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POST OFFICE SAVING BANK

APPLICATION FOR NOMINATION OR CANCELLATION OR VARIATION OF NOMINATION

......................................................... .......................................
Name of Post Office Account No.

* I/We the depositor (s) of savings / Cumulative Time Deposit / Recurring Deposit 1/2/3/5 years Time Deposit account
No. ........................................... hereby nominate the persons(s) named below, under sectrion 4 of the Government
Saving Bank Act, 1873 to be the sole recipent(s) of the amount standing at the credit of the said account.

Name and address of person who may receive


Name & address of nominee Date of birth
the said amount during the nominee's
mionority
............................................ .......................................... ................................................................
............................................ ......................................... ................................................................
............................................ ......................................... ................................................................

The names(s) of nominee(s) may not be entered in the passbook.

This nomination supersedes the previous nomination made in respect of the said account which
standsregistered under No................................. or ..................................................... date .........
3 .*@
No nomination has been previously made in respect of the said account which is in force.

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