postal forms

ANIL WAKANKAR’S

2011

POSTAL HAND BOOK

PART II (FORMS)

ANIL WAKANKAR

P O S T A L A S S T T . , P A L I , D I S T R A I G A D 4 1 0 2 0 5 ( M A H A R A S H T R A )

POSTAL HAND BOOK (PART II) BY ANIL ANANT WAKANKAR, POSTAL ASSTT., PALI 410205

PREFACE

I am very pleased to present a booklet prepared by me

named POSTAL HAND BOOK part II. This is the third edition of

this booklet.

From last some years I have been maintained a set of

forms which is useful while working as Postal Assistant or Single

Handed Sub Postmaster. My first Postmaster Shri Jayant

Kemnaik was very particular in providing service to the

customers. This is the set of forms handed over to me by him at

the time of his retirement. He had kept those forms for his own

use at the time when he was working as Postmaster. At that

time there was not a single Xerox machine at the places of

Tahsil level also. I have only made that set of forms available to

everybody.

I shall be satisfied when this book will helpful to somebody

while working the day today work.

Anil Anant Wakankar,

Postal Asstt.,

Pali,Dist Raigad.

eMail id [email protected]

mailto:[email protected]


POSTAL HAND BOOK

PART II (FORMS) INDEX

SL NO

DESCRIPTION OF FORM PAGE NO

APPLICATION FOR ADVANCES 1 Application for Festival Advance 7

2 Application for Cycle Advance 08

3 Form of Surety Bond required for advances 09-10

4 Application for Purchase of scooter Advance 1-12

5 Application for conversion of GPF advance into withdrawal 13-14

6 Application for LTC advance 14

7 Application for advance/withdrawal from GPF Genl-30 16-17

RURAL POSTAL LIFE INSURANCE 1 CERTIFICATE OF INVESTMENT IN RURAL P.L.I. Format 18

2 DECLARATION FOR REVIVAL OF RPLI/PLI POLICY Format 19

3 APPLICATION FOR CLAIMING THE AMOUNT OF RPLI OF THE DEACEASED INSURANT

20

4 APPLICATION FOR CLAIMING MATURITY VALUE OF ASSURANCE POLICY

LI-9(B) 21

5 APPLICATION FOR CLAIMING SURRENDER VALUE OF ASSURANCE POLICY

LI-23 22

6 APPLICATION FOR CLAIMING SERVIVAL PAYMENT OF ANTICIPATED ENDOMENT ASSURANCE POLICY

format 23

7 APPLICATION FOR LOAN ON THE SECURITY OF INSURANCE POLICY LI-35 24

SAVINGS BANK 1 APPLICATION FOR TRANSFER OF SAVINGS BANK ACCOUNT SB10(B) 25

2 APPLICATION FOR NOMINATION IN RESPECT OF P.O. SAVINGS BANK ACCOUNT

SB-55 26-27

3 Application for the FACILITY OF MAKING WITHDRAWALS BY CHEQUES from SB Account

SB/CQE4

28

4 Application for the purpose of availing the facility of automatic transfer

from SB Account to CTD/RD account

SB-83

29

5 Application for duplicate passbook Format 30-31

6 Binder Top Sheet Format 32

7 R.D. Ledger card SB-71 33-34

8 MIS Incentive Bill Format 35-36


9 BALANCE REPORT FOR TRANSFER OF …………….. ACCOUNT Format 37

10 APPLICATION FOR TRANSFER OF MONTHLY INTEREST OF MIS ACCOUNT TO THE SAVINGS BANK ACCOUNT

Format 38

APPLICATION FOR TRANSFER OF MONTHLY INTEREST OF MIS ACCOUNT TO THE SAVINGS BANK ACCOUNT(MARATHI)

126

11 BILL FOR CLAIM OF COMMISSION BY GDS SUB/BRANCH POSTMASTERS FOR DEOSITS IN SAVINGS ACCOUNTS

Format 39

12 BILL FOR CLAIM OF COMMISSION BY GDS SUB/BRANCH POSTMASTERS FOR DEOSITS IN T.D. ACCOUNTS

40-41

13 APPLICATION FOR THE TRANSFER OF POST OFFFICE TIME DEPOSIT ACCOUNT(S) AS SECURITY

SB 13(a)

42

14 APPLICATION FOR TRANSFER OF MONTHLY INTEREST OF MIS ACCOUNT TO THE SAVINGS BANK ACCOUNT

Format 127

SAVINGS CERTIFICATES 1 Application for the issue of Duplicate Savings Certificates NC 29 44

