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UCobProducts and/ orservices
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introduced
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Signatureof 2'd Applicant Signature
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I herebydeclarethatthe dateot birthol minoris .................,.
/ / .......,...........
who is my (relationship)
"'".. and I arn hiVhernaturalguardian/ lawfulguardian
appointedvide courtorderdated
(copyenclosed). I shallrepresentthe saidminorin all
,l. r.i"t". i'*"r"tt theBank
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DECLARATTON
tN CASEOF NO FFTLL(SMALLDEPOS|T)
ACCOUNT
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As lrue' do nol possesanyof thedocuments requiredlor Personal ldentity/ Address proof.lAVecertitythatthe
address asmentioned.inthecustomer profiledocument istrueandcorrect,
in theaccount L/wealsounderstand thatthebalance
at anytimewillbe limited
to Rs.50,000/-* andtotaltransaction
lac*intheyear'Asandwhenthebalance in theyearwillbe restricted
to Rs.1
or totaltiansactions;;l;;. limits,UCOBankwilltreattheaccount
as a normalsavingsBankaccount andnormalKYCprocedure as perganrs ertantguidelines willbefollowed.In
non-submissionof the required documents to the bank,UCo Bankhasthe rightto freezelclose
H;ffi',of the
* Subject to change as perRBI/Bank guidetines.

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TheManlger,UCo Bank
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fi-q q-6bq/ DearSir;

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to honour at cheques orother
we requesrandauthorise youuntiranyol usshalrgiveyounoticeinwritingto thecontrary made on our behalf
rlpt by uswithyouor bi's accepted or notes
orderswhichmaybe crrawn on ourthisjointaccorlnt with you whether such
oiorOersor billsor notes to our account
signedby anyoneof us andto debitsuchcheques or withdrawal of any ol us'the
be forthe'me beingin creditor overdrawn. In the eventof death,insolvency this
account standing to our credit in our
ot us shallhavef ullcontrolof anymoneys thenandthereafter
or survivors
survivor to ourcreditin,::t withyoushall
thatallronuy, nowor neieatter standing
accountwithyouandit isunderstood ol the"-t:o'nt
account' lt is further
in the eventli us dyingduringine currency
berongto the survivoror survivors ""v "t is noipayaote to at of us jointly)the account i' in
or an account (v'rrich
undersrood thatiranyoneo1usforbidspayment of at or us or survivor or
ceaseto carryinterest andshatnotbepayabre ,*r.pi onthedischarge
creditshalrthereupon or other orders' bills or notes
we alsorequest youto accepttheendorsement o1anyol oneof usto cheques
survivors.
payableto us.
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dec6fi1lr{giqgqFovstKdRfi-q*na*ffilrRrfiftTtigwa:\rq{{ffisrffEt.it to you
to be jointlyandseverallyliable
anytimebe overdrawn
we joinflyandseverallyagreeif our accountor accountsat
you thereonincludingcommission interest'
and
lor any moneysfor tne tirie being owingto
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or othermovabreproperty (whether oursjointlyorthatol
we arsoioin,yandseverary agreethatat moneys, securities
shalrbeand remain assecurity andshall
anyor eitherof useitherjointry inor comingintoyourposse.ssion
or severaty)
1oyoufrom
andliabilities tirneto time'
standcharged lortheduepayt.nt ot oui lointindebteiness

Signature
E-{dTeT'V
{KIsTV Signature E'{fl'efl/ Signature
 T+i+o'ffi u"oBANK
snq"r*'swtT+
frg/roneneNcH
use
CIq EWTET{ q.ft.q.ri dftq
NAME SIGNATURE PF NO. DATE
1. qR.+qm-dfbe.c<re|ruq{f,iiq
vcqilLtq at1qtct
Introducer's
Signature/
Documentsverified
by
e. qrflfrd$r{d tqrq ft-qr qrqt
qrfhr-dF{i-{rd (ffi
Bqftirfr i fi-do-dv.rrg'
q-{IrrqT)
Creation of Customer Profile
authorized by (invtrrose
presence custom er profile
filledin)
s. €.rdrsldT.di;IrfifqEd,
{trrd-qi ol qfuqi flq dr
q"s'rfr-f,,iisq* * srgfi b
.* -),a
.IIq -q+I +qlq ---
dql qIrcItI
*ofror Eerqr s-{ffi
AccountopeningAuthorized,
copiesof documentsobtained
& verified,
Customersname
checkedwiththe barredlist
and Riskcategoryverifiedby

4. qTnTdtr+srd
Account
openedby

5. ETaFII-q
flftd a-{i gq qft{rr (qi)bqns' ........o1qetqr qsr *{ ffi-a} qfffi q-rqtfi.r$ I
Letterof thankssentto the A,icHolde(s)on ................. & acknowledgement
receivedon ...............

