Referrence No.

: 0000134804

ACCOUNT OPENING FORM FOR RESIDENT INDIVIDUAL(SINGLE/JOINT) ACCOUNTS

Branch : BALTIKURI SOL ID : 0755 Date : 22/05/2019

KYC NO.
Customer ID
A/C NO.
Name of account holder MR.AKASH MAL

I/We request you to open my/our deposit a/c with your branch/bank as under:(Tick ✓relevant type of account)
Type of A/c Scheme Name Type of A/c Scheme Name
SB A/c ✓ Recurring Dep. A/c

Current A/c Term Deposit

In case of Savings Bank A/c (Please ✓from the following)

With Cheque Facility Without Cheque Facility Tierised Facility Zero Balance BSBDA (Small A/c) Others

✓
In case of Fixed Deposits :

Period Amount Int. Rate Maturity Amt Int. *Auto Renewal on *Auto Renewal on Int. Credited to
Payment(M/Q/H/ maturity(Principal maturity(Principal A/c No. & Branch
Y) only)– Pl. tick + Int.)– Pl. tick

May be renewed automatically for the same period/ for ................. (period) unless you receive any other communication from me/us at least a day before
due date of maturity.

In case of Recurring Deposit :

Month Installment Amt. Maturity Date Maturity Value A/c No. & Branch in which Amt. will be Credited on Maturity

FULL NAME, in Capital Letters (in order of first, middle & last name, leaving a space between words): M/F

1 AKASH MAL M
2
3
4
5

First Applicant Second Applicant Third Applicant Foutrh Applicant Fifth Applicant
Customer ID (if any
existing)
Specimen Signature
/Left/Right thumb
impression

Please paste recent

Passport size
photograph with
signature across the
photograph

Please choose ✓from the following (if Staff/Ex-Staff, mention EMP No.):

Senior Citizen Staff (EMP No.): Ex-Staff (EMP No.) Pensioner NRI Minor High Networth
Individual Others/General ✓
Relationship with minor ( ✓ tick one)
Name of the Guardian (In case of Minor) :
Attach proof for minor's DOB
Father & Mother & Legal* Others
Natural- Natural-
Guardian Guardian
* In case of legal guardian ( guardian appointed by court), enclose copy of court order

Name and address of Employer

First Applicant 2nd Applicant 3rd Applicant 4th Applicant 5th Applicant

Pin Pin Pin Pin Pin

Operating instruction (Please mark ✓ in appropriate box) :

Self ✓ Any One Or Survivors Or Survivor Minor & Natural Guardian Operated
By Latter
Minor A/C Operated By Mother As
Guardian
First Only First Two Only First Three Jointly Any Two Jointly Or Survivors Or
Survivor
Any Three Jointly Or Survivors Or All Jointly Or Survivors Or Survivor All Jointly Minor Natural Guardian Operation By
Survivor Guardian
Minor And Legal Guardian Opration Minor Alone Opr By Self Either Or Survivor Former Or Survivor
By Latter

Facilities required (Please mark ✓ in appropriate box/es) :

Facilities required (Please mark ✓ in appropriate box/es) :Requirement of Statement of

Cheque Book

A/c ( PI. tick ✓ )

Issued cheque series No............................ to............................ Monthly Weekly* Daily*
Date of Issue : * Service Charge will apply*

Add-on facility:(Pl ✓ ) I wish to avail the following facility(ies) -

Internet banking-UCO e-banking UCO VISA Debit Card/Rupay Card Mobile Banking

Other Information (Pl.✓ tick one) :

Education Non-Matric ✓ SSC/HSC Graduate Post Graduate Others:

If Salaried, employed Proprietorship Public Ltd. MNC Private Sector Pvt. Ltd. Govt. Others (Specify)
with
If Professional Doctor Architect CA/CS IT Consultant Engineer Lawyer Others (Specify)
If Business* Manufacturing Real Estate Service Provider Trader Agri. Stock Broker Others (Specify)
If Business* Sales & Marketing. Food & Grocery Textiles Electrical & Pharma Contractors Shop & Malls
Electro