2 Report on application for duplicate 44

3 BOND OF INDEMNIT Nc-61 45-46

4 BOND OF INDEMNITY Nc54(a) 47-49

5 BOND OF INDEMNITY Nc54(B) 50-52

6 Certificate of holding of NSC & Discharge of NSC Format 53

7 Application for discharge of savings Certificates at the office other than office of registration.

Format 54

8 Advice of payment of certificate N.C.-10 55

9 Application for transfer of Post Office Savings Certificates as Security NC-41 56-57

10 Application for transfer of Savings Certificate from one person to another

NC34 58-59

11 DAILY TOTALS OF KISAN VIKAS PATRAS/6N.S.C.(VIII) ISSUED Format 60

12 DAILY TOTALS OF KISAN VIKAS PATRAS /6NSC (VIII) DISCHARGED 61

13 Form of application of nomination of Savings Certificates NC-51 62-63

14 Application for Cancellation or variation of Nomination previously made in respect of Postal Savings Certificates

Nc53 64-65

15 APPLICATION FOR TRANSFEROF SAVINGS CERTIFICATE(S) FROM ONE POST OFFICE TO ANOGTHER

NC 32 66-67

16 Certificate of holding and accrual of annual Interest 68

SENIOR CITIZENS SAVINGS SCHEME

1 Application for opening the Senior Citizens Savings Account Form A 69-71

2 Declaration to be attached with Form ‘A’ of SCSS Format 72

3 Application for extension of the Senior Citizens Savings Account Form B 73

4 Application for closer of the Senior Citizens Savings Account Form E 74

5 Application for closer of the Senior Citizens Savings Account by spouse or legal heir.

Form F 75


6 Annexure I to form B of SCSS ACCOUNT(Letter of indemnity) 76

7 Annexure II to form B of SCSS ACCOUNT(Affidavit) 77

8 Annexure III to form B of SCSS ACCOUNT(Letter of disclaimer on Affidavit) 78

9 Application for Transfer of the Senior Citizens Savings Account Form G 79

10 Income Tax FORM NO 15(G) 80-81

11 Income Tax FORM NO 15(H) 82-83

12 Application for continue of discontinue of the Senior Citizens Savings Account by spouse

Format 84

SANCTION OF D.D.CLAIM CASES 1 APPLICATION FOR CLAIM UNDER THE SCHEME OF PROTECTED

SAVINGS 85-88

2 Claim application for settlement of savings certificates of the deceased holder where nomination has been registered

Format 89

3 Claim application for settlement of the claim to a Savings Bank account of the deceased Depositor where nomination has been Registered

90

4 Claim application form for settlement of savings bank account of the

deceased depositor Where the claim is preferred by legal evidence 91-92

5 Claim application form for settlement of savings Certificates of the

deceased holder Where the claim is preferred by legal evidence 93-94

6 Post Office Savings Bank/Savings Certificate claim application where no nomination exists or legal evidence is not produced

SB-84 95-97

7 Report on The Savings Certificate (s) Belongs to DECEASED HOLDER 98

8 BOND OF INDEMNITY[To be executed by heirs of deceased Savings

Bank Depositors and deceased Holders of P O Savings Certificates]

SB 25

99-101

9 D.D.SANCTION MEMO (SB) Format 102

10 D.D.SANCTION MEMO (NSC/KVP) NC 34 103

11 D.D.SANCTION MEMO (MIS) 104

12 D.D.SANCTION MEMO (TD) 105

13 D.D.SANCTION MEMO (RD) 106

14 REPORT FOR SUB OFFICE SAVINGS BANK DEATH CLAIM CASES 107

MISC.

1 Daily T.D.S. Deduction statement 108

2 Medical Certificate for leave or extension or commutation of leave 109

3 CHARGE REPORT 110

4 Certificate of deduction of tax at source of the Income Tax Act, 1961. IT 16A 111

1 MEMO OF ADMISSION OF PAYMENT MO10(A) 112

2 CERTIFICATE OF PAYMENT OF MONEY ORDER MO10(B) 112

3 Request to forward the paid Money Order Voucher MO35 113

4 MONEY ORDER REDIRECTION SLIP MO12 115

5 NOTICE TO PAYEE MO11 115

6 H.O. Journal of Indian Postal Orders paid MO66 115


7 Application for revival of SB a/c (Marathi) 117

8 STATEMENT OF D.A. ARREARS PAID TO SWEEPER AND WATERMAN 118

9 cçvççÇDçç@[&j/jçÆpçmìj Hç$ç HççvçíJççuçíkçÀçí vç çÆcçuçvçíHçj çÆMçkçÀç³çlç. 119

