DAMYANTI DHARAMSHI GONDALIA

BM/20020

28-Mar-2021

15 5.90 *

GT/2943338 04-APR-2021 8,14,196 PREMIUM DEPOSIT-CUMULATIVE

8,14,196

F 21-SEP-1967
VRINDA MUKUND ZAVERI CUST NO 53286020
SHREE KRUPA 2ND FLOOR
44,M G ROAD, PAN AABPZ7853K
GHATKOPAR-WEST
EMAIL ID MUKUND_ZAVERI@[Link]
MUMBAI 400086
NATIONALITY : INDIAN MOBILE 9821123357

* ROI will change if there is a rate revision by HDFC before 04-APR-2021

M 03-AUG-1962
MUKUND B ZAVERI CUST NO 61036140
SHREE KRUPA 2ND FLOOR
44,M G ROAD, PAN AAAPZ0430F
GHATKOPAR-WEST EMAIL ID MUKUNDZAVERI@[Link]
MUMBAI 400086
MOBILE 9821123357
NATIONALITY : INDIAN

CUST NO

PAN
EMAIL ID

NATIONALITY : MOBILE

03950100007223 BANK OF BARODA

400012030 GHATKOPAR (W)
BARB0GHATKO

TransactionID - 3063222
I/We hereby declare that the first named depositor mentioned in my/our application is the beneficial owner of this deposit and as such he/she should be
treated as the payee for the purpose of tax deduction under Section 194A of the Income Tax Act, 1961. I/We hereby agree to abide by the attached terms and
conditions governing the deposit.
I/We certify that the information provided above is in accordance with section 285BA of the Income Tax Act, 1961 read with Rules 114F to 114H of the Income
Tax Rules, 1962. I/We also certify that I/we am/are not a tax-resident of any country other than India. The information provided by me/us above as well as in
the documentary evidence provided by me/us are, to the best of my/our knowledge and belief, true, correct and complete and that I/we have not withheld any
material information that may affect the assessment/categorization of the account as a Reportable account or otherwise. I/We permit/authorise HDFC Ltd to
collect, store, communicate and process information relating to the Account and all transactions therein, by HDFC Ltd. and any of its affiliates wherever
situated including sharing, transfer and disclosure between them and to the authorities in and/or outside India of any confidential information for compliance
with any law or regulation whether domestic or foreign. I/We undertake to inform you immediately of any changes that may take place in the information
provided above as well as in the documentary evidence provided by me/us or if any certification becomes incorrect and to provide revised self-certification
along with documentary evidence. I/We also agree that my/our failure to disclose any material fact known to me/us, now or in future, may invalidate my/our
application and HDFC Ltd. would be within its right to put restrictions in the operations of my/our account or close it or report to any regulator and/or any
authority designated by the Government of India (GOI)/RBI for the purpose or take any other action as may be deemed appropriate by HDFC Ltd. If the
deficiency is not remedied by me/us within the stipulated period, I/We thereby accept and acknowledge that HDFC Ltd. shall have the right and authority to
carry out investigations from the information available in public domain for confirming the information provided by me/us to HDFC Ltd. It shall be my/our
responsibility to educate myself/ourselves and to comply at all times with all relevant laws relating to reporting under section 285BA of the Act read with the
Rules thereunder. I/We also agree to furnish such information and/or documents as HDFC Ltd. may require from time to time on account of any change in law
either in India or abroad in the subject matter herein. I/We shall indemnify HDFC Ltd. for any loss that may arise to HDFC Ltd. on account of providing incorrect
or incomplete information.
I/We further declare that, I/We am/are authorized to make this deposit in the above-mentioned scheme (HDFC Deposit) and that the amount kept in the
deposit is through legitimate source and does not involve directly or indirectly any proceeds of schedule of offence and/or is not designed for the purpose of
any contravention or evasion of the provisions of the Prevention of Money Laundering Act, 2002 and any Rules, Regulations, Notifications, Guidelines or
Directions thereunder, as amended from time to time. I/We shall provide any further information and fully co-operate in any investigation as and when required
by the Corporation in accordance with the applicable Law. I/We further affirm that the information/details provided by me/us is/ are true and correct in all
respect and nothing has been concealed. I/we hereby authorise HDFC to send Email/SMS alerts for all transactions relating to my/our deposits. I hereby give
my consent to HDFC for sending OTP (One Time Password) on my mobile number to facilitate processing of my deposit transactions using OTP
authentication.
I/We have gone through the financial and other statements/particulars/representations SIGNATURE OF DEPOSITOR(S)
furnished/made by HDFC Ltd. and after careful consideration, I/we am/are making the
deposit with HDFC Ltd. at my/our own risk and volition. Authenticated using OTP verification by VRINDA
FIRST/SOLE/ MUKUND ZAVERI on 28-MAR-2021 at [Link]
PM through mobile number 9821123357
On Maturity of the deposit, I/We hereby give my/our explicit consent to HDFC GUARDIAN
Limited to Authenticated using OTP verification by MUKUND B
ZAVERI on 28-MAR-2021 at [Link] PM through mobile
D Renew principal and interest
SECOND number 9821123357

D Renew principal
D Pay the principal and interest to my/our designated Bank Account
mentioned herein.
THIRD

FORM DA 1 : NOMINATION
Nomination under Section 36B of the National Housing Bank Act, 1987 and Rule 2(1)
of the Banking Companies (Nomination) Rule, 1985 in respect of HDFC deposits.

/
VRINDA MUKUND ZAVERI
I We----------------------------------------
nominate the following person to whom in the event of my/ our/ minor's death the amount of this deposit may be returned by HDFC Ltd.

Name & Address DHVANIL MUKUND ZAVERI

of Nominee
SHREE KRUPA 2ND FLOOR44 M G

,MUMBAI Pin Code 400086

Email ID MUKUNDZAVERI@[Link]
Customer No. (If KYC is already complied) 53619077 PAN ABCPZ3261B
Mobile 9821123357
Relationship with SON Gender M Age 30 Date of Birth of Nominee 06-APR-1991
Depositor (If any)

As the nominee is a minor on this date, I/We appoint (Name, address & date of birth)*

to receive the amount of the deposit on behalf of the nominee in the event
SIGNATURE OF DEPOSITOR(S)#
of my I our / minor's death during the minority of the nominee.
Authenticated using OTP verification by VRINDA
* Leave out if nominee is not a minor. FIRST/SOLE/ MUKUND ZAVERI on 28-MAR-2021 at [Link]
GUARDIAN PM through mobile number 9821123357
# Where deposit is made in the name of a minor, the nomination should
Authenticated using OTP verification by MUKUND B
be signed by a person lawfully entitled to act on behalf of the minor. ZAVERI on 28-MAR-2021 at [Link] PM through mobile

SECOND
number 9821123357
# Thumb impression shall be attested by 2 witnesses. (use separate form DA 1)
G154/07/2020

D Please tick if nominee's name should not be printed on Deposit Receipt/ THIRD
Application for renewal of deposit - We will accordingly arrange to print the ---------------
nominee name on the renewal application. �-------------------