Application For Deposit

Regd No. 1381 Estd.
1872
THE MYLAPORE HINDU PERMANENT FUND LTD
Regd. Office Nos. 22 & 24 (Old Nos. 32 & 33) South Mada Street, Mylapore, Chennai - 600 004.
Phone Nos. : 24641099, 24641230 Locker Phone No. : 24615472
CIN : U65991TN1872PLC001381 E-mail : mhpfltd@yahoo.co.in Website : www.mhpf.in
Branches : .............................................................
APPLICATION FOR DEPOSIT

Customer ID A/C No. Date :
Share No. :
Aadhaar No. PAN No.
I / We wish to place a Deposit as mentioned below Rs. Rs. (in words) ......................................
........................................................................................ and enclose a cheque / DD No...................................
Dt................................... Drawn on ............................................................... Branch........................................
MODE OF RECEIPT : Cash Cheque Adjustment
APPLICATION FOR : New Renewal (Previous FD/PFD/RID/Ac/ No.).....................
CATEGORY : Shareholder Director Relative of Director
SCHEME : FD PFD RID RD SD SDL
PERIOD OF DEPOSIT : 1 Year 2 Years 3 Years 4 Years 5 Years
REPAY ON MATURITY TO : Sole Depositor E or S Rate of Interest...................%
TAX TO BE DEDUCTED : Yes my PAN / GIR NO.......... No. Form Yes No.
15H / 15G Furnished :
A/C. NO. OF ANY OTHER : A/C No. (s)............................................ Amount...........................................
DEPOSIT WITH MHPF
PLEASE ISSUE TDS CERTIFICATE IN Consolidated Form Individual Form
I am /We are agreeable to receive Rs.............................................................. on maturity of this account.
NAME (In Block Letters). if minor, Guardian’s Names and DOB of Minor* AGE OCCUPATION
1......................................................................................................................................................................
2.......................................................................................................................................................................
Father’s / Husband’s Name NOMINEE

1.............................................................................. Name.........................................................................
2.............................................................................. Age..................... Relationship....................................
FULL ADDRESS OF THE APPLICANT (in Block Letters) INTEREST OPTION M Q H Y on maturity
............................................................................... Cheque to Residential Address Ist Name / IInd Name

S.B. A/c No.
..............................................................................
In the name of.....................................................
.............................................................................. Bank Name.........................................................
Branch................................................................
..............................................................................
IFSC No. : .........................................................
PHONE : MOBILE : Transfer to my SD/RD/A/c No.................... with your Fund
DECLARATION : I / We have read the terms and conditions of the Company governing this deposit scheme as also
the prevailing interest rates for deposits and accept that they are binding on me / us.
VERIFICATION : I have gone through the financial and other statements / particulars / representations furnished /
made by the Company and after careful consideration, I am making the deposit with the Company at my own risk
and volition.
SIGNATURE OF APPLICANTS :
1......................................................................... 2...............................................................................
1......................................................................... 2...............................................................................
Please Note :
*1. In the case of deposit in the name of minor (below 18 years of age) only the FATHER or MOTHER or GUARDIAN of
the Minor should sign this form.
2. In the case of deposit E or S ALL the depositors MUST sign in the space provided above.
Form No. 62 / 20,000-07-2017

Application For Deposit

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Regd No. 1381 Estd.

APPLICATION FOR DEPOSIT

MODE OF RECEIPT : Cash Cheque Adjustment

APPLICATION FOR : New Renewal (Previous FD/PFD/RID/Ac/ No.).....................

CATEGORY : Shareholder Director Relative of Director

SCHEME : FD PFD RID RD SD SDL

PERIOD OF DEPOSIT : 1 Year 2 Years 3 Years 4 Years 5 Years

REPAY ON MATURITY TO : Sole Depositor E or S Rate of Interest...................%

Father’s / Husband’s Name NOMINEE

............................................................................... Cheque to Residential Address Ist Name / IInd Name

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