sacs Post oFrce SANS BANK a ACCOUNT OPENINGIPURCHASE OF CERTIFICATE APPLICATION FORM FOR INDIVIDUALS “~~ For Office Use Post Office Date: SOLID: ‘Tecount Registration] IFT) No. CIFIO(Z) CiFIDIS) For Applicantisy |. We request you to open : Savings/Basie Savings/RDITD___YearIMIS/SCSS/PPFISSA or Issue NSC(BS" Issue) or KVP amylourname. “2. Full Namo of ApplicantGuardian (in case of MinoriLunatic AG), in CAPITAL Letters (leave space between words) ‘MrNirs {Ms JOther t Name Middle Name Last Name Gonder (WE) 1 2 3 "3. Full Name of FatherHusbandiMother, in CAPITAL Letters 74. Residential Address 2" Applicant Flat Noveidg name | ‘StreetRoad/LocallyiVilage TehsilPost Office City and District State Pin Code "Tel/iobite No {optional} E-mail (optional) “5. Applicant's Date of Bith (ddimmiyy) PAN Number oF Form 60/61) 1 2 3 (CIF 1 (ifaready exists) 6. Operating Instruction (please tick J the empty bo») ‘Single’Self |__| Either or Survivor (Joint-B) Jointly GointA)_ “7. Detail of Know Your Gustomer (KY) documents submitted :~ Photo 1D. adress Prost pplican icant + = = r "Wie of Document Document No Vat vp tof eay) Detail of First Deposit :- Amount Figures) (words Mode of Deposit 9. Nomination We nominate the person(s) named below under Section 4 ofthe Governmont Savings Bank Act, 1873 (5 of 1873) {0 be the sole reciplent(s) of the amount standing atthe credit of the account In the event of my/our death, amo & address of Date of Birth Name & address of person who may recolve te! ‘nomineets) ‘incase of inorty of te nomine minor). ‘Signature of witness In ease doposiior wish fo make nomination Name & Address of witness *Mandatory Fields to be filled by customer. Scanned with CamScanner{avakbnan wuwmens ae 11.Please open Minor AIC through Guardian/Lunatic Account through Guardian/Blind/Physically Handicappediiterate through AgenPensionerfBPL/SB Basic Savings Accounl/Sanchayaka AccountOthers, i {ain case of Minor/Lunatic Account, please fil Name of Minor/Lunatic and his/her Relationship with applicant Ja In case of other than MinorfLunatic, please enter Name of Sanchayka/Government Welfare Scheme and PPOIBPLRegistration/Enrollment number :~ +14, Amount of Monthly Installment (In ease of RD Account) -Rs(in figures)__(ihwords}_ 15. In case services of SASIPPFIMPKBY Agent are taken :- Name of Agent, Authority No, Nalid Up to, a 416. Standing Instructions if any =, 47. le authorize Agent (name), to receive PassbookiCertiicates on mylourbehal. og ———SSSSSCSC«R 418, Recieved Certificate(s) = = Signature of investorImessenger/Authorized agent. Declarations We hereby declare that UWe have clearly understood POSE General Rules 1981 and Post Office Savings Account Rules 4981/ Post Office Recurring Deposit Rules 1981/ Post Office Time Deposit Rules 1951/ Monthly income Account Rules 4987/Senior Citizens Savings Scheme Rules, 2004 and Sukanya Samriddhi Account Rules 2014, PPF Rules 1968, NSC(VII) and (Xl)issue Rules, KVP Rules (amended from time to timo) governing the accounts/Certificates under this scheme and to ‘bide by such rules framed by the Central Government as may be applicable to the account from time to time. We hereby ‘declare that UWe will adhere to the maximum Investment limit notified under various scheme for selfjointiminor accounts, andincase of any excess investmentis found, willnotclaim interest. DATE: ‘Signature/Thump Impression:= ‘Applicant 2" Applicant Applicant ‘Space for affixing photo of appicants(n case of SCSS Joint Account, pease affix jint photograph ofboth spouses) A. For Office Use only CCertiied that have verified the documents submitted with this application form and confirm that KY norms are fully complied with, Following numbers of NSCIKVP Issued (in case of NSCIKVP Application) :- Serial Nos. of Certificates ‘Denomination Date of issue Date of encashment {All Fields to be entered into system by Cout Signature of BPM 2 Signature of Sub/Head Postmaster DateStamp ‘GMGIPN.- 2PSDINK-2018-Loose 3,00,00,000 Copies. Scanned with CamScanner