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Page 1: Prefix First Name Middle Name Last Name

Prefix First Name Middle Name Last Name

Prefix First Name Middle Name Last Name

Page 2: Prefix First Name Middle Name Last Name

I/We hereby nominate Mr./Mrs/Ms.......................................................................to receive money payable by the Insurance Company in the event of my/our death .I/We hereby declare that his/her receipt shall be sufficient discharge to the Bank.(ii)As the nominee is minor on this date, I/We appoint Mr./Mrs/Ms. ............................................................................................................son/daughter/wife of Mr……………………………………………………………………………………………………........................................Resident of ..................................aged...............years to receive money on behalf of nominee during his /her minority.

Page 3: Prefix First Name Middle Name Last Name

Under penalty of perjury, I/we certify that: I understand that Punjab National Bank is relying on this information for the purpose of determining the status of the account holder named above in compliance with FATCA/CRS. Punjab National Bank is not able to offer any tax advice on FATCA or CRS or its impact on the account holder. I shall seek advice from professional tax advisor for any tax questions.

I/We agree to submit a new form within 30 days if any information or certification on this form becomes incorrect.

I /We agree that as may be required by domestic regulators/tax authorities, Punjab National Bank may also be required to report, reportable details to CBDT or other authorities/agencies or close or suspend my account, as appropriate.

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 on this Form including the taxpayer identification number is true, correct, and complete. I also confirm that I /We have read and understood the FATCA/CRS Terms and Conditions and hereby accept the same.

10.1-I/We confirm that all the information given in this application form including PNB 1228 ( ) is true, correct, complete and up-to-date in all respect and I/We have not

withheld any information. I/We shall be held responsible for the same at the same at all times if it is found incorrect. I/We confirm having read and understood the Rules and Regulations of the Bank including Bank’s tariff regarding the conduct of the account/ deposits and pertaining to the phone banking, Debit Cards, Internet Banking and Electronic Banking facilities (Collectively called the said banking facilities) and agree to be bound and abide by them/ any other rules that may be in force from time to time. It is my/our responsibility to obtain the terms and conditions from your bank and read the same. I/ We confirm my/ our residential status as per Indian Income Tax Act1962, is Non Resident Indian and I/We agree and undertake to inform the Bank in writing of any change in residential status. I/We undertake to operate and use the account/ deposit as well as the said banking facilities strictly in accordance with the Exchange Control Regulation as laid down by the Reserve Bank of India from time to time. All communications will be sent on provided registered mobile No & registered E-mail id.

CUSTOMER MASTER FORM / KNOW YOUR CUSTOMER (KYC) /CKYCR FORM FOR INDIVIDUALS

Page 4: Prefix First Name Middle Name Last Name
Page 5: Prefix First Name Middle Name Last Name

Annexure 3. Section (c) Guardian in case of a minor account:


Date of Father/Husband Father Husband First Name Middle … Name Middle Name Surname Father/Husband Name Father Husband Middle Name Surname Address Country State District PIN Folio

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