AddNomineeDetailsModForm31 01 2017 PDF

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Form DA 3

Variation of Nomination under Section 45ZA of the Banking Regulation Act, 1949 and Rule 2(6) of the

Banking Companies (Nomination) Rules, 1985 in respect of Bank Deposits

I / We
Name/s Address/es
1-91/20 PLOT NO16 OPP SABARI GARDENS,RAMNAGAR
RANJITH KUMAR THALLAPELLY
COLONY, PARVATHAPUR,GHATKESAR

hereby cancel the nomination made by me/us in favour of

Name & Address Relationship with depositor, if any Age


VIJAYA LAXMI THALLAPELLY
MOTHER
SAME AS PRIMARY APPLICANT

and hereby nominate the following person to whom in the event of my/our/minors death, the amount of deposit, particulars

whereof are given below, may be returned by

Deposits
Nature of the Account Distinguishing No. Additional Details, if any

Savings 078010100226639

Nominee:

Name: PRIYANKA THALLAPELLY

Address: SAME AS PRIMARY APPLICANT

Relationship with depositor (if any) WIFE Age 25 Years

Print Nominee Name# Y #Depending upon the option selected here, nominee name will get printed / not printed on statements, passbooks, etc.

If nominee is minor his/her date of birth

*As the nominee is a minor on this date I/we appoint

Name:

Address:

Relationship with minor*: Age Years

to receive the amount of the deposit on behalf of the nominee in the event of my/our/ minors death during the minority of

the nominee.

**Signature(s) / Thumb impression(s) of depositor

Witnesses: ***

1 . Signature 2 . Signature

Name: Name:

Address: Address:

Place: Date: Place: Date:

*Strike out if nominee is not a minor.

** Where deposit is made in the name of a minor the nomination must be signed by a person lawfully entitled to act on

behalf of the minor.

*** Thumb impression(s) to be attested by two witnesses.

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