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!
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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
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1
1
1
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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 impressiso
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