FORM – 1 [See sub-paragraph (1) of paragraph 3]

(Application for opening an Savings Account)

To
The Postmaster Recent Photograph(s)
of Depositor(s)
_____________________________

Sir,
I/We ……………………………………………………………………………………………………………………….…………….. (account holder(s)/guardian)
hereby apply for opening of an account under Post Office Savings Account Scheme in your Post Office. I/we tender
herewith Rs……………./- (Rs……………………….………………….) in cash as initial deposit.

My particulars are as under:-

1. Name of First Depositor : ……………………………….………………………………………………… (CIF - ………………………………………………....)
Date of Birth : ……/.……/…….…(DD/MM/YYYY) (In words) …………………………………….……..…………………………….………………………
Name of Husband/Father/Mother/Guardian appointed by court: …………………………………………………..………………………………….
2. Name of Second Depositor : ……………………………….…………………………………………… (CIF - …………………………………………………..)
Date of Birth : ……/.……/…….…(DD/MM/YYYY) (In words) …………………………………….……..…………………………….………………………
Name of Husband/Father/Mother: ……………………………………………….………………………………………………..………………………………….
3. Name of Third Depositor : ………………………………….…………………………………………… (CIF - …………………………………………………..)
Date of Birth : ……/.……/…….…(DD/MM/YYYY) (In words) …………………………………….……..…………………………….………………………
Name of Husband/Father/Mother: ……………………………………………….………………………………………………..………………………………….
4. Name of Minor / Person with unsound mind a/c holder : ……………………………….…………………………(CIF - …………..……………..)
Date of Birth : ……/.……/…….…(DD/MM/YYYY) (In words) …………………………………….……..…………………………….………………………
Name of Husband/Father/Mother: ……………………………………………….………………………………………………..………………………………….
5. Aadhaar Number of applicants : ………………………………………………… and …………………………………………………
6. PAN of applicants : …………………………………………………. and …………………………………………………
7. (a) Present Address : ………………………………………………………………………………………………………………………………………………………
(b) Permanent Address : ………………………………………………………………………………………………………………………………………………….
8. Contact details – (a) Mobile Number(s) : …………………………………………… and …………………………………………….
(b) Email ID : ………………………………………………………………
9. Type of Account (strike through whichever is not applicable) : Single / Joint / through Guardian for Minor / person of
unsound mind or blind or differently abled through authorised person.
10. (*)Details of Birth Certificate (in case of Minor) - a) Certificate Number : ………………………….……………………………………
b) Date of Issue : ……/.……/….……(DD/MM/YYYY) c) Issuing authority ………………………………………………………………………
11. (*) Name of Guardian (Natural/Legal) : …………………………………………………………………………………………………………………………
(In case the account is opened on behalf of a Minor/person of unsound mind)
12. Details of other KYC documents of applicant(s) attached -
(a) Proof of identification : ……………………………………… Number : …………………………………………………………………………………….……
(b) Address proof : ……………………………………………..…… Number : ………………………………………………………………………….………………
(The following documents are accepted as valid documents for the purpose of identification and address proof: 1. Passport 2. Driving license 3.
Voter’s ID card 4. Job card issued by NREGA signed by the State Government officer 5. Letter issued by the National Population Register containing
details of name and Address)

(Contd…)
13. The operation of the account will be:- (a) By all the holders together or the surviving holder/s
(For Joint account only) (b) By either of the holder/s, or the surviving depositor/s
14. My / our Specimen Signatures
(i) ……………………………….………………….… (ii) ………………….…………………………...… (iii) ……………………………………………………….…
(Name) : ………………………………………………………………………………………………………………….…………………………………………………………

(i) ……………………………….………………….… (ii) ………………….…………………………...… (iii) ……………………………………………………….…

(Name) : ………………………………………………………………………………………………………………….…………………………………………………………
(i) ……………………………….………………….… (ii) ………………….…………………………...… (iii) ……………………………………………………….…
(Name) : ………………………………………………………………………………………………………………….…………………………………………………………
I hereby undertake to abide by the scheme provisions and Government Savings Promotion Rules, 2018 applicable on the Scheme and amendments
issued thereto from time to time.
I further declare that I and the depositor both are Resident citizen of India and undertake to inform the account office of any change in our
residency/citizenship status in future.

Date: ……/.……/….……(DD/MM/YYYY) (Signature or thumb impression of applicant(s) / guardian)

Nomination
15. I/we……………………………………………………………………………………………………………………………………………………..hereby nominate
the person(s) mentioned below to whom to the exclusion of all other persons in the event of my death the amount standing
to my credit in Post Office Savings Account Scheme at the time of my death would be payable.
S.No. Name(s) of the nominee(s) Full address (s) Aadhaar number Date of birth Share of Nature of
and relationship of of nominee entitlement entitlement
nominee (optional) in case of Trustee or
minor owner
1.

2.

3.

As the nominee at Serial No.…… specified above is minor, I appoint Shri/Smt/Kumari ….…………………………………………..………..
S/o,D/o,W/o……………………………………………………………… Address……………………………..…………………………………………………………
to receive the sum due under the said account in the event of my death during the minority of the nominee(s).

1. Signature of witness (1) : …………….……………………………… Name & Address : ……………………..……………………………………………..

2. Signature of witness (1) : …………….……………………………… Name & Address : ……………………..……………………………………………..

Date: ……/.……/….……(DD/MM/YYYY) (Signature or thumb impression of applicant(s) / guardian)

For use of Post Office

The account has been opened in the name of…………………………………..…………………… on ……/.……/….……(DD/MM/YYYY) with
initial deposit of Rs………………………………… & with Account No.__________________________ dated_________________.
Customer identification Number………………………………..
Nomination has been registered vide No……………………………………..dated………………………………………..

Date Stamp Signature and seal of competent authority.