PPF Account No.

PF Form – A CIF No.:

APPLICATION FOR OPENING A PUBLIC PROVIDENT FUND ACCOUNT UNDER THE

PUBLIC PROVIDENT FUND AMENDMENT SCHEME – 1984

To,
Branch Manager,
Date: Central Bank of India
HAZRATGANJ Branch.

I _____________________________________________hereby apply for opening an account

under the Public Provident Fund Amendment Scheme 1984 in my name / in the name of
Mr./Ms __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ of whom I am guardian and
tender herewith Rs. __ __ __ __ __ __ (Rupees __ __ __ __ __ __ __ __ __ __ __ __ __ __ _)
in cash/cheque as the initial subscription.

Permanent address of Subscriber/Guardian:

I agree to abide by the Provisions of the Public Provident Fund Amendment Scheme 1984 and
amendments issued thereto from time to time. I declare that I do not maintain any other Public
Provident Fund Account.

Account in the name of Minor: ______________________ _____________________________________

Date of Birth of Minor: ____________________________ Signature / Thumb Impression of Subscriber/Guardian

Applicant's Relationship with Minor, If any_ __________

Additional
Specimen

Date:

PLEASE PROVIDE NOMINATION DETAILS OVERLEAF

For Office Use Only

The account has been opened on __ __ __ _ _ with Rs. __ __ __ __ __ __ under Public Provident Fund
Account No. __ __ __ __ __ __ __ __ __ __

Passbook has been issued on __ __ __ __ .

Officer – in – charge
APPLIACTION FOR THE NOMINATION / CHANGE / CANCELLATION OF NOMINATION
UNDER PUBLIC PROVIDENT FUND SCHEME 1984

To,
Branch Manager,
Central Bank of India
HAZRATGANJ,LUCKNOW.
Subject: Application for Nomination or Change/Cancellation of Nomination.
Sir,

1. I ________________________________________________ hereby nominate the following person, mentioned

below, to whom, to the exclusion of all other persons, in the event of my death the amount standing to my credit in the account
would be payable in accordance with the provisions contained in the scheme.

S. No Name of the nominee along with Date of birth of nominee in case Share of the nominee in
relationship with the depositor of minor / age in other case the amount payable

Photograph
of the
nominee
Permanent Address

(Signature / Thumb
Impression of the nominee)

2.* As the nominee above is minor, I appoint Shri/Smt/Kumari ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
[name with permanent address of the person in respect of minor nominee] to receive the sum due under the
said account in the event of my death during the minority of the nominee(s).

3.* This is in supercession of the nomination made by me earlier at the time of opening of account/vide my
application dated __ __ __ __.

4.* I __ __ __ __ __ __ __ __ __ __ __ hereby request to cancel the nomination made by me earlier vide my

application dated __ __ __ __

Witness (Signature, Name and Address)

1. __ __ __ __ __ __ __ __ ___ ___ ___ __

2. __ __ __ __ ___ _____ ___ ___ ___ ___ __ _ __

Date:__ __ __ __ ______________________
Place: __ __ __ __ __ __ Signature of the Depositor
*Score out whichever is not applicable (name and address)

For Office Use Only

The above nomination has been registered on __ __ __ __ __ __ __ _ _ AND/OR the earlier nomination dated __ __ __ __
has been changed/canceled.
Necessary entries have been made in the Passbook.

Date: __ __ __ __ __ Signature of the Incharge