Hindu ✓
Religion Muslim Sikh Christian Others:

Religion Buddhist JAIN Neo Buddhist Parsi Zorastrian N/A

Category General ✓ OBC SC ST

Annual Income (Rs.) Up to 50000/- 50001 - 1.5 Lac 1.5 – 5 Lac 5 Lac – 10 Lac Above 10 lacs

General ✓
Status Blind Parda Nashin Phy-Handicapped Distressed Illiterate Others (Specify):
Woman Poor
Identification Mark NA

Instruction for premature payment, premature extension and allowing loans to one or more of the account holder(s) or the survivors(s) :

The bank on receipt of written application from Sri/Smt/Ms........................................................................................the former/the later/the first name/the second nameetc. of

us Either or Survivor of us/Anyone or Survivors or survivor of us in its absolute discretion and subject to such terms and conditions as the Bankmay stipulate, grant a loan

advance against the security of the term deposit receipt to be issued in our joint names, or make premature Payment of the,proceeds of the deposits to the former/the first

named of us/either or survivor of us, etc./the second name of us/anyone of us or survivors of us close/ transfer his account on instruction from any of us.

DECLARATION (Please mark in appropriate boxes):

[ ✓ ] I/We declare that I/We we do not enjoy any credit facilities with other bank/s.

[ ] I/We declare that I/We have following deposit accounts and/or credit facilities with your /other banks branches:-

Bank & Branch Place of Bank/Branch Type of Account/Facility Amount Account No.
TERMS & CONDITIONS & DECLARATION (Please mark in appropriate boxes) :

I/We have read , understood and agree to abide by the Banks rules relating to the conduct of the above accounts/services /products/Fees & charges

which are displayed on the web site www.ucobank.com contained in the brochures of the Bank from time to time. I/We wish to be informed about the

various features /products and promotional offers made by the Bank from time to time.
• Please issue cheque book and recover charges from my/our accounts as per norms of the bank.
• Account will be operated and balance along with interest payable as per operational instruction given above.
• I shall represent the said minor in all future transactions of any description in the above account until the said minor attains majority.
• I will indemnify the Bank against the claim of the above minor of any withdrawal/transactions made by me in his/her account.
• I/We also agree to maintain the minimum monthly balance which the Bank to avail the facilities and agree to pay or Bank may debit the charges from my account if
minimum monthly balance is not maintained and any other charges stipulated by the Bank.
• I/We also agree to maintain the minimum balance which the bank stipulates to avail the facilities and agree to pay or Bank may debit the charges from my account
if minimum balance is not maintained and any other charges stipulated by the Bank.
• I/We have read the Account Rules and hereby agree to be bound by the terms and conditions outlined to these rules which govern the Account which I/We am/are
opening /will open the UCO BANK and amendments to the rules made from time to time and those relating to various services availed by me. I/We understand that
the Bank may at its absolute discretion discontinue any of the services completely or partially without any notice to me/us.
• I/We authorize UCO Bank or its agents to make references and enquiries as may be deemed necessary in their discretion with regard to the information furnished
in this application. UCO Bank and its agents are empowered to exchange, share or part with all the information , data or documents relating to my /our application
inter se among themselves or to other Banks/Financial Institutions/Credit Bureaus/Agencies /Statutory Bodies/such other entities /persons as may be deemed
necessary or appropriate or as may be required for processing of such information/ data by such person/s or for furnishing of the processed information data
/products thereof to other Banks/Financial Institutions /Credit Bureaus / Agencies/users registered with such agencies.

(Full Signature)

1st Applicant.................................................. 2nd Applicant................................................... 3rd Applicant...................................................

4th Applicant................................................... 5th Applicant...................................................

_______________________________________________________________________________

IN CASE OF CURRENT ACCOUNT OPENED BY A SINGLE INDIVIDUAL :

The account will be operated upon by me and I authorize you to honour all cheques or other orders which may be drawn by me on this account and to debit, such cheques

or orders or bills or notes to my account with you whether such account be for the time being in credit or overdrawn.

