
 Annexure 1 - FATCA-CRS Self Certification Form Individual - New Accounts
1. Name Of The Account Holder: ABHI C
2. AADHAAR Number (Optional)
3. Nationality Indian
4. City Of Birth NA
5. Country Of Birth NA
6. Occupation Type Salaried NA (Others - Please specify)
7. Residence Address For Tax Purposes (Include City, State, Country and Pin a) Same as Overseas Address
Code) (Please Tick Anyone) b) Same as Permanent Address
a) Residential
8. Address Type (Please Tick Anyone) b) Business
c) Registered Office
Tax residence declaration (please tick any one, as applicable to you)
a) I am a tax resident of India and not resident of any other country
b) I am a tax resident of the county/ies mentioned in the table below
Please indicate ALL the countries in which you are a resident for tax purposes and the associated Tax ID Number below:
Country # Tax Identification Number% Identification Type (TIN or Other%, please specify)

#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 $
$ It is mandatory to supply a TIN or functional equivalent if the country in which you are tax resident issues such identifiers. If no TIN is
yet available or has not yet been issued, please provide an explanation and attach this to the form

Declaration
I, ABHI C holder of passport number Z6286524 residing at 9 ROSEVILLE COURT hereby declare that:
I am neither a citizen of USA nor a resident of USA for tax purposes despite being my place of birth is in USA (by persons having U S
birthplace, but not a U S citizen/ tax resident)
OR
I am neither a citizen of USA nor a tax resident of any country other than India even though
a) My residence/mailing address/telephone number is of a country other than India
b) I have a standing instruction to an account maintained outside India
(By persons having foreign country indicia, but are tax residents of India)

Certification
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 is true, correct, and complete.
I/We also confirm that I/We have read and understood the FATCA CRS Terms and conditions below and hereby accept the same.

Date :20-DEC-2023 ABHI C

Place : NA Name Of Applicant Applicant's Signature

FATCA-CRS Terms and Conditions
The Central Board of Direct Taxes has notified Rules 114F to 114H, as part of the Income-tax Rules, 1962, which Rules require Indian
financial institutions such as the Bank to seek additional personal, tax and beneficial owner information and certain certifications and
documentation from all our account holders. In relevant cases, information will have to be reported to tax authorities/ appointed agencies.
Towards compliance, we may also be required to provide information to any institutions such as withholding agents for the purpose of
ensuring appropriate withholding from the account or any proceeds in relation thereto. Should there be any change in any information
provided by you, please ensure you advise us promptly, i.e., within 30 days. Please note that you may receive more than one request for
information if you have multiple relationships with Federal Bank or its group entities. Therefore, it is important that you respond to our
request, even if you believe you have already supplied any previously requested information. If you have any questions about your tax
residency, please contact your tax advisor. If you are a US citizen or resident or green card holder, please include United States in the
foreign country information field along with your US Tax Identification Number.
$ It is mandatory to supply a TIN or functional equivalent if the country in which you are tax resident issues such identifiers. If no TIN is
yet available or has not yet been issued, please provide an explanation and attach this to the form

Page | 4
 CheckList
Check Please
Identity Proof
Points tick
1 First page of the current valid passport (page where your photo and name appears)
2 Last page of the passport where you personal details like Father's name ,Address are given
3 Address Proof
a) Last page or the page in the passport where your address appears.
If the address mentioned in the form is different from the address in passport please submit any of the following
containing present address
b) Indian Driving License
c) Voter's Identity Card
d) Telephone bill
f) Letter from any recognized public authority
4 NRI Status Proof
Residence VISA / Employment VISA / Student VISA /Labour Card / Residence Permit / Uniform ID Card of the resident
country.
5 Attestation of Identity , Address and NRI Status proof
a) Embassy Attested
b) Attested by Notary Public
c) Attestation by a banker or Exchange Company
d) Directly submitting to our branch / Relationship Managers
e) Self Attested*

*In case the required documents are self attested , the following are mandatory
6 An account payee cheque of your existing NRE a/c with a Bank in India, drawn in your name for a minimum Rs 5000/- .
Original Overseas Bank or Credit Card Statement, of a recent date (not more than 6 months old) - Self Attested by the
7
customer.
8 Other Important Points to be Noted
Please attach a copy of your PAN Card along with the application. If you don't have a PAN Card, duly filled and signed
FORM 60 need to be attached along with the application.
Before sending the Application, please ensure that you have ticked () any one of the items in the check points 1 - 5 above.
If the items mentioned in check points 1-4 are self-attested, Check points 6 and 7 are mandatory. In such case the original
of all the documents have to be submitted at your branch for verification during the next visit to India/home town.

___ I hereby declare that all the documents ticked in the checkpoints 1-4 with necessary attestation will be forwarded alongwith the AOF.
___ I hereby declare that I will submit the original of the documents mentioned in check points 1-4 above during my next visit to India/home
town.

Date :20-DEC-2023 ABHI C

Place :NA Name Of Applicant Applicant's Signature

Page | 5