Date * Branch Name *

Branch ID*

Entity Name

D D M M Y Y Y Y

First Name Middle Name Last Name

Application Form No.

Product Type * Savings Account Current Account Fixed Deposits

Account Opening Form for Institutional Segments

(Trust, Associations, Society, Clubs & Government Bodies)

Registered Office Address *

Address

City State

Pin Code

E-mail ID

Telephone

Mobile Fax No.

Website

Communication Address *

Same as Registered Address Other (Please fill detail below)

Address

City State

Pin Code

E-mail ID

Telephone

Mobile Fax No.

if not having PAN, fill form 60/61

Annual Turnover

Mode of Operation *

Jointly by any Two

As per the Trust Deed / Board Resolution/Account Opening Authority Letter

Jointly Severally

Others ____________________________________

Form 49A (if yes, please share a copy of form 49A)

We are exempt from the requirement of PAN (we shall submit it exemption certificate & relevant declaration)

Note : Fields marked with ‘*’ are mandatory fields.

2

Constitution* Trust Society

Government

Association Section 8 Companies

International Unregistered Club

Section 25 Companies

Segment* Education Religious Institution

Clubs

Healthcare NGO

Sports Association Professional AssociationTrade Association

Housing Society/RWA Central Govt. Organisation

State Govt.Dept/Agency

Private Trust Retrial Trust

Govt. Scheme Funds

DefenceLocal Authority/Body

Co-operative CreditSocieties

Quasi-Govt./Autonomus Body

Sub Segment*

School National Institutes

Hospitals

College University

Research Centres Charitable/Social/WelfareCSR Foundation

Temple Gurudwara

Endowment Board

Church Mosque/Dargah

Diocese Sports ClubWaqf Board

Private Club Gymkhana Family Trust PF Trust

Gratuity/SA Trust Pension Fund Trust ESOP Trust Gram Panchayat

Office DDO/BDOMunicipal Corporation Municipality/Municipal Council

Details of Authorised Signatories

Authorised Signatory - 1 New customer Existing Ujjivan customer

Name* First Name Middle Name Last Name

If existing customer, Customer ID

Maiden Name (if any)

Designation*

If existing Ujjivan SFB customer, the rest of this section can be left blank

Bank

Gramin bank PSU

Regional Rural BankCooperative Bank

Others ______________

PAN Number* if not having PAN, fill form 60/61

Father`s Name*

Mother`s Name*

Mother`s Maiden Name

Gender* Male Female Third Gender

Date of Birth* D D M M Y Y Y Y

Marital Status* Unmarried Married Others

*

*

Signature & Orgn. Stamp

3

C-KYC Number

Telephone No. Mobile No.*

Fax No.

E-mail ID*

Internet Banking * Yes No

If Yes Transact View (*attach relevant document)

Proof of Address* Document Name

Document ID Number Date of Expiry D D M M Y Y Y Y

Authorised Signatory - 2 New customer Existing Ujjivan customer

Name* First Name Middle Name Last Name

If existing customer, Customer ID

Maiden Name (if any)

Designation*

If existing Ujjivan SFB customer, the rest of this section can be left blank

PAN Number* if not having PAN, fill form 60/61

Father`s Name*

Mother`s Name*

Mother`s Maiden Name

Gender* Male Female Third Gender

Marital Status Unmarried Married Others

C-KYC Number

Telephone No. Mobile No.*

Fax No.

E-mail ID*

Internet Banking * Yes No

If Yes Transact View (*attach relevant document)

Proof of Address* Document Name

Document ID Number Date of Expiry D D M M Y Y Y Y

(Please enter preferred mobile no. & E-mail ID)

(Please enter preferred mobile no. & E-mail ID)

Proof of Identity* Document Name

Document ID Number Date of Expiry D D M M Y Y Y Y

Date of Birth* D D M M Y Y Y Y

Signature & Orgn. Stamp

Proof of Identity* Document Name

Document ID Number Date of Expiry D D M M Y Y Y Y

4

Authorised Signatory - 3 New customer Existing Ujjivan customer

Name* First Name Middle Name Last Name

If existing customer, Customer ID

Maiden Name (if any)

Designation*

If existing Ujjivan SFB customer, the rest of this section can be left blank

PAN Number* if not having PAN, fill form 60/61

Father`s Name*

Mother`s Name*

Mother`s Maiden Name

Gender* Male Female Third Gender

Marital Status Unmarried Married Others

C-KYC Number

Telephone No. Mobile No.*

Fax No.

