Union Bank of India : Personal Information Declaration and undertaking form

Notice

Reports

Financials

Union Bank of India

Personal Information,Declaration and Undertaking by the Candidate (with appropriate enclosures)

Sr.	Particulars		Information Disclosed
No.
I. Personal Details
1.	Name in Full
2.	Father's Name
3.	Gender (M/F/Others)
4.	Present Address
5.	E-mail address & alternate e-mail address:
	Telephone Number with STD code:
	Mobile Number:
6.	Nationality
7.	Date of Birth
	(dd/mm/yyyy) and Age		- - / - - / - - - - Age : - - years - - months
8.	Educational qualifications
9.	Director Identification Number (DIN)
10.	Aadhaar Number (Optional)
11.	(a) Permanent Account Number (PAN)
	(b) Charge where the proposed director is assessed
	to tax (Income Tax jurisdiction)/name and address of
	Income Tax Circle/Ward
	(c) Details of filing of return(s) and payment of taxes for
		Date of Filing	Amount of tax paid (INR)
	past 3 years
12.	Permanent address
			Union Bank of India | Integrated Annual Report 2023-24	3

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Sr.	Particulars	Information Disclosed
No.
13.	Details in the form of a brief write up on the relevant
	knowledge or experience in respect of one or more of
	the matters namely accountancy, agriculture and rural
	economy, banking, co- operation, economics, finance,
	law, small scale industry, information technology,
	payment and settlement systems, human resources,
	risk management, business management or any
	other matter the special knowledge of and practical
	experience of which would in the opinion of the Reserve
	Bank be useful to the Banking Company
14.	Present occupation (designation, name of the
	organisation and brief write-up on experience)
15.	Previous occupation covering minimum of past ten
	years, with complete address of the organisation(s)
	worked in, date of joining, date of relieving (including
	reasons), designation, etc.
16.	In case a Chartered Accountant, indicate the following:
	(a) Membership Number of Institute of Chartered
	Accountants of India (ICAI):
	(b) Date of registration with the ICAI:
	(c) Name and Address of the registered firm/s:
	(d) Details of the Audit(s) presently undertaken by the
	firm(s) or by you:
17.	Name of the banker(s) with Branch and Account
	Bank Name	Branch	Type of A/c	A/c Number
	Numbers (savings/current/loan accounts) where you
	are a primary account holder:
18.	Details of shareholding, if held in any entity, either
	in physical or dematerialized form, by you, spouse,
	and your minor child. (attach demat/shareholding
	certificate)
19.	Any other information relevant to directorship of the
	bank:
II. Relevant Relationships of proposed director
20.	List of relatives, [Refer Section 2(77) of the Companies
	Act, 2013 and Rule 4 of the Companies (Specification of
	Definition) Rules, 2014] if any, who are connected with
	any bank:
21.	List of entities in which:
	(a)interested [Refer Section 184 of the Companies Act,
	2013]:
	(b)beneficial ownership [Refer Section 89 of Companies
	Act, 2013 as also the applicable Significant Beneficial
	Ownership Rules of MCA]:
	(c) Trustee (also mention any other relationship with
	reference to a trust):

