Account No.

C I F 01

C I F 02

Application Form Form No: BMD/PRA/01/V01

;ekam;alre$lrejkaf.a úia;r itg;ghsh;$fspd; tpguk; Details of the Depositor/s

,smskhKftup

Address

Branch

YdLdjfpis

;ekam;alre 1 itg;ghsh; 1 Depositor 1

D D M M Y Y Y YDate

Èkhjpfjp

iïmQ¾K ku( uhd$fuh$ñhKOg; ngau;: jpU$jpUkjp$nry;tp

Full Name: Mr/Mrs/Ms

Contact No.

ÿrl:k wxlhnjhiyNgrp ,y.D D M M Y Y Y Y

Date of Birth

Wmka Èkhgpwe;j jpfjp

National Identity Card No.

cd;sl ye÷kqïm;a wxlhNjrpa milahs ml;il ,y.

b;=reï iy;slfha úia;r Nrkpg;G rhd;wpjopd; tpguk; Details of the Savings Certificate

Required Maturity Period ( Minimum 1 Year and Maximum 20 Years)

wjYH l,amsÍfï ld, iSudj ^wjuh jirla iy Wmßuh jir 20la&tpz;zg;gpf;Fk; jtiz (Fiwe;jJ 1 tUlk;$ $baJ 20 tUlq;fs;)

Amount of the Initial Deposit (In Words)

uQ,sl ;ekam;a uqo, ^wl=frka&Muk;g itg;Gj; njhif (vOj;jpy;)

.Amount of the Initial Deposit (In Figures)

uQ,sl ;ekam;a uqo, ^b,lalfuka&Muk;g itg;Gj; njhif (,yf;fj;jpy;)

re'&.

Rs.

re'&.Rs.

I am/am not an income tax payer

wdodhï nÿ f.jñ $fkdf.jñehd; tup fl;Lgtu; / fl;Lgtu; my;y

f.jhs kï ,smsf.dkq wxlhfl;Lgtu; Mapd; Nfhg;G ,y.

If so, file No.

,smskhKftup

Address

iïmQ¾K ku( uhd$fuh$ñhKOg; ngau;: jpU$jpUkjp$nry;tp

Full Name: Mr/Mrs/Ms

;ekam;alre 2 itg;ghsh; 2 Depositor 2

Contact No.

ÿrl:k wxlhnjhiyNgrp ,y.D D M M Y Y Y Y

Date of Birth

Wmka Èkhgpwe;j jpfjp

cd;sl ye÷kqïm;a wxlh

National Identity Card NoNjrpa milahs ml;il ,y.

I am/am not an income tax payer

wdodhï nÿ f.jñ $fkdf.jñehd; tup fl;Lgtu; / fl;Lgtu; my;y

f.jhs kï ,smsf.dkq wxlhfl;Lgtu; Mapd; Nfhg;G ,y.

If so, file No.

B - fï,a $ kpd; mQ;ry;

E-mail

B - fï,a $ kpd; mQ;ry;/E-mail

Rs. 25,000/- Rs. 50,000/- Rs. 100,000/-Rs. 250,000/- Rs. 500,000/- Rs. 1,000,000/-

Rs.5,000,000/- Rs. 10,000,000/-Maturity value of the required certificate (Please mark ‘√’ in the appropriate cage)

wjYH iy;slfha l,amsÍfï jákdlu^wod< fldgqfõ ,l=K fhdokak&

tpz;zg;gpf;Fk; rhd;wpjopd; Kjpu;T ngWkjp

(cupa $l;bw;Fs; milahskpLf)

For office use only

;ekam;alre 1 itg;ghsh; 1 Depositor 1

............................Èkh jpfjp DateSignature of the 1st Depositor

1jk ;ekam;alref.a w;aik1Mk; itg;ghsupd; ifnahg;gk;

Signature of the 2nd Depositor

2jk ;ekam;alref.a w;aik2Mk; itg;ghsupd; ifnahg;gk;

1. The maturity value of this account represented by the certificate , has been calculated on the basis that its initial deposit will accrue an interest at the rate of........% per annum.2. The holder/s will be entitled to the proceeds of this account represented by the certificate , after the maturity date subject to government taxes and levies.3. Premature withdrawals are not allowed from this account , represented by the certificate.4. Premature termination of this account represented by the certificate , will be subjected to a reduction in the Maturity Value.5. If the proceeds of the account represented by the certificate, are not claimed by the beneficiary at maturity, it will be transferred to a one year Fixed Deposit Account and thereafter, such deposits will be governed by the rules applicable to Fixed Deposit Accounts.

CONDITIONS

1 uQ,sl ;ekam;=jg''''''''''''''''''''']l jd¾Isl fmd,shla tl;=ùfï moku u; fuu iy;slh u.ska ksrEmKh jk .sKqfï l,amsÍfï jákdlu .Kkh lr we;'2 l,amsÍfï Èkfhka miq fuu iy;slh u.ska ksrEmKh jk .sKqfï jákdlu rcfha wkqu; nÿ iy .dia;= j,g hg;aj ysñlre$ysñlrejkag ysñfõ'3 l,amsfrk f;la fuu iy;slh u.ska ksrEmKh jk .sKqfï uqo,a wdmiq .ekSug wjir fokq fkd,efí'4 iy;slh u.ska ksrEmKh jk .sKqu l,amsr Sug m%:u wjika lsrSfïoS l,a msÍfï jákdlu wvq lsrSug hg;afõ'5 iy;slh u.ska ksrEmKh jk .sKqu l,amsÍfï§ uqo,a wdmiq ,nd fkd.kafka kï wod< uqo,a tla wjqreÿ ia:djr ;eka am;a .sKqulg udre lrk w;r" t;eka mgka ia:djr ;ekam;= .sKqï j,g wod< kS;sÍ;s n,meje;afjkq we;'

fldkafoais

1. toq;fg;gLk; rhd;wpjopy; Fwpg;gpl;l fzf;fpd , ; Kjph;tpd; Nghjhd ngWkjpahdJ Muk;g itg;Gj; njhiff;F Mz;bw;F …….% $l;L tl;bAld; Nrh;f;fg;gLk;

vd;w mbg;gilapy; fzpf;fg;gl;Ls;sJ.

2. toq;fg;gLk; rhd;wpjopy; Fwpg;gpl;l fzf;fpd , ; Kjpu;T jpfjpapd; gpd; Kjpu;T ngWkjp mDkjpf;Fl;gl;l mur thpfs; kw;Wk; fl;lzq;fSf;F cl;gl;L

,jd; chpikahsh;/ chpikahsu;fSf;F chpj;jhFk;.

3. toq;fg;gLk; rhd;wpjopy; Fwpg;gpl;l fzf;fpd; , Kjph;T fhyj;jpw;F Kd; gz kPsg;;ngwy; mDkjpf;fg;gl khl;lhJ.

4. toq;fg;gLk; rhd;wpjopy; Fwpg;gpl;l fzf;fpd , ; Kjph;T fhyj;jpw;F Kd; ,f;fzf;fpid %Ltjhapd; cupj;jhd Kjpu;T ngWkjp Fiwf;fg;gLk;.

5. toq;fg;gLk; rhd;wpjopy; Fwpg;gpl;l fzf;F , Kjph;tilfpd;w NghJ Fwpj;j njhifia kPsg;ngwhtpbd , ; mj;njhif xU tUl epiyahd itg;Gf; fzf;nfhd;Wf;F

khw;wg;gLtJld; ,f;fzf;F md;W Kjy; epiyahd itg;G fzf;;FfSf;fhd tpjpfSf;F cl;gLj;jg;gLk;.

epge;jidfs;

;ekam;alre 2 itg;ghsh; 2 Depositor 2

fuu .sKqu mj;ajd f.k hdu iïnkaOfhka mj;akd kS;sÍ;s" jHjia:d fr.=,dis uu$wms lshjd f;areï.;a nj fuhska iy;sl lrk w;r" mqoa.,slj ud $ wm fj;±kqï §ula fkdl<o" fuu .sKqu iïnkaO kS;sÍ;s yd fr.=,dis j,g tlÕ ùug iy bÈßfha§ l,ska l,g nexl=j mkjkq ,nk kS;sÍ;s ms<sme§ug;a bka ne|S isàug;atlÕ fjñ$fjuq

,f; fzf;if nraw;gLj;Jk; tpjpKiwfis thrpj;J tpsq;fpf; nfhz;Nld; / nfhz;Nlhk;; vd;Wk; ,f;fzf;F njhlu;ghf tq;fpapdhy; tpjpf;fg;gl;l

tpjpKiwfSf;Fk; epge;jidfSf;Fk; fl;Lg;gl;L ,zq;fp xOfTk; tq;fpapdhy;; Neubahf mwptpahjpUg;gpDk; fhyj;jpw;F fhyk; tq;fpapdhy;

eilKiwf;F nfhz;L tug;gLk; tpjpKiwfSf;Fk; epge;jidfSf;Fk; fl;Lg;gl;L ,zq;fp xOfTk; ,j;jhy; rk;kjpf;fpd;Nwd; / rk;kjpf;fpd;Nwhk;.

I/We have read and understood the rules and regulations for the conduct of this account and I/We hereby agree to comply with and be bound by the rules and regulationsmade or imposed by the Bank with regard to this account and which may come into effect and be enforced by the Bank from time to time not withstanding the fact that suchrules and regulations have not been personally notified to me / us.

tla whl= ñh.sh úg .sKqfï fYaIh cSj;ajk .sKqï ysñhdg ysñjkq we;'

vq;fspy; xUtu; ,wg;gpd; capUld; cs;s fzf;F itg;ghsu; fzf;fpd; Kjpu;T njhiff;F cupj;Jilatuhthu;.

In the event of the death of any of us, the surviving account holder will be entitled to the maturity value.

noaO .sKqula kï $l;Lf; fzf;F Mapd; If it is a Joint Account

iy;slh Ndr .kakd ,oS'rhd;wpjo; ngwg;gl;lJ.

Certificate Received.

Signature of the 1st Depositor

1jk ;ekam;alref.a w;aik1Mk; itg;ghsupd; ifnahg;gk;

Signature of the 2nd Depositor

2jk ;ekam;alref.a w;aik2Mk; itg;ghsupd; ifnahg;gk;

For office use only

Date of maturity

Amount initially deposited:

Serial No:

D D M M Y Y Y Y

.

Authorized Officer Manager

jD;a;sh njhopy; Profession

fiajd fhdaclhd njhopy; toq;Fgtu; Employer

fiajd fhdaclhdf.a ,smskh njhopy; toq;Fgupd; Kftup

Address of the Employer

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