3.

Declarations
Rules, 2018 applicable
on
General: (1) /We hereby unde
on the Scheme and amendments issued thereto from
time totime
(Details available at https://www.indiapost.gv.in/yAS/Pages/RT/RTI-Manual-5.aspx) to inform tne
of India and undertake
unsound mind is/are Resident citizen
4we further declare that 1We/Minor/person of
account office of any change in My/our residency/citizenship status in future.
and thereafter, account holder will
be operated by me till account holder attained age of 18 years
hereby agree that account will through Guardian).
operate the account. (In case of
SSA and Minor Account opened
(4) In case services of SAS/MPKBY Agent are taken: -

Authority No.... . Date of validity..

OAgE *************** ******************
to SB, SB to RD etc.) if
any************************************************************************

(5) Standing Instruction (i.e. MIS

Account in the name ofthe
depositor in
under Sukanya Samriddhi
account has been opened
DSA:I hereby declare that no other
any of the Post office/Bank in the country. Account in the name of
the
under Public Provident Fund
that no other account has been opened
UPPE (1) I hereby declare in the country.
myself/minor in any of the Post office/Bank in the accounts opened in my name
and in the name of minors
further declare that I will abide by the ceiling of maximum deposit the Scheme provisions.
(2)1 as in contravention to
in excess of the ceiling will be treated
provision of the scheme and any deposit under "National Savings Monthly Income
as per
declare details of my/Our existing accounts
as on today
MIS/SCSS I/We hereby
any ofthe Post in the country.
Office/BankCustomer
Account/ SeniorCitizen Savings Scheme"in
Date of opening Amount
Identification Account Name of Post
SI.No. Name of Scheme deposited Number (CIF No.) Number office/Bank
(MISor Scss) of account

is more, details of all accounts should be filled and attached as annexure duly signed.
If number of accounts
Please tick (V) the appropriote boX Aay Keumar Bocn
thumb impression of Applicant(s)/Guardian
Signature or

Date:

4 Nomination
mentioned below to whom to
the exclusion of all other persons
in
nominate the person(s) the time of my death
we.. o .hereby Name of Scheme) at
to my credit in
.

the event of my death the amount standing

Nature of
would be payable. Aadhaar number Date of birth of nominee Share o
Full in case ofminor nominee entitlement entitlement
S.No. Name(s) of the of nominee
nominee(s) and address Trustee or owner
relationship (optional)

above is/are minor(s), .

/we appoint
at Serial No.(s).. . Specified
the nominee(s) O******************"******************************s*****stn********************************
AS

Shri/Smt/Kumarl..
*********************************************************************************n**so***s*****************************************************************************
lail************************************************************
********* ******" I
***********lo

nominee(s).
Address.. during the minority of the
*********
******
°o****

of my/Our death
the said account in the event
receive the sum due under

(In case, applicantls) is/lareilliterate) ****************** * ********* ***

*************************************"***************
*******************A**********************"*************** ***a** *** *********

1. Signature of witness. *******************************************************************

***********************************************************************************************************
************************

Name & Address....

***
************************************** ******
********************************************************************a***"*******************
2. Signature of witness.
*********************************************"***********************************************************************a********************************************************************
*****************

Name & Address.o

of Applicant(s)/Guardian
Place: Signature or thumb impression
Date:
FORUSE OF POST OFFICE is
ldentification as well as address proof documents submitted. Opening of account
this application and
I have carefully examined
**ssnasbllasaeaassoreo***a*s*se***
..(Date) under
approved. ************* na*ssssueees

Account has been opened in the name

of. **********************s*******************e

******
daied....*eaeesessos********
SGheme vide A/c
No.. ******
uwww.o
Nomination registration details:-
Post Master
Date Stamp Signature of Sub/Asst./Head
Branch Post Master Designation stamp
Signature of GDS
Date Stamp Name Stamp of EDBO