Form of Application for Purchase of National Savings Certificates (Ix Issue)

FORM-1

(See Rule 6)

Serial No. . . . . . . . . . . . . . . . . . . . . . . . . ..

FORM OF APPLICATION FOR PURCHASE OF NATIONAL SAVINGS CERTIFICATES (IX ISSUE)

To

The Postmaster

Sir,

I/We hereby tender Rs. . . . . . . . . . . . . . . . . . . . . . . . .(Rupees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .only) in cash/by cheque No . . . . . . . . . . . . . . . . . . . . . . . . . . . for purchase of National Savings Certificates IX Issue of the type Single/Joint A/Joint B.

(a)  in the name(s) of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . and . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(b)  in case of minor, his/her date of birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . encashable by the minor’s parent/guardian Shri/Smt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. I/We nominate the person(s) named below who shall on my/our death, receive payment.

Sl. No.

Name of Nominee

Full Address

Date of birth of minor nominee

 

  

  

  

3. I/We hereby agree to abide by National Savings Certificates (IX Issue) Rules, 2011.

4. The Certificates may be made over to my/our agent Shri/Smt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Authority No. . . . . . . . . . . . . . . or messenger who presents the application.

Signature/Thumb impression of Investor

Signature and address of Witnesses to nomination

Date. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address. . . . . . . . . . . . . . . . . . . . . . . . .. .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  

  

Received the certificate(s)

Delete whichever is not applicable

Signature of Investor/messenger/authorised agent.

  

Date. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

TO BE COMPLETED BY THE POST OFFICE

S.No. of Certificates

Issue Price (Rs.)

Date of encashment

Initials of the Postmaster

Remarks like transfer, issue of duplicate, etc. with initials

  

  

  

  

  

Date. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Signature of Head/Sub Postmaster

 

 

 

 

 

 

FORM-2

DEPARTMENT OF POSTS

[See Rule 14(1)]

Serial No. . . . . . . . . . . . . . . . . . . .

FORM OF APPLICATION FOR NOMINATION UNDER SECTION 6 OF THE GOVERNMENT SAVINGS CERTIFICATES ACT, 1959

(This form will be filled in by the holder(s) and submitted with the certificates to the Postmaster of the office where the certificate stands registered)

To

The Postmaster

Sir,

Under provisions of section 6(1) of the Government Savings Certificates Act, 1959, I/We . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .the holder(s) of Savings Certificates detailed below, hereby nominate the persons mentioned below, who shall, on my/our death, become entitled to the Savings Certificate(s) and to be paid the sum due thereon to the exclusion of all other persons. I/We hereby declare that I/We have not so far made any nomination in respect of these certificates.

Sl. No.

Name of the nominee(s) nominee

Full Address

Date of birth of in case of minor

  

  

  

  

2. As the nominee(s) at serial number(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .above is/are minor(s). I/We appoint Shri/Smt./Kumari. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..(name and full address) as the person to receive the sum due thereon in the event of my/our death during the minority of the nominee(s).

3. The certificates detailed below are enclosed.

Sl. No. of Certificates

Denomination

Date of Issue

Office of Issue

  

  

  

  

Address

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

(In case of illiterate holder, father’s name should be given)

Yours faithfully,

  

Signature (or thumb impression

  

If illiterate of holder(s)

Witnesses-

 1.  Name

Address

 2.  Name

Address

N.B. In the case of illiterate holders, the witnesses shall be persons whose signatures are known to the Post Office.

Order of the Postmaster accepting the nomination.

Date Stamp of Post Office

Signature of Head/Sub-Postmaster

 

 

FORM-3

[See Rule 14(4)]

Serial No. . . . . . . . . . . . . . . . . . . . . . . . .

FORM OF APPLICATION FOR CANCELLATION OR VARIATION OF NOMINATION PREVIOUSLY MADE IN RESPECT OF SAVINGS CERTIFICATES UNDER SECTION 6 OF THE GOVERNMENT SAVINGS CERTIFICATES ACT, 1959

(This form will be filled in by the holder/s and submitted with the certificates to the Postmaster of the office where the certificate stands registered)

To

The Postmaster

Sir,

Under provisions of Section 6(1) of the Government Savings Certificates Act 1959, I/We . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .the holder(s) of Savings Certificates detailed below, hereby cancel the nomination previously made by me/us in respect of these certificates and registered in your office under No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .dated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

*In place of the cancelled nomination. I/We hereby nominate the person/s mentioned below, who shall, on my/our death become entitled to the savings certificates and be paid the sum due thereon to the exclusion of all other persons.

Sl. No.

Name of the nominee(s)

Full Address

Date of birth of nominee in case of minor

  

  

  

  

*To be filled in case of variation only.

2. As the nominee(s) at serial number(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..above is/are minor(s). I/We appoint Shri/Smt./Kumari. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(name and full address) as the person to receive the sum due thereon in the event of my/our death during the minority of the nominee(s).

3. The certificates detailed below are enclosed.

Sl. No. of Certificates

Denomination

Date of Issue

Office of Issue

  

  

  

  

Address

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(In case of illiterate holder, father’s name should be given)

Yours faithfully,

  

Signature (or thumb impression

  

If illiterate of holder(s)

Witnesses-

 1.  Name

Address

 2.  Name

Address

N.B. In the case of illiterate holders, the witnesses shall be persons whose signatures are known to the Post Office.

Order of the Postmaster accepting the nomination.

Date & Stamp of Post Office

Signature of Head/Sub-Postmaster

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