Rahaman

F.No.

(Regd. & Head Office, Mangalore – 575 002)

Fields with (star) are compulsory Please fill the form in black ink only.

Customer ID No: Account No: CURRENT ACCOUNT Application Form (Other than Individuals)

Type of A/C: General / MBB General Quarterly Average A/c *: Branch : 5000

* Pearl 10000 Branch Code:CUSTOMER DETAILS Ruby 50000 Sapphire 100000 Diamond 300000

Name / Account Title: Date of Incorporation: Mailing Address Address: *

*

Permanent Address * Address: * * * * PIN: * *

City: State: Tel./Mob: Fax:

*PIN:

* City: * State: Tel/Mob: Fax: CONSTITUTION *

Private Ltd. HUF PAN/GIR No. of Applicant:

Public Ltd.

Partnership

Sole Proprietorship Others: Please specify

Trust /Asso. /Soc./Clubs

FORM 60 (to be filled by those who do not have either PAN or GIR) Are you a Tax Assessee:
Yes / No

If Yes, details of Ward/Circle/Range where the last return of income was filled: Reason for not having PAN/GIR No. :

I belief. Verified at

do hereby declare that what is stated is true to the best of my knowledge and this the day of 20

Signature of the declarant INTRODUCTION DETAILS Name of Introducer: Address: PIN: Tel./Mob: Occupation: Customer Id: A/c No: * City: State: Fax:

I know the customer for a period of months/years and confirm his/its address. The introducer needs to hold an account with Karnataka bank Ltd for more than 6 months. Date:-

Signature of Introducer

For Office Use
Signature Verified p. Sr./Br. Manager

SIGNATURES AND PHOTOGRAPHS OF PERSON/S AUTHORIZED TO OPERATE THE CCOUNT (Please sign in Black Ink) Paste recent passport size photograph (Not reqd.for Govt.Depart ments) Signature Signature Paste recent passport size photograph (Not reqd.for Govt.Depart ments)

Mr./Ms/Dr. Designation

Paste recent passport size photograph (Not reqd.for Govt.Depart ments)

Signature

Signature

Mr./Ms/Dr. Designation

Paste recent passport size photograph (Not reqd.for Govt.Depart ments)