FORM SL 1A





Nomination under section 45ZE read with section 56 of the Banking Regulation Act, 1949 and Rule 4(2) of the Co-operative Banks (Nomination) Rules, 1985 by joint hirers in respect of safety locker



I/We, ..............(name and addresses) ...............nominate the following person(s) to whom in the event of the death of one or more of us .............(name and address of branch/office in which the locker situated) ................may give access to the locker and liberty to remove the contents of the locker, particulars whereof are given below, jointly With the survivor or survivors of us.

Locker:-

Nature of

Nominee:-

Distinguishing mark or No.

Additional details if any

Name

Address

Relationship with hirer, if any

Age

Place:

Date:

Name(s), signature(s) and address(es) Signature/ Thumb impression(s) of witness(es)+ of hirer(s)

+Thumb impression shall be attested by two witnesses