E-mail ID*

Internet Banking * Yes No

If Yes Transact View (*attach relevant document)

Please note: Physical statement would not be provided if opted for e-statement.

Deduct TDS as applicable

Do not deduct TDS as exempted from Tax (Tax exemption certificate to be submitted)

TDS Deduction*

Proof of Address* Document Name

Document ID Number Date of Expiry D D M M Y Y Y Y

Date of Birth* D D M M Y Y Y Y

Signature & Orgn. Stamp

Proof of Identity* Document Name

Document ID Number Date of Expiry D D M M Y Y Y Y

(Please enter preferred mobile no. & E-mail ID)

Daily

5

Details for Fixed Deposit

Terms & Conditions1) All important charges pertaining to your Saving Account/Current Account & Deposit Accounts are mentioned in the service charges and fees brochure. However, this list is not exhaustive and you may visit our website www.ujjivansfb.into view the other charges which are applicable.2) Copy of Terms and Conditions, Service Charges and Fees brochure and the Code of Banks' commitment for individual customers can be obtained from the branch/ Bank website.3) Interest on the Savings& Deposit Accounts will be paid at the rate stipulated by RBI and decided by the bank from time to time. 4) Service Taxes as applicable will be levied on all fees.5) Adequate balance should be maintained in the account before issuing a cheque.6) The Bank can at its sole discretion discontinue any service partially / completely or change fees by providing 30 days' notice. All revision in fees will be displayed on the Notice Board of the branches of Ujjivan Small Finance Bank Limited and also on our website www.ujjivansfb.in7) The Bank reserves the right to close the account in case of unsatisfactory conduct of the account.8 The Bank reserves the right, at its own discretion; to close the account in case initial funding cheque is returned / bounced and funding as per account type is not received within 15 days of account opening. 9) The deposits of the Bank are insured with DICGC and in case of liquidation of the bank; DICGC is liable to pay each depositor through the liquidator, the amount of his deposit upto Rs. One Lakh within two months from the date of receipt of claim list from the liquidator.10) On maturity of deposit, in absence of any written instructions on disposal, the Bank reserves the right at its discretion to renew the deposit along with accrued interest thereon at prevailing rates of interest for a similar tenor of the deposit which has matured. 11) In case of premature withdrawal of deposit based on instructions of primary depositor or the instructions of all the joint depositors in the case of joint deposit, the bank shall have the right to recover interest already paid or the penalty, if any, from the proceeds of the fixed deposit in accordance with prevailing regulations of the bank and the Reserve Bank of India. 12) The Bank computes interest on its domestic deposit accounts based on the actual number of days in a year (i.e. 366 days in a leap year and 365 days in a non-leap year).

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www.ujjivansfb.in Ê清Óæçp…®ÜÈÉ ±ÜŨÜÎìÓÜÇÝWÜáÊÜâ¨Üá.

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12) ¸ÝÂíP… ñܮܰ ¨æàÎà¿á sæàÊÜ~ TÝñæWÜÙÜ ÊæáàÇæ ÊÜÐÜì¨ÜÈÉ ÊÝÓܤÊÜÊÝX CÃÜáÊÜ ©®ÜWÜÚWæ A®ÜáÓÝÃÜÊÝX Ÿwx¿á®Üá° ÇæPÜR ÖÝPÜáñܤ¨æ (Aí¨ÜÃæ A—PÜ

ÊÜÐÜì¨ÜÈÉ 366 ©®Ü, A—PÜ ÊÜÐÜìÊÜÆÉ¨Ü ÊÜÐÜì¨ÜÈÉ 365 ©®ÜÊÜ®Üá° ±ÜÄWÜ|®æWæ ñæWæ¨ÜáPæãÙÜáÛñܤ¨æ).