4 Union Bank of India | Integrated Annual Report 2023-24

Notice

Reports

Financials

Sr.	Particulars	Information Disclosed
No.
22.	List of entities, existing and proposed, in which holding
	Name of the company
	substantial interest within the meaning of Section 5(ne)
		/ firm
	of the Banking Regulation Act, 1949.
		Country of incorporation
			Number of shares
			Face Value of each share
			Total face value of share
			holding
			Shareholding as % of
			total Paid up Capital
			Beneficial interest (in
			value as well as % terms)
			Whether the entity is
			a Section 8 Company
			under Companies Act,
			2013
23.	Details of holdings in entities incorporated abroad and
	having a place of business in India.
24.	Name of Bank/NBFC/any other company in which
	currently or in the past a member of the Board/ Advisor
	etc. (giving details of period during which such office is
	being/ was held).
25.	If connected with any entity undertaking hire purchase,
	financing, investment, leasing and other para banking
	activities (nature of association to be mentioned),
	details thereof.
26.	If a stock broker or connected with any entity engaged
	in share broking activities, details thereof.
27.	Details of fund and non-fund-based facilities, if any,
	presently availed in person and/or by entities listed in
	(21) to (26) above.
28.	Cases, if any, where as an individual or the entities
	listed at (21) to (26) above have defaulted or declared
	as willful defaulter in the past in respect of credit
	facilities obtained from a bank/NBFC/any other lending
	institution.
III. Records of professional achievements
29.	Professional achievements relevant for the directorship.
IV. Proceedings, if any, against the proposed director
30.	(a) As a member of a professional association/
	body, details of disciplinary action, if any, pending or
	commenced or resulting in conviction in the past or
	whether been banned from entry at any profession/
	occupation at any time, details thereof.
	(b) If subject of any written complaint or accusation
	regarding individual professional conduct or activities,
	details thereof.
31.	Details of prosecution, if any, pending or commenced
	or resulting in conviction of self or the entities listed at
	(21) to (26) above for violation of economic laws and
	regulations.
			Union Bank of India | Integrated Annual Report 2023-24	5

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Sr.	Particulars	Information Disclosed
No.

1. Details of criminal prosecution, if any, pending or commenced or resulting in conviction.
2. If indulged in any breach of AML/CFT guidelines, details thereof.
3. If attracting any of the disqualifications envisaged under
   Section 164 of the Companies Act, 2013, details thereof.
4. If adjudicated insolvent or has suspended payment or has compounded with creditors, details thereof.
5. If found to be of unsound mind and stands so declared by a competent Court, details thereof.
6. (a) If convicted by a Criminal Court of an offence which involves moral turpitude or otherwise, details thereof.
7. 1. If convicted by any Court of law, details thereof?
8. If holding any office of profit under any nationalised bank or State Bank of India, except for holding the post of a whole-time director, details thereof.
9. If as an individual or any of the entities at (21) to (26) above have been subject to any investigation/vigilance/ matters of enquiry from any of the previous employers or government departments or agency, details thereof.
10. If found guilty of violation of rules/ regulations/ legislative requirements by customs/ excise/ income tax/ foreign exchange/ other revenue authorities, details thereof.
11. If reprimanded, censured, restricted, suspended, barred, enjoined, or otherwise sanctioned by any regulator such as SEBI, IRDAI, PFRDA etc., professional organisation,
    or activities, details thereof. (Though it shall not be necessary for a candidate to mention in the column about orders and findings which have been later on reversed/ set aside in toto, it would be necessary to make a mention of the same, in case the reversal/ setting aside is on technical reasons like limitation or lack of jurisdiction, and not on merit. If the order is temporarily stayed and the appellate/ court proceedings are pending, the same also should be mentioned).

v. General Information

1. If a professional like Chartered Accountant, Advocate etc. and presently undertaking/ undertaken any professional work in any bank, provide details thereof including the name of the bank and period of association with the bank.
2. If a sitting MP/MLA/MLC or holding political position in Municipal Corporation or Municipality or other local bodies, provide details thereof.

VI.	In the interest of disclosure and transparency, should there be any other information relevant for assessing 'fit
	and proper', provide details thereof.
	Undertaking
	I confirm that the above information is to the best of my knowledge and belief, true and complete. I undertake to
	keep the bank fully informed, as soon as possible, of all events which take place after my appointment which are
	relevant to the information provided above.

6 Union Bank of India | Integrated Annual Report 2023-24

Notice

Reports

Financials

Sr.	Particulars	Information Disclosed
No.
	I also undertake to execute a 'Deed of Covenant' as required to be executed with the bank.
	Place :
	Date :	Signature of Candidate
	Enclosures :
	Note :
	1. Wherever space is not sufficient, please attach the information as annexure in chronological order and with
	appropriate cross reference
	2. Each page (including annexures) is reuired to be signed by the candidate.
	Remarks of Nomination and Remuneration Committee
	(NRC) / Board of having satisfied itself that the above
	information is true and complete.
	Place :
	Date :	Signature of the Chair

Union Bank of India | Integrated Annual Report 2023-24

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