10 Format of letter to Issue of duplicate money order. 120

11 UNSOLD STOCK STATEMENT OF 6 NSC (VIII)/kvps/IPOS 121-122

12 APPLICATION FOR CHANGE OF NOMINATION OF PLI 123

13 Intimation for drawing of crossed Cheque. 124

14 APPLICATION FOR LEAVE SR 1 125


APPLICATION FOR FESTIVAL ADVANCE

Name of Festival ________________________________

1. Name of official:-

2. Designation:-

3. Basic Pay:-

4. Amount of advance required:-

5. Whether Temporary or Permanent:-

6. Date from continuously in service:-

7. Whether the recovery of previous advance is till outstanding:-

8. Whether on leave or suspension(state nature of leave):-

Date: - Signature of Applicant

I certify that neither I have drawn any festival advance during the current

year not any previous Festival Advance is still outstanding against me, If this

statement proves fails, disciplinary action may be taken against me.

Date: - Signature of Applicant

Declaration in case of temporary servants

I hereby agree to stand surety for the above Advance or part there of

being found unrecoverable, I agree to pay the same in on lump sum or in

installments may be decided by the Department.

Date:- Signature of surety

Name and Designation


APPLICATION FOR CYCLE ADVANCE

1) Name and Designation of the applicant:-

2) Basic Pay:-

3) Whether Permanent or Temporary:-

4) Amount of Advance required:-

5) Whether such advance was sanctioned previously,

if so give details:-

6) No and date of sanction if any

7) No of installments in which repayment is desired:-

8) Reason why cycle advance is necessary:-

Certified that, I have not received cycle advance during preceding three

years.

Place:-

Date: - Signature of applicant.

I verified the particulars of serial No 1 to 3 and 8and recommended / not

recommended the grant of advance.

Appointing Authority.

N.B. In case of temporary officials, Surety bond in the prescribed form is

necessary.


Form GFR 21 (See Rule 181)

Form of Surety Bond KNOW ALL MEN BY THESE PRESENTS THAT I, …………………………………………… Son of …………………………., resident of …………………………………. in the District of …………………………… at present employed as a permanent …………………………… in the ………………………………….. (Hereinafter called “the surety “ ) am held and firmly bound into the President of India (hereinafter called “the Government” which expression shall include his successors and assignees) in the sum of Rs ………….. (Rupees ……………………………… …………………………………………………… only ) with interest as hereinafter specified and all cost between attorney and client and all charges and expenses that shall or may have been incurred by or occasioned to the Government to be paid to the Government FOR WHICH PAYT to be well and truly made I hereby bind myself, my heirs, executors, administrators and representatives firmly by these presents. As witness my hand this ………………… day of …………………………. two thousand and ………………………………….. WHEREAS the Government has agreed to grant to ……………………………., sib if ……………………………., a resident of ……………………………………. in the district of …………………………………… at present employed as temporary………………………………… in the ……………………………… (Hereinafter called, “the borrower” at the borrower’s own request an advance of Rs ……………………… (Rupees ………………………………………… Only) for the …………………………………………. AND WHEREAS THE BORROWER has undertaken to repay the said amount in …………………………….. Equal monthly installments with interest as calculated at the rate and in the manner prescribed under rule 198 and Government of India’s Decisions (1) and (2) there under of the General Financial Rules, 1963, thereon or on so much thereof as shall for the time being remain due and unpaid calculated at fixed Government rates in force for Government loans from the day of the advance. AND WHERAS in consideration of the Government having agreed to grant the aforesaid advance to the Borrower the Surety has agreed to execute the above bond with such condition as hereunder is written. NOW THE CONDITION OF THE ABOBVE - WRITTEN Bond is that if the said Borrower shall, while employed in the said ……………………………….DULY and regularly pay or cause to be paid to the Government the amount of aforesaid advance owing to the Government my installments with interest as calculated in the aforesaid manner thereon or on so much thereof as shall for the time being


