Gramin Digital Seva

New Bank Account Application Form

Full Name

Father's / Husband's Name

Date of Birth

Gender Select Male Female Other

Marital Status Select Married Unmarried

Select Account Type Select Savings Current

Select Bank Choose Bank Axis Bank State Bank of India HDFC Bank Punjab National Bank

ATM/Debit Card Select Yes No

Net Banking Select Yes No

Passbook Select Yes No

Cheque Book Select Yes No

Nominee Name

Relationship with Nominee

State Select Uttar Pradesh Maharashtra Bihar Other

District (For UP) Select Lucknow Gorakhpur Varanasi Meerut

Village

Post

City

Full Address

Mobile Number

Email ID (optional)

Payment Mode Select Cash at Shop UPI