Sidbi Fixed Deposit Application Form (Page 2 of 8) in pdf

Bank details for the payment of interest and principal (only of First Depositor) *

Name of the Depositor / Father / Guardian : __________________________________________________________________________

(In case, the first depositor is a minor on the date of maturity, then bank account particulars of the Father / Guardian, in whose

account the maturity amount has to be credited)

Bank Name: ____________________________________ Branch __________________________ IFSC Code _________________

A/c Type :

Saving

urrent

A/c No







Only for depositors Opting for Electronic Clearing Service (ECS)

Yes

I/We would like to avail ECS facility.



(If yes, please enclose a cancelled Personalised Cheque leaf / self attested photocopy of cheque)

I / We hereby declare that the particulars given above are correct and complete. If the transmission is delayed / not affected for

reasons of incomplete / incorrect information, or such facility is not arranged for that Branch/Centre. I / We would not hold SIDBI

responsible. I / We have read the terms and conditions and agree to discharge the responsibility expected of me / us as a participant

in the Electronic Clearing Service

Signature of depositor



Declaration in case of deposit made by Non Resident Indian

''I/We certify that the amount being deposited with SIDBI does not represent inward remittances or transfer from Non - Resident (External)

Account / Foreign Currency (Non Resident) Account (Banks) into the NRO account No. ____________________________________,

Bank ________________________________________________________ Branch ________________________________________

IFSC Code ________________________________.City ______________________________

Signature of depositor

==========================================================================

FOR OFFICE USE ONLY

Date of receipt of application

: ____________________________________________________



All particulars in FD form have been filled

: Yes





KYC documents have been verified with originals

: Yes





PAN details checked with Income Tax data base

: Yes



Cheque / Demand Draft deposited for realization on

: ____________________________________________________

Checked by

verified by

Cheque / Demand Draft realized on

: ____________________________________________________

CIF No

: ____________________________________________________

FDR / Deal No

: ____________________________________________________

FDR / Deal Date

: ____________________________________________________

FDR details verified and Issued on

: ____________________________________________________

Deal Created by : Name & Signature

Deal Authorized by : Name & Signature

Signature of BO Incharge

Sidbi Fixed Deposit Application Form Page 2

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