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1- Account No. and type ( SB / CTD / RD / TD etc.

whether minor public / joint account etc. and in
respect of CTD TD account state the category
of account.)
2- Post office which account stand
(with name of Head Office)
if the account is connect a HO
Name (s) of depositor(s)
or authorization operation the account
3- Address of the depositor (s)at the time of
opening of account .
4- Name(s) of depositor (s)
5- Name(s) of husband / Guardian person
or authority operating the account .
6- Date of opening of account and office.
at which opened if different from that
at column .
7- Date and particulars of the post transaction
in the account .
8- Balance at credit after the 1st transactions in the account.
9- Name of the Post office from which the account
was last transaction to office when at column 2 where applicable .
10- Date and circumstance of loss of pass book result or effort
made to trace it .
11- Whether loss was reported to the police and if so with what results.
12- Remarks
Affix Rs.10/-stamp
here as fee.10/-
The particulars are given above are true to the best of my/out
knowledge. A duplicate pass book may please be issued to me/us I shell surrender the
original pass book if stamp the fee of Rs. 10/-has been paid by affixing postage stamps.
Please score out if examination has been attend,

Signature (s) of depositor(s)

Guardian / Person or authorities
Dated: operating the account

Note: If accurate information can not be furnished in respect of column and, available
particulars may be given.

1- Has the account has treated in the

ledger / binder index to ledger cards /
furnished by the participant (s) only
with the records.
2- Does the signature (s) of the applicant (s)
tally with specimen (s) records if not,
has he/she been satisfactorily identified?
3- Has the registration of undeliverable pass books
in safe custody at HO been consulted and if the
pass book available in the HO or SBCO or
lying undelivered in the sub office .
4- Do you consider further enquiries called for
as laid down in Rule 445 or P&T Man. Vol. VI Part II .
5- If answer to (4) in eears results of enquiries made.
6- Recommendations regarding issue of a duplicate
pass book.

Signature of APMDPM (SB)

Date: HO or SPM designation stamp

Part II
(In respect of application received from sub office only)
1- Have the particulars of account as
given in the application verified with
HO records.
2- Has the register of undelivered pass book
in the safe custody at the HO has been consulted
and is the pass book available in HO or SPO.
3- Recommendation of APM / DPM (SB) HO regarding .

Signature of APMDPM (SB)

HO or SPM designation stamp

Order of the Head Poster Master

Duplicate Pass Book may / may not be issued.

Signature of Head Post Master

with designation stamp

Part IV

Receipt the duplicate pass book

Received I……………………… …………………………No. of account ……………….
with a balance of Rs, …………………………

Date stamp of post office Signature(s) of depositor(s)