FORM: E (See sub rule (1) of rule 8 and rule 9) Setial NO. nn APPLICATION FOR CLOSURE OFAN ACCOUNT UNDER SENIOR CITIZENS SAVINGS SCHEME, 20 ‘Subject : Application for withdraw / closure of account. Sir, 1, Loewen daughter /wife of .. of. mtn te and depositor of account No.. (hereinafter referred to as the ‘said account’) hereby apply for closure of the said account with immediate effect. The interest of Rs. and deposit of Rs.. » TOTAL (INTEREST + DEPOSIT) Rs. amy iny bbe refunded to me immediately. 2. The Pass Book is enclosed. ‘Signature or thumb impressionof the Depositor FOR USE BY THE DEPOSIT OFFICE ‘Account no. senna Qe Of deposi ~ amount of deposit Rs. ‘Withdrawal on aecount of Interest Rs... totaling to Rs.. is sanctioned in favour of the depositor, * Recovery of overpaid interest Ri charges (10 be specified) Rs. « deduction of Rs. (Rupees... NET AMOUNT PAID Rs.. Received a sum of Rs, from office ) as per details furnished above, Signature / Thums impression of the depositor * Score out whichever is not applicable,