6.vR{q-{dt€TfsTtT€toiiq
lt1e-+;qgrfrf,or$gV........ .....o1q-*r}qrrrqtoii-{........................o1
qrefrerqqft.r$ t
htrogug:fdidnotcallontheBranch.
Letter
ofthankssenton ..........
andacknowledgement
ranairraal nn

q)fuq *'t aflo dfu'q t-t qt.a'qs}fuq

--* \A
n cr)rl ulll(s+l
RiskCategory
: [-l HighRisk l_J MediumRisk LowRisk

qefr eR qe Rfreilel rrg ?:.'.+ - .-

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q ? t --l
.ll
E\-l\r St\ fiqtfit
l"t Reviewdoneon 2nd Reviewdone on
(crftqfOate) 6rfrunate1
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sF rilqr-iifui o1 q'r+f,+d-Emfi ftftq=r{ eTfuFeq1g49Ei Errn45 sg q siti +-qrsrrfl
dtq'fr( qriTi?F{) fi-"{q l ges +' ft=qq2(1) fi cftftc flqio-{
NOMINATION
DETAILS Nomination
undersec 45zA ot the BankingFegulationAcl 1949and
Bankingcompanies(Nomination) Bure2(1) o,the
Rures19g-5in rispectof BankDeposits.-

T61t6 ft$ uroBANK

.Fr{ Sq 1/ FormDA 1

') ':s'' """""""""<rr(rl

t r | - q l s f q r { q - q * q r g|
l/We """"""'
. (name&address)
nominatethefollowing
person
to whomintheeventot my/ourlminor's deaththearnount of depositheldintheaccount,
particulars
whereofaregiven
belowmaybe returnedby..........,....... .........
branch of thebanr.
q'{l rFI w5'rl
cTRftff qlt, qftElf E) E4tt,qR 6t$ El
eIPdR-ffi
Natureof Deposit Addl.Details,ltany Name& Addressof nominee

qq-rofli $'qi?TTrfr'fr qR rrfrfr er+qroe),

61,qF{6l{ d, rTffi Age of the nominee d crq ft1f,rfte-
Relationship of the ll nornineeis a minor,
nomineewith the dateof birth
Depositor,if any

qfu srTqq1nTfl-qd ffffi eFrrriot, ern,{ /Eqrrffi ht o'flfiFil

b +r'o it/*,t/"uo*;Eufr.*
kff,i*1y1ly:F:f o-{iilrq*zdrnzssTn.
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t''lrq'Yql
3fr-i
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tqR rrfrfr ffrqFr'c d d {q qfr o} ore t }
Asthenominee is a minoronthisdate,l/weappoint
Mr/Mrs/Miss.........,....
(Name,address andage)to receiverheamountofdepositintheaccount
ourlminord deathduringtheminority of thenominee. ";.oeffi;;;nof;;;;;fl*;;;;ilil;
lstrikeoff,if nomineeis nota minorl

do ft e-drqig (q-rqfrGrrrdgs ri) / FO-RBANKUSE (,Acknowtedgement

cverleaD
 ci/w vner'4i3r{erT+dTf /iS $ fu t wir ga/erar-ffirui/qrsft ra'qrrdls fr ilffi fi nq znre-e#eoii /c er{
L/Weinstructthe branch to indicate/notto indicatethe nameof the nominee In PassBooldstatementof aceounU
FDR.
qTfr-ftbTTfl E-{dTer{
(ffi-r) crft-ftETq-Fqrc
fuEq(ql?ftqeT{et)
SpecimenSignature
of nominee(optional) ldentification
markof nominee(if iiliterate)

qqi=I/ Place:

etftq/oate: qqrfi-dt (sTt) b 6{flrq1g"

Signature
/Thumbimpression ,
of Deposiior(s)
qtqfr/Witness: T{qfr/Witness:
tIrT/ Name(s): 1IrI/ Name(s):
rm'(d linOoress(es): troi(i ;lRooress(es):
qww ri/Tel.uo.:
T{r{F{ d/Tel. fro. :
te{FTIPlace: RIll/ Place:
orftq/oate: erfttg/oate:

qrefr(d) t'er+rW si.li al urq @ qTsfr(st)fi"ewrefi/ eiXt at Erq@

Signature
/Thumbimpressionof witness(es) Signature/Thumbimpressionof witness(es)

[+d " qR fufr sffi{w b cH' ii vRi qq161 qfr t, n} sffi{w'sn et}r 1i oTdsr{ffi fri$5. eo-qg€{er6
gT{rrrqi6-{-qr E-{drerfud
fuqI qrq I
[Note'Wheredepositis madein the nameof a minor,the nomination
shouldbe signedby a lawfullyentiiledguardian
to act on behallof the minor.
@ siTlal ETqd flfbqi drrTrrsrfr-{fu\ qrq...
@ Thumbimpression
(s)needlo be attested
bytvrowitnesses.

qftf +-r YrrqT ---o,

qlq$ | -a*
ct\t(5
UCO BANK BIO ACKNOWLEDGEMENT Date:

Eq eilqh€rdT€. (qqdio /arq rrrcr/ffi q'q'T oTrR

) ...,..........". ol med
fr/4q-fr/i, .,........... qrg ,.,.,,..,,,......,
b qeT d rnd d1-.]q toq.TqerTqb
qTq'io{ft1qrR {+mT-ier{+ t I
weacknowledge receiptofNomination
made byyouinfavour
ofShri/smt./Ms. ..............-....
^^^l .,.- :- -^anoal
ageo yrs In reoyawrv'.
........-......... n f ryvu,
r n r r r ......!....
(sB/cAlrD etc.) A/c. No. ................ on Form DA .l

Cfrcil ucIEFF
/ Branch Manaoer
't0