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AUGUUNI ULUSUKE runim [8-/A) PATIIEN! UKUEK Se (For office use only) Payment Detail PASS BOOK MUST ACCOMPANY THIS FORM (To be filled by Depositor) Date @ “ner Application Side Name _ Date Type of Account : SB/RD/TD/MIS/PPF/NSSISCSSI/PPF etc. oe ee! OE “ 1 ' ' 1 t Principle amount-Rs. ' (+) Interest due Rs. H (-) Recovery of overpaid Interest Rs. ' (-) Deduction if any Rs. (in case of premature closure) ' Total Amount due Rs. {In words) Shown as balance. 4 Pay Rs. e (in figures) (in wor i ' ' 1 1 1 ' ' 1 ' ' 1 ' Account No Please pay to selffmessenger (whose name & signatures are given below) the sum of Rs. (In figures) Rs. in my passbook plus/minus interest/recoveries as admissible under the rules. Date Stamp Signature of Postmas Name of Messenger. Signature or thumb : ’ Acquittance Signature of Messenger impression of depositor (To be filled by depositor/messenger) Received Rs. : = (both in words and figures) “Signature or thumb impression of depositor (Required only if payment is required through messenger) Intitial of PA Intitial of APM Date Signature or thumb impressi so Sa WA & AR Wgy sige er anes a rene (arrrat SRT ART SIT) RR ATA a 3 em ewe / eB A / ATR / He / HATH / RTT / HN / FS ____ Te. aa eee FR Rear A Fay 8) a AG srg ha aT eet asf afta/ eta %. (tet #) ; wm. (aa) ofA DBT RTA See FY er : ATH 2 BRT aT aS 2 ITA ag ARTA fa | aT aT airs & Fer 5 “a Pp agra ares 2s rez TART) , Sieh WERTH H HTETTAR SE (drat raters ArT eq) Ged: RAG #1 AT feat ____ aa Aer ae —* XB. (4) Fea (=) aeftres reper earner BY erage (- —) were ah rE ew He 8) aa ger . (area H) are aa 4 & (sigh) ater ON AIR & BeTAR TAT | (sparerat Rees BRT AT GT) , . FE (grat aire ait, err A) . . ne : FETA TT sys & Peat

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