AIPL Customer Application Form - Arogya India Projects Limited

TM
AUTHORISED CENTRE COPY
Mode of
Deposit
Application No.
Mthly.
Qtly.
Half
yearly
yearly
Amount : Rs.
PAN of Member
A
P
In words Rs. _______________________________________________
P
By Cash/D.D.No. ____________________ Dated _________________
(A Public Limited Company)
Drawn on (Name of Bank and Branch) __________________________
_________________________________________________________
Signature of Applicant
Address Proof attached (Please Tick whichever is applicable)
Identity Card
Electricity Bill
Passport
Telephone Bill
Voter I. Card
Driving License
(If any other, Please specify) ____________________________________________________________
Photo ID Proof attached (Please Tick whichever is applicable)
Pan Card
Passport
Voter I. Card
Identity Card
L
An ISO 9001-2008 Company
I
Signature of Introducer
TM
Prosperity Starts here....
Driving License
(If any other, Please specify) ____________________________________________________________
C
A
T
I
O
Signature of Applicant
ACCOUNT OPENING FORM VERIFICATION
I .................................................................................. E.C. ..................................... (Authorised Centre Manager
has verified this Account Opening Form in respect of following.
A)
KYC document (as per AOF) has been checked by me and I certify that it is valid, satisfactory, genuine and
as per the guidelines provided to us.’
B)
Member has signed the AOF in my presence/presence of introducer Mr........................................................
(Code No. ....................................................................)
C)
D)
Member/Introducer has self attested the KYC document in my presence/presence of Introducer
(Mr................................................................................................. (Code No. ..........................................)
All mandatory fields in AOF have been checked by me and are properly filled as per guidelines
I certify that the account meets the requirements of Society and I recommend that it should be opened.
N
F
O
Scheme Benefits
Loan against deposit facility upto
75% of the principal amount
Accidental Death Benefit
R
Name .................................................................
E.C. ...................................................................
Signature & Stamp Name with Code of Authrised person
M
Gandhi Nagar, 6th Lane, Berhampur, Ganjam - 760001,
Ph : 0680-3207733, 9337675296
website : www.arogyaipl.com
Sr. No : _______________
TERMS AND CONDITIONS
AROGYA INDIA PROJECTS LIMITED
APPLICATION FORM
TM
Authorised Centre Name ______________
Authorised Centre Code ______________
Region____________________________
Prosperity Starts here....
(A Public Limited Company)
An ISO 9001-2008 Company
Gandhi Nagar, 6th Lane, , Berhampur, Ganjam - 760001,
Ph : 0680-3207733 website : www.arogyaipl.com
Dear Sirs,
I hereby apply for opening an Account in Arogya India Projects Limited RD Benefit Scheme of your Company.
Membership No.
Tenure
Code
Months
TM
Denomination : Rs.
Account Opening Date
Account No.
TM
PassBook No.
1st Receipt No.
MY PARTICULARS ARE AS UNDER :
Full Name
Shri/Smt./Km.
Personal Identification :
Age
Years Date of Birth
Occupation
Servie/Student/Business/
Farmer/other
Name of
Father/Husband
Address
House No.
Vill/Mohalla
Dist.
P.O.
Pin code
State
Telephone No. (P&T/Mobile, if Available)
Name of
Nominee
Relation
Age
Signature of Nominee

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