NOMINEE ADDITION FORM-DA 1
PLEASE USE BLOCK LETTERS * Mandatory For Bank Use only - Service Request No. Date D D M M Y Y Y Y
Nomination under Section 45 ZA of the Banking Regulations Act 1949 and Rule 2(1) of the Banking Companies (Nomination) Rule
1985 in respect of Bank deposits
*I/We Name(s) and address(es)
Name(s) and address(es)
nominate the following person to whom in the event of my/our/minor’s death the amount of the deposit in the account, particulars whereof are given below,
maybe returned by RBL Bank Ltd., (Name and address of branch in which deposit is held)
I agree/ do not agree for the name of my/our nominee to be displayed on Fixed Deposit Advice/Statement of Account and/or other documents/letters.
Nature of deposit Account No. Additional details, if any
Name & Address of Nominee Relationship with the Age If nominee is a
Depositor, if any minor, date of birth
Nominee Mobile Number:
DA1 Apr2024 V1.0
Nominee Email Address :
*As the nominee is a minor on this date, I/We appoint Mr. /Ms. /Mrs. (Name, address and age)
(Name, address and age)
to receive the amount of the deposit in the Account on behalf of the nominee in the event of my/our/minor's death during the minority of the nominee.
Witness 1 Witness 2
Name Name
Address Address
Place : Place :
Signature Signature
Date : D D M M Y Y Y Y Date : D D M M Y Y Y Y
**Signature/***Thumb impression of 1st Applicant **Signature/***Thumb impression of 2nd Applicant **Signature/***Thumb impression of 3rd Applicant
Name Name Name
*Strike out if the nominee is not a minor. **Where deposit is made in the name of a minor, the nomination should be signed by
***Thumb impression shall be attested by 2 witnesses. a person lawfully entitled to act on behalf of the minor.
BRANCH USE SECTION NOC/RPU USE SECTION
Date of Receipt D D M M Y Y Y Y Branch Code
Date of Receipt at Central Desk D D M M Y Y Y Y
Signature Verified by Name & Signature
Signature Verified by Name & Signature
Employee Code Approval [Name/Signature by Branch Manager]
Employee Code
Processed POD No for rejection letter send on
Narration/Reference
Date D D M M Y Y Y Y ACKNOWLEDGMENT – DA1
Customer Name :
DA1 Apr2024 V1.0
Customer ID : Signature of Bank Official with seal
We acknowledge receipt of nomination made by you in favour of:
Name of the Nominee :
Account No. 1 Account No. 2
With respect to your
Account No. 3
Page 1 of 1