Deposit Amount (FD) Rs. *

Tenure *

Interest PayoutFrequency*

Maturity Payment Option *

Bank Account Details *

Monthly

Same as interest payout option

Bank Name

Month Days

Quarterly Half Yearly Annually At Maturity/

Issue DD/PO

Branch Name

Account Number

IFSC Code

MaturityInstruction*

Yes No

Renew Principal Only Renew Interest Only Renew Principal and Interest both

Interest PayoutOption *

Credit to my Ujjivan Small Finance Bank A/c

Credit to my accountwith other bank

If Yes,

Auto Renewal

____________________________________________________________________

ROI*

In figuresAmount in words

Cumulative

6

13) Customer should carefully examine the entries made in the statement of accounts & draw bank's attention to any errors/omissions/discrepancies that may be discovered within 30 days from the date of the entries failing which the same shall be deemed to be correct & accepted by the customer & the customer shall not be entitled to question the correctness/accuracy thereof.14) The Bank may disclose information about customer's account if required or permitted by any law, rule or regulations or at the request of any public or regulatory authority or if such disclosure is required for the purposes of preventing fraud, without any specific consent of the customer.15) The terms and conditions mentioned herein shall be governed by and subject to the laws of Republic of India.

Declarations1. I/We wish to avail the banking facilities/products from Ujjivan Small Finance Bank and have read, understood and agree to the Terms and Condition (a copy of which supplied to me/us by the Bank) governing the opening of an account with Ujjivan Small Finance Bank, which may be amended by Ujjivan Small Finance Bank from time to time and hosted and notified on the website of Ujjivan Small Finance Bank. 2. I/ We understand that any changes in terms and conditions applicable to the channels mentioned above would be made available to me on request at the branch/displayed on Branch Notice Board. I/ We undertake that I/ We will be wholly liable/ responsible for all types of transactions done on my/ our above said account through my/ our card(s) issued by the Bank to me/ us. I/ We have read the rules and regulations with regard to issue of the Bank's Debit/ATM Card and I/ We shall abide by the same.

3. I/We have read, understood and agree to the charges/costs, mentioned in the extant Schedule of Charges displayed on the website of Ujjivan Small Finance Bank.

4. I/We agree to abide by and be bound by all applicable rules/ regulations/ instruction/ guidelines issued by the Reserve Bank of India and the Common Reporting Standards (CRS)in force from time to time. I/We have declared our status as per the rules applicable under section 285BA of the Income Tax Act, 1961 (the Act) as notified by Central Board of Direct Taxes (CBDT) in this regard.

5. I/We authorize Ujjivan Small Finance Bank to conduct my/our credit history verification with CIBIL or any other credit rating agency and acknowledge that Ujjivan Small Finance Bank shall have the right and authority to carry out investigations from the information available in public domain for confirming the information provided by me/us to Ujjivan Small Finance Bank. I/We declare that I/we have not availed any credit facility from any bank or have obtained NOC from such bank(s) for opening of a current account with Ujjivan Small Finance Bank.

6. I/We agree to furnish and intimate to Ujjivan Small Finance Bank any other particulars that we are called upon to provide on account of any change in law/statutory requirements either in India or abroad. I/We authorize Ujjivan Small Finance Bank to exchange, share or part with all the information provided herein with financial institutions/ agencies/ statutory bodies/ other such persons, as may be required by Ujjivan Small Finance Bank. I/We shall not hold Ujjivan Small Finance Bank or its agents/representatives liable for using/sharing such information.

7. I/We hereby declare that the information provided herein as well as in the documentary evidence provided by me/us to Ujjivan Small Finance Bank (the “Customer Information”) is true, correct and complete in all aspects to the best of my/our knowledge and that I/We have not withheld any Customer Information that may affect the assessment/categorization of the account as a Reportable account or otherwise. I/We further agree that any false/misleading Customer Information given by me/us or suppression of any material fact will render my/our account liable for closure and the bank shall have the right to initiate any action, under law or otherwise.

8. If any of the information provided here is incorrect, I/We hereby agree to indemnify and keep indemnified Ujjivan Small Finance Bank, affiliates and their successors or assignees.

9. I/We agree and understand that Ujjivan Small Finance Bank reserves the right to reject my/our account opening application form/request without assigning any reason thereof and without being liable to me/us in any manner whatsoever.

10.I/We agree and understand that the services provided by the Bank are neither transferable nor assignable to any party. The rights and obligations accrued upon me/us herein or otherwise by virtue of my/our account with the Bank cannot be assigned or transferred.

11.I/We understand that as per extant Reserve Bank of India guidelines, opening of any current account require declaration of existing credit facilities with any of the Bank's branches or any other bank. I/We shall declare details of any such Credit facilities enjoyed with any Bank in the Account Opening Form, as per the required format therein

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10. ®Ý®Üá/®ÝÊÜâ ¸ÝÂíQ¯í¨Ü J¨ÜXÓÜƳ$vÜáÊÜ ÓæàÊæWÜÙÜ®Üá° ¿ÞÄWÜã ÊÜWÝìÀáÓÜáÊÜí£ÆÉ A¥ÜÊÝ ¿ÞÊÜâ¨æà ±ÜûÜPæR ¯Áãàg®æ ÊÜÞvÜá ÊÜí£ÆÉ Gí¨Üá

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7

Document Name Date of ExpiryDocument ID Number

12. ®Ý®Üá/®ÝÊÜâ TÝñæ ñæÃæ¿ááÊÜ Êæã¨ÜÆá ¸ÝÂíQ¯í¨Ü ¯ÃÜûæà±ÜOÝ ±ÜñÜÅÊÜ®Üá° ±Üvæ¨Üá A¨Ü®Üá° ¯ÊÜáWæ J²³$ÓÜáñæ¤àÊæ.

13 ®Ý®Üá/®ÝÊÜâ ¸ÝÂíP… ®Ü®ÜWæ AÔ¤ñŲ̈ÜÈÉÃÜáÊÜ/ÖæãÓÜ Eñܳ®Ü°/ÓæàÊæWÜÙÜ PÜáÄñÝX SMS ÊÜáñÜá¤/A¥ÜÊÝ CÊæáàÇ…WÜÙÜ®Üá° PÜÙÜá×ÓÜÆá Óܳ$ÐÜrÊÝX

ÓÜÊÜá¾£ÓÜáñæ¤àÊæ. D ÓÜÊÜá¾£¿áá ®Ý®Üá/®ÝÊÜâ ÈUñÜ ÃÜã±Ü¨ÜÈÉ ÊÜá®ÜË ÊÜÞw PæãÙÜáÛÊÜÊÜÃæWæ ÊÜÞ®ÜÂñæ¿á®Üá° ±Üvæ©ÃÜáñܤ¨æ. D ´ÝÃÜí®ÜÈÉ EÇæÉàUÓÜÇÝXÃÜáÊÜ

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14. ¸ÝÂíQ®Ü ¯¿áíñÜÅ|WÜÚWæ A£àñÜÊÝ¨Ü ¿ÞÊÜâ¨æà PÝÃÜ|WÜÙÜá A¥ÜÊÝ ±ÜÅÊÜááS ÍÜQ¤WÜÙÜ PÝÃÜ|ÊÝX E¨Ü½ÊÜÊÝWÜáÊÜ ¿ÞÊÜâ¨æà Zo®æWÜÙÜ ÓÜíŸí«ÜÊÝX

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A¥ÜÊÝ gÊݸݪÄWæ ¸ÝÂíP… Ÿ¨ÜœÊÝXÃÜáÊÜâ©ÆÉ GíŸ AíÍÜÊÜ®Üá° ®Ý®Üá/®ÝÊÜâ ¯gÊæí¨Üá J²³$PæãÙÜáÛñæ¤àÊæ ÊÜáñÜᤠÓÜÊÜá¾£ÓÜáñæ¤àÊæ.

Authorised Beneficial Owner -1 Signature Authorised Beneficial Owner -2 Signature Authorised Beneficial Owner -3 Signature

12.I/We undertake to obtain the requisite No Objection Certificate/s from such Bank/s and hand it/them over to you before the account gets opened.13.I/We expressly consent and authorise the Bank to send SMS and/ or e-mails to inform me/ us on any information or updates relating to the Bank's existing/ new product/ services. The said consent is valid till such time I/ We withdraw the same in writing. Banks will send all alerts to the preferred mobile number and email address mentioned in this form. The Bank will also use these details for sending out transaction information and updates about products and services. Alerts that have been mandated by Reserve Bank of India and such alerts as deemed appropriate by the Bank will be sent even if you have not subscribed for the facility. Regulatory and risks alert will be send by the Bank by default without charges.14.I/We acknowledge and agree that Bank shall not be liable or responsible for failure to discharge any of its obligations contained herein or elsewhere including but not limited to completing any transaction, due to any cause arising out of or related to any force majeure event or for any reasons beyond the reasonable control of the Bank.

Proof of Identity

Proof of Address

Know Your Customer (KYC) Documentation

The terms and conditions mentioned above have been explained to me and I declare that I have understood and consented to all the terms and conditions and also the declarations and agreed to abide by them.

Account/Fixed Deposit

/Savings