Deposit Application Form

Fill in the deposit details step-by-step. Review terms and conditions before share application.

Fill Deposit Form Details

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Deposit Type

Amount in Figures (₹)

Term (Months)

Amount in Words

Form Date

Share No.

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REGD. No. 18-250 18 of 93

ESTD. 1994

SURIYAN BENEFIT FUND (MADRAS) LIMITED

Declared as NIDHI Company by Govt. of India

487, Mint Street, Chennai - 600 079

DEPOSIT APPLICATION FORM

(To be filled in by depositor Use Block Letters Tick where applicable)

Ph : 25203205

App No: SBF-DEP-2026-00000

Date

TYPE

AMOUNT

TERM

Fixed DepositSavings DepositRecurring Deposit

In Figures Rs.

In Words Rs.

MONTHS

REMITTANCE DETAILS

From

NumberBank

Cheque

Draft

Cash

DatedPlace

RenewalFD/RD No.Maturity Date

Amount Rs.

Name of the First Depositor Mr./Mrs./Ms.

* Age :

Father/Husband/Guardian Name Mr./Mrs./Ms.

Name of the Second Depositor Mr./Mrs./Ms.

* Age :

Father/Husband/Guardian Name Mr./Mrs./Ms.

Nominee :

Relationship : * Age :

Share No.

Folio No.

Type of Account

Sole/First Depositor/JointlyEither or SurvivorAny one or Survivor

Address

Pincode

Phone No.

Occupation

Interest Option

MonthlyQuarterlyHalf YearlyYearly

Tax to be deducted

YesNoNot Applicable

Payment of Interest

To Collect CashTo Collect Post dated cheque

To credit SB A/c No.

with SBF / Others

Introduced by

Name and Address :

Signature :

DECLARATION

I/We have gone through the Financial and other Statements/Particulars/ representations furnished/made by the Fund and after careful consideration, I/we making the deposit with the Fund at my own risk and volition.

Signature of First depositor / guardian

Signature of Second depositor / guardian

FOR OFFICE USE ONLY

AMOUNT

DEPOSIT DATE

MATURITY DATE

F.D / RD / S.B / OTHER / NO,

(Please see overleaf for rules & regulations governing the Deposits)

* If minor date of birth