-------------------------------------------------

Signature

________________________________________________________________________________

IN CASE OF JOINT ACCOUNT :

We request and authorize you until any of us shall give you notice in writing to the contrary to honour all cheques or other orders which may be drawn onthis joint account

kept by us with you or bills accepted or notes made on our behalf signed by any one of us and to debit such cheques or orders or bills ornotes to our account with you

whether such account be for the time being in credit or overdrawn. In the event of death, insolvency or withdrawal of any of us,the survivor or survivors of us shall have full

control of any moneys then and there after standing to our credit in our this account with you and it is understoodthat all moneys now or hereafter standing to our credit in our

account with you shall belong to the survivor/ survivors in the event of any of us dying during thecurrency of the account. It is further understood that any one of us forbids

payment of an account (which is not payable to all of us jointly) the account if incredit shall thereupon cease to carry interest and shall not be payable except on the

discharge of all of us or survivor/survivors. We also request you to acceptthe endorsement of any of one of us to cheques or other Orders, Bills or Notes payable to us.

We jointly and severally agree if our account or accounts at any time be overdrawn to be jointly and severally liable to you for any moneys for the time beingowing to you

thereon including commission and interest.

We aiso jointly and severally agree that all moneys , securities or other movable property (weather ours jointly or that of any or either of us either jointly orseverally) in or

coming into your position shall be and remain as security and shall stand charged for the due payment of our joint indebtedness and liabilitiesto you from time to time.

1st Applicant........................................... 2nd Applicant........................................... 3rd Applicant...........................................

4th Applicant........................................... 5th Applicant...........................................

________________________________________________________________________________

Declaration in case of NO FRILL (SMALL DEPOSIT) Account

As l/We. do not possess any of the documents required for personal identity/Address proof I/We certify that the Address as mentioned as earlier is true andcorrect. l/We also

understand that the balance in the account at any time will be limited to Rs . 50.000/-* and total transaction in the year will be restricted toRs.1 lac*. as and when the balance

or total transaction exceed these limits, UCO BANK will treat the account as a normal Savings Bank account and normalKYC procedure as per Bank's extent guidelines will

be followed. In the event of non submission of the required document to the bank, UCO BANK has theright to freeze/close the account.

* Subject to change as per RBI/Bank Guidelines Signature/LTI/RTI .................................................

________________________________________________________________________________

FOR ILLITERATE PERSONS/VISUALLY lMPAlRED* ACCOUNT : Date .......................................

The Manager,

UCO Bank,
 ............................................................................ Branch

The content of the account opening form and the rules of the bank regarding Saving bank/ Current Deposit Account in force for the time being has beenexplained to the

depositor and fully understood by him/her and he/ she affixed his/her left/right thumb impression hereunder in my presence in token thereof.*Bank’s guidelines for visually

impaired persons alongwith related request letter/indemnity letter/letter of undertakinghas been aiso explained to the depositor and fully understood by him/her in my

presence and he/she has his/her left/right thumb impression hereunder

LEFT/RIGHT thumb impression/Signature of the depositor (Signature of person explaining the above details)

Illiterate Person's identification marks ..............................................................................................................................................................

Signature of Authorized Officer

________________________________________________________________________________

Add On facilities :

1. UCO VISA DEBIT CARD

Primary Account No. SOL ID

Secondary Account no.(for linking) SOL ID
Secondary Account no.(for linking) SOL ID

Declaration:I have read and understood the terms and conditions relating to various services under UCO Vtsa Debit Card and I agree to abide by

andbe bound by them as they have in force now and will be in force now will be in force from time to time for the card. I request you to provide me the

UCOVisa Debit Card and the PIN (Personal identification No.) I agree.

1. To change my PIN periodically for maintaining secrecy of my account level information

2. To keep my PIN confidential without giving any room for its disclosure to any person .

3. To be responsible for any disclosure of my PIN or account level information to any person and that the Bank shall not be held responsible for any

loss or damage caused to me on account of such discIosure.

4. That the Bank may at its absolute discretion discontinue the facility completely or partially without any notice to me.

5. That the Bank may debit my primary or secondary account for operations through the UCO Visa Debit Card .

Further I authorize you to debit my account with the applicable service charges for use of the Card at any point of sales/ at any Visa enabled ATM other

than Bank's own ATM.

“I/We understand and undertake that the usage of UCO VISA/RuPay Debit Card shall be strictly in accordance with the Exchange Control Regulations/

RBI Guidelines/Other Forex Regulations and in the event of any failure to do so, I/we will be liable for action under Foreign Exchange Management Act,

1999 and the amendments thereof stipulated by RBI from time to time.”

Signature of Applicant .................................................

We also request you to please issue ADD ON CARD in the subject account to the joint account holder Mr ./Mrs. .............................................................................................

Sign. of First Applicant ....................................................................... Sign. of Second Applicant ......................................................

(FOR BRANCH USE ONLY)

UCO VISA/RuPay Debit Card No. .....................................................................................................................................................................................

UCO VISA/RuPay Debit Card and PIN mailer handed over on .........................................................................................................................................

Card activation request sent on .........................................................................................................................................................................................

Card Expiry date ................................................................................................................................................................................................................

Signature of Officer : ........................................................ EMP No. ....................................................... Date .................................................................

_______________________________________________________________________________

2. UCO e-BANKING

I would like to avail UCO e-Banking Services and would like to link the following accounts for the purpose.

l confirm that l am the sole account holder/l have the required mandate from the joint account holder of the linked accounts, (in case of joint accounts)*, to operate the

accounts through UCO e-Banking Services.

 A/C No. Customer ID (Branch use) Mode of operation Name of Joint A/C holder ** We permit the applicant to access all these accounts
through UCO e-Banking Services
Signature of the Joint A/C holder(s)

* Access through UCO e-Banking services in respect of bank account will be permitted only where the mode of operation of the account is single/either or survivor/anyone or

survivor.

** In case joint accounts the applicant needs to obtain mandate from the joint A /C holder(s) in the column mentioned above.

Declaration I have read the 'Terms and Conditions' and 'Disclaimer' applicable to UCO e-Banking Services and I accept the same which are displayed on

http://www.ucobank.com the site maintained by UCO Bank. Further, I also agree that the transactions and requests executed in the above mentioned account through UCO

e-Banking under my User ID and password will be legally binding on me.

I do hereby indemnify and forever keep indemnified the Bank and its successors and assigns of from and against any or all claims, actions, penalties, thatmay be made,

suffered or incurred by the Bank by reason of non -compliance by me of any of the terms and conditions made therein.

Date : ................................................ Signature of Account Holder ..............................................................

Place : ...............................................

(FOR BRANCH USE ONLY)

Application Sl. No.

We confirm having verified the signatures and mandates for the accounts including those of joint account holders . We also confirm that KYC norms havebeen complied with

by the account hoIder(s). Recommended for extending UCO e-Banking facilities.

Date : ................................ Sign. Manager .......................................................... Senior Manager .................................................................

EMP No. ................................................................... EMP No. ............................................................................

___________________________________________________________________________________________

3. UCO m-BANKING

Mobile No.

I would like to avail UCO mBanking Services.

I confirm that l am the sole account holder/l have the required mandate from the joint account holder of the linked accounts, (in case of joint accounts)*, to operate the

accounts through UCO mBanking Services.

A/C No. Customer ID (Branch use) Mode of operation Name of Joint A/C holder ** We permit the applicant to access all these accounts
through UCO m-Banking Services
Signature of the Joint A/C holder(s)

* Access through UCO e-Banking services in respect of bank account will be permitted only where the mode of operation of the account is single/either or survivor/ anyone

or survivor.

** In case joint accounts the applicant needs to obtain mandate from the joint A /C holder(s) in the column mentioned above.

Declaration I have read the 'Terms and Conditions' and 'Disclaimer' applicable to UCO mBanking Services and I accept the same which are displayed on

http://www.ucobank.comthe site maintained by UCO Bank Further, I also agree that the transactions and requests executed in the above mentioned account through UCO

mBanking through my mobile device and MPIN will be legally binding on me.

I do hereby indemnify and forever keep indemnified the Bank and its successors and assigns of from and against any or an claims. actions, penalties. that may be made,

suffered or incurred by the Bank by reason of non-compliance by me of any of the terms and conditions made therein.

Date : ................................................ Signature of Account Holder ........................................................

Place : ...............................................

(FOR BRANCH USE ONLY)

Application Sl. No.

We confirm having verified the signatures and mandates for the accounts including those of joint account holders . We also confirm that KYC norms have been complied

with by the account hoIder(s). Recommended for extending UCO m-Banking facilities.

Date : ................................ Sign. Manager .......................................................... Senior Manager .................................................................

EMP No. ................................................................... EMP No. ............................................................................

___________________________________________________________________________________________

Nomination Form Form DA 1

Nomination under section 45ZA of the Banking Regulation Act 1949 and 2(1) of the Banking Companies (Nomination) Rules 1985 in respect of bank deposits.

I/We name(s) .................................................... and .................................................... nominate the following persons to whom in theevent of my/our/minor’s death, the

amount of the deposit held in the account, particulars whereof are given below may be returned by UCO Bank....................................................................... Branch.

Deposit Nominee

Nature of Deposit Account No. Additional Details (If Name of Nominee Address of Nominee Relationship with Age If Nominee is Minor
any) Depositor (if any) his/her DOB#
KAKULI MAL NASKAR PARA MOTHER 41
,BALITIKURI,HOWRA
H,HOWRAH,WEST
BENGAL,711113

# As the nominee is a minor on this date, l/We appoint Mr./Mrs./Miss................................................................................................................................................................

(Name, Address. and Age) to receive the amount of deposit in theaccount on behalf of the nominee in the event of my/our/minors death during the minority of the nominee.

Place : ......................................................................

Date : .......................................................................... #Strike out if nominee is not minor

*Signatures/Thumb impression of Depositors @Signature, Name and Address of Witness(es)

* Where deposit is made in the name of a minor the nomination should be signed by a person Iawfully entitled to act on behalf of the minor.

Thumb impression(s) of depositor(s) should be witnessed by two person(s).

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _

ACKNOWLEDGEMENT

Date :

We acknowledge receipt of nomination made by you in favour of Shri /Smt./Ms.................................................................................................................. aged ..........

yrs. in respect of your ................................................ A/C type. ........................... A/C No. ............................... On Form DA1

........................................................

Branch Manager

For Office Use

S.No Description Name of Authorised Staff Signature

1 Applicant interviewed & purpose ascertained by

2 Letter of thanks sent to A/c. holders on
3 Money laundering Risk Classification

[ ] Low [ ] Medium [ ] High

4 ........................................................................

Signature of Branch Manager/Manager

EMP No. : ..................................................

Date : .......................................................

Branch : ................................... Sol ID : ...........................................

 1st Applicant's details

1.Annexure-A

New Update:- Know Your Customer (KYC) Application Form - Application Form I Individual

KYC Number :

1.PERSONAL DETAILS (Please refer instruction ‘A’ at the end)

Prefix First Name Middle Name Last Name

Name* (Same as ID PROOF) MR. AKASH MAL

Maiden Name (If Any*)

Father/Spouse Name* MR ARUP MAL

Mother Name* MRS KAKULI MAL

Date of Birth 10/09/2008

Gender Male ✓ Female Transgender

Marital Status Married Unmarried ✓ Others

Nationality* IN-Indian ✓ Other

Residential Status* Resident Individual Non-Resident Indian Foreign National

Person of indian Origin ✓ Country Code

Occupation
Salaried Proprietorship Public Ltd. MNC Private Sector Pvt. Ltd. Govt.

Profession Doctor Architect CA/CS IT Consultant Engineer Lawyer

Business* Manufacturing Real Estate Service Provider Trader Agri. Stock Broker Others (Specify)
Sales & Food & Grocery Textiles Electrical & Pharma Contractors Shop & Malls
Marketing. Electro

Student✓
Other Occupation Retired / Pensioner House Wife Other

2.TICK IF APPLICABLE/RESIDENCE FOR TAX PURPOSES IN JURISDICTION(S) OUTSIDE INDIA (Please refer
instructions ‘B’ at the end, if applicable)
ADDITIONAL DETAILS REQUIRED* (Mandatory only if section 5.2 is ticked)

3166*/ISO 3166 Country Code of jurisdiction of Residence* IN

Tax Identification Number or equivalent (if issued by jurisdiction)*
Place/ City of Birth
ISO 3166 Country Code of Birth* IN
3.PROOF OF IDENTITY (Pol)* (Please refer instruction ‘C’ at the end )
Certifided copy of any one of the following Proof of Identity (Pol) needs to be submitted)

ISO 3166 Country Code of jurisdiction of Residence*

A-Passport Number Expiry Date

B-Voter ID Card
C-PAN Card
D-Driving Licence Expiry Date
E-UID (Aadhaar) 663616368236
F-NREGA Job Card
Z-Others (any document notifided by Identification No.
the Central Government)

4.PROOF OF ADDRESS (PoA)* (Certified copy of any one of the following Proof of address (PoA) needs to be
submitted)
4.1 CURRENT/PERMANENT/OVERSEAS ADDRESS DETAILS (Please see instruction G. IV at the end)

Address Type* Residential/Business Residential ✓ Business

Registered Office Unspecified

Proof of address* Passport Driving Licence UID (Aadhaar) ✓ PAN Card

Voter ID Card NREGA Job Card Others

Address*: NA,NASKAR PARA

City/Town/Village HOWRA District HOWRAH

State /U.T Code* WB Pin / Post Code* 711113 ISO 3166 Country Code* IN

4.2 CORRESPONDENCE / LOCAL ADDRESS DETAILS*

Same as Current / Permanent / Overseas Address details ( In case of multiple correspondence / local addresses, please fill ‘Annexure A2’)

Address Type* Residential/Business Residential ✓ Business

Registered Office Unspecified

Proof of address* Certificate of Incorporation/Formation Registration Certificate

Address*: NA,NASKAR PARA

City/Town/Village HOWRA District HOWRAH

State /U.T Code* WB Pin / Post Code* 711113 ISO 3166 Country Code* IN

4.3 ADDRESS IN THE JURISDICTION WHERE ENTITY IS RESIDENT OUTSIDE INDIA FOR TAX PURPOSES*(applicable if section 2 is ticked)

Same as Current/Permanent/Overseas Address details Same as Correspondence /Local Address details

Address Type* Residential/Business Residential Business

Registered Office Unspecified

Proof of address* Certificate of Incorporation/Formation Registration Certificate

Address*: ,,

City/Town/Village District
State /U.T Code* Pin / Post Code* ISO 3166 Country Code* IN
5.(CONTACT DETAILS (All communications will be sent on provided Mobile No./Email-ID) (Please refer
instruction ‘F’ at the end)

Tel. (Off) Tel. (Res)

Mobile 9051162783 FAX

E-mail-id:

6.DETAILS OF RELATED PERSON* (In case of additional related persons, please fill ‘Annexure B2’) (Please refer
instruction ‘G’ at the end)

Addition of Related Person ✓ Deletion of Related Person

KYC Number of Related Person (If available*)

If KYC number is available, only ‘Related Person Type’ and ‘Name’ is mandatory.

Guardian of Minor ✓
Related Person Type* Nominee

Authorised Representative Beneficial Owner

Authorised Signatory Court Appointed Official
Beneficiciary Assignee

Name* (Same as ID PROOF)

Prifix First Name Middle Name Last Name

MR. ARUP MAL

PROOF OF IDENTITY (Pol)* (Please refer instruction ‘H1’ at the end )

(Certifided copy of any one of the following Proof of Identity (Pol) needs to be submitted)

A-Passport Number Expiry Date

B-Voter ID Card
C-PAN Card
D-Driving Licence Expiry Date
E-UID (Aadhaar) 500727621236
F-NREGA Job Card
Z-Others (any document notifided by Identification No.
the Central Government)

7.REMARKS (If any) :

8.APPLICATION DECLARATION :
*I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I 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 am aware that I

may be held liable for it.

*My personal KYC details may be shared with Central KYC Registry.

*I hereby consent to receiveing information from Central KYC Registry through SMS/Email on the above registered number/email address.

Signature/Thumb Impression of Applicant

Date ................................................................................................. Place .................................................................................................

3.ATTESTATION/FOR OFFICE USE ONLY

Documents Received Self-Certifided True Copies Notary

Risk Category High Medium Low

IN PERSON VERIFICATION CARRIED OUT BY INSTITUTION DETAILS

Identity Verification Done Date ..........................................

Emp. Name Name UCO BANK

Emp. Code Code

Emp. Designation

Emp. Branch.

Employee Signature Institutional Stamp

Annexure-A1
In case of multiple correspondence / local addresses, please fill ‘Annexure A1’
UCO BANK : Know Your Customer (KYC) Application Form (Individual : Correspondence/ Local Address)
1.(PROOF OF ADDRESS (PoA)* (Certified copy of any one of the following Proof of Identity (Pol) ends to be submitted) (Please see

instruction ‘E’ at the end)

1.1CORRESPONDENCE / LOCAL ADDRESS DETAILS*

Same as Current /Permanent /Overseas Address details

Address*: ,

City/Town/Village District
State /U.T Code* Pin / Post Code* ISO 3166 Country Code* IN

2.CONTACT DETAILS (All communications will be sent on provided Mobile No./ Email -ID) (Please refer
instruction ‘F’ at the end)

Tel. (Off) Tel. (Res)

Mobile FAX

E-mail-id:

3.APPLICATION DECLARATION
* I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I 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 am aware that I may be held liable for it.

* My personal KYC details may be shared with Central KYC Registry.

* I hereby consent to receiveing information from Central KYC Registry through SMS/Email on the above registered number/email address.
 Signature/Thumb Impression of Applicant

Date ................................................................................................. Place .................................................................................................

4.ATTESTATION / FOR OFFICE USE ONLY

Documents Received Self-Certifided True Copies Notary

Risk Category High Medium Low

IN PERSON VERIFICATION CARRIED OUT BY INSTITUTION DETAILS

Identity Verification Done Date ..........................................

Emp. Name Name UCO BANK

Emp. Code Code

Emp. Designation

Emp. Branch.

Employee Signature Institutional Stamp

Annexure-A2
Know Your Customer (KYC) Application Form /Individual /Related Person
1.DETAILS OF RELATED PERSON* (In case of additional related persons, (Please refer instruction ‘G’ at the
end)

Addition of Related Person ✓ Deletion of Related Person

KYC Number of Related Person (If available*)

If KYC number is available, only ‘Related Person Type’ and ‘Name’ is mandatory.

Guardian of Minor ✓
Related Person Type* Nominee

Authorised Representative Beneficial Owner

Authorised Signatory Court Appointed Official
Beneficiciary Assignee

Name* (Same as ID PROOF)

Prifix First Name Middle Name Last Name

MR. ARUP MAL

PROOF OF IDENTITY (Pol)* (Please refer instruction ‘H’ at the end )

(Certifided copy of any one of the following Proof of Identity (Pol) needs to be submitted)

A-Passport Number Expiry Date

B-Voter ID Card
C-PAN Card
D-Driving Licence Expiry Date
E-UID (Aadhaar) 500727621236
F-NREGA Job Card
Z-Others (any document notifided by Identification No.
the Central Government)

2.APPLICATION DECLARATION :
*I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I 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 am aware that I

may be held liable for it.

*My personal KYC details may be shared with Central KYC Registry.

*I hereby consent to receiveing information from Central KYC Registry through SMS/Email on the above registered number/email address.

Signature/Thumb Impression of Applicant

Date ................................................................................................. Place .................................................................................................

3.ATTESTATION/FOR OFFICE USE ONLY

Documents Received Self-Certifided True Copies Notary

Risk Category High Medium Low

IN PERSON VERIFICATION CARRIED OUT BY INSTITUTION DETAILS

Identity Verification Done Date ..........................................

Emp. Name Name UCO BANK

Emp. Code Code

Emp. Designation

Emp. Branch.

Employee Signature Institutional Stamp