remain due and unpaid calculated at fixed Government rates in force for Government loans from of day of advance until the said sum of aforesaid manner shall be duly paid, then this bond shall be void, otherwise the shall be and remain in full force and virtue. BUT SO NEVERTHELESS that if the Borrower shall die or become insolvent or at any time cease to be in the service of the Government, the whole or so much of the said principal sum of Rs ……………. (Rupees …………………………………………………………………………………..only) thereof as shall then remain unpaid and the interest due on the said principal sum calculated in the aforesaid manner from the day of the advance shall immediately become due and payable to the Government and be recoverable from the Surety in one installment by virtue of this bond. The obligation undertaken by the Surety shall not be discharged or in any way affected by an extension of time or any other indulgence grantee by the Government to the said borrower whether with or without the knowledge or consent of the Surety. The Government has agreed to bear the stamp duty, if any, for this document. Signed and delivered by ………………………………………………………. the said …………………….. (Signature of the Surety) …………………………………. Designation ……………………………………. at ……………………………… Office to which attached this ……………………………. ………………………………………………………… Of ……………………………… in presence of 20 ……………………………… (1) ……………………………………………………. Signature, Address (2) …………………………………………………… Of the witnesses

ACCEPTED For and on behalf of President of India


APPLICATION FOR ADVANCE FOR PURCHASE OF SCOOTER

1. Name of Applicant:-

2. Designation of applicant:-

3. Name of office where working:-

4. Pay substantive officiating special:-

5. Anticipated prize of Scooter:-

6. Amount of advance required:-

7. Date of superannuation or retirement or date :-

of expiry of contract in case of contract officer

8. No of installments in which the advance is

Desired to be repaid:-

9. Whether advance for similar purpose was

obtained previously and if so:-

a) Date of drawal of the advance:-

b) The amount of advance and or interest

thereon still outstanding if any:-

10. Whether the intention is to purchase:-

a) A new or old motor car/ cycle:-

b) If the intention is to purchase motor

car/ cycle through a person other than

a regular or reputed dealer or agent.

Whether previous sanction of the competent

authority has been obtained as required

under Rule 15(20 of C.C.S. (Conduct)

Rule 1964.

c) Date of entry in the department:-

d) Length of service:- Years Months Days


11. Whether the officer is on

leave/ is about to proceed on leave.

a) Date of commencement or leave:-

b) The date of expiry of leave:-

12. Are any negotiation of preliminary

enquiries being made so of the Motor

Car/Cycle within one month from the

date of drawal of the advance.

13. a) Certified the information given above is complete and true.

c) Certified that I have not taken delivery of the Motor Car/ Cycle on a/a of

which I apply for the advance that I shall complete negation for

purchase of pay finally and take possession of the motor car/ cycle

before the expiry of one month from the date of drawal of the advance

and that I shall ensure it from the date of taking delivery of it.

Signature of the applicant

Recommended of head of Division/Unit.

Signature of the head of Division/Unit.


DEPARTMENT OF POSTS, INDIA.

FORM OF APPLICATION FOR CONVERSION OF AN ADVANCE INTO FINAL WITHDRAWAL

Name of the Subscriber:- Designation:- Pay :- Name of the provident Fund and Account No: - General Provident Fund.-- Balance at credit on the date of application:- Opening Balance- Subscription:- Refund of advance:- Total:- (-) Advance taken:- Net Balance:- (a) Balance outstanding to be converted in to final withdrawal :- (b) Interest due on the amount of advance taken. 7. (a) Purpose for which Advance was taken :- (b) Date of payment of the advance:- (c) Amount of Advance Sanctioned:- 8. Particulars of communication under which advanced was sanctioned:- Whether any advance of final withdrawal has been drawn previously for the purpose mentioned above, if so, particulars thereof:- (a) Total service, including broken periods, if any, on the date of this application:- Period of service, left on the date of this application:- Date of superannuation:- Place:- Date:- Signature of Applicant The above particulars have been verified to be correct:-

Signature and Designation of recommending Authority


SANCTION OF THE COMPETANT AUTHORITY _____________________________________________________________ No. / B-2 / / Dated at Alibag the _____________________________________________________________

Sanction of the Supdt. Of Post Offices, Raigad Division is hereby conveyed under Rule 16(A) of the G.P.F.(C.S.) Rules, 1960 for the conversion into final withdrawal of an amount of Rs. ________ (Rupees_________________________ ___________) being the outstanding balance out of G.P.F. Advance of Rs _______ (Rupees ______________________________________ ) sanctioned on ________ And drawn in Bill no. of Alibag for the purpose of ______________________________ To Shri/Smt __________________________________ of the office of the ___________ G.PF. Account No____________________ Supdt. Of Post offices, Raigad Division, Alibag 402201 . ------------------------------------------------------------------------------------------------------------ No- B-2


DEPARTMENT OF POSTS, INDIA APPLICATION FOR ADVANCE OF LEAVE TRAEL CONCESSION.

1. Name of the official/officer:- 2. Designation and office to which attached:- 3. Basic Pay:- 4. Whether permanent or temporary:- 5. Whether completed one year of service:- 6. Whether surety is attached:- 7. Period of leave:- 8. Date of commencement of outw2ard journey:- a) Whether proposed to All India Tour LTC :- b) Whether proposed to avail a Home Town LTC:- c) Place of LTC:- 9. Home Town given in Service Book:- 10. Actual fare and approximate distance:- 11. Date and Block of years when last LTC availed:- 12. Block of Two/Four years for which LTC is being applied:- 13. Whether staying with family, particulars of the family members availing the LTC with age and relation:- 14. Amount of advance required:- I hereby certify undertaken to produce Railway receipt or cash receipts from S.T., etc. for the journey to be under taken by me within 10 days of the drawal of advance failing which I shall refund the advance in full or same may be deducted from my pay. The final LTC bill will be submitted within one month from completion of return journey. Date Signature of the official. Recommendations of supervising officer.


Genl-30

Application for Advance/Withdrawal for GPF Account.

1. Name of the Subscriber:

2. Account No:

3. Designation:

4. Pay:

5. (A) Amount of Advance required:

(B) Whether advance or final withdrawal:

6. (a) Purpose for which the advance is required:

(b) If advance is required for House Building etc.

the following information may be given.

i) Location and measurement of the plot:

ii) Whether the plot is free hold or on lease:

iii) Plan for construction:

iv) If the flat or plot is being purchased from a

House Building Society, the name of the

Society, the location and measurement etc.:

v) Cost of construction:

vi) If purchase of plot is from D.D.A. or any housing Board

etc. the location, diamantine may be given:

(C) if advance is required for education of Children, following details may be given.

i) Name of son/daughter:

ii) ii) class and institution/ college where studding:-

iii) Whether a day scholar a hostler:-


(D) If advance is required for treatment of allying family

members following details my be given.

i) Name of the patient and relationship:

ii) name of the hospital/dispensary/doctor where

the patient is under going treatment;

iii) Whether outdoor/indoor patient:

iv) Whether reimbursement available or not:

(7) Amount of consolidated advance and number (and amount)

of monthly installments in which consolidated advance is

proposed to be recovered.:

(8) Full particulars of the pecuniary circumstance of the

subscriber justifying the application for temporary withdrawal:

I certify that particulars given above are correct and completed to the best of my

knowledge and belief and that nothing has been concealed by me.

Date Signature and designation of applicant

OFFICE REPORT 1) Balance at credit of the subscriber on the date of application as bellow. i) Closing Balance as per statement for the year ii) Credit from ………………… To …………………… Subscription iii) Refund of advance/advances iv) Withdrawal during the period from ………………….. to …………………….. v) Net Balance 2) Amount of advance/advances outstanding Amount of advance taken on the date Balance outstanding Rs …………………………….. of sanction Rs………………. 3) Rule under which the request is covered …………………………………………………………

P/A APM, Accounts


CERTIFICATE OF INVESTMENT IN RURAL P.L.I. It is certified that Shri ___________________________________has invested Rs _____________________________________________Only in Rural P.L.I. /P.L.I. in the name of his spouse and himself during the period from April 0 to March 06details of which are given bellow.

Sl no

Name of Insurant Policy no Amount of monthly Premium

Total Amount invested during April….. …. to March………

Remarks

1

2 3

Date stamp Signature of PM/SPM


DECLARATION FOR REVIVAL OF RPLI/PLI POLICY

I ____________________________________ Holder of PLI/RPLI policy No

_________________ hereby declare that there has been no adverse change in my

personal or family history or my occupation,

Signature of Insurant __________________

Present Address ______________________

____________________________________

MEDICAL CERTIFICATE

I have carefully examined Shri/Smt.______________________________________

Holder of PLI/RPLI Policy No _____________________________________. I am

of this opinion that he/she is not suffering from disease likely to shorten &that

he/she had not suffered from any serious disease.

Signature ___________________________

Name & Address of Dr. ________________

____________________________


DEPARTMENT OF POSTS, INDIA.

APPLICATