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Joint Liability Group (JLG) Loan Cum Account Opening Form

Joint Liability Group (JLG) loan Cum Account Opening FormFor Bank Use Only (* Fields are Mandatory)Application No.: INDC ustomer ID: Account No.:Please affix a recent photographandSign across the photoBranch:SOL Code:Date:YYYYMMDDO ccupation Code:*Segment CodeAccount Statement Delivery Mode: Printed Statement on Quarterly BasisAddress DetailsCurrent Address:Permanent Address: Same as Current AddressCityPINS tateCountryMobile NumberDistrict Code:CityPINS tateCountryMobile NumberDistrict Code:Customer Information(First Name)(Middle Name)(Last Name)Maximum 32 characters.*Name:Existing Customer ID:(If applicable) * Account Type:NormalSimplified (for low risk customers)SmallOTP based e-KYCKYC Number:*Mother s Maiden Name:*Date of Birth:YYYYMMDDE xpiry Date:YYYYMMDDD riving Licence:*Aadhaar Number:Voter Identity Card:*Spouse Name:*Father's Name:*Mother s Full Name:Marital Status:MarriedUnmarriedWidowDivorcedOthe rEducational Qualification:Illiterate10th and belowIntermediateGraduatePost GraduateReligion: HinduMuslimChristianSikhBuddhistJainPars iOthers* Person:YesNoCategory:GeneralOBCSCSTO thersMBCP lease fill FATCA

Please contact DCB 24-Hour Customer Care to enquire about your account application status. 2654-Ver 1.2 –September 2018 DCB Bank Limited M063 / Sep 18 / 1.0 Form No. 60 (See second proviso to rule 114B) Form for declaration to be filed by an individual or a person (not being a company or firm) who does not have a permanent account and who enters into any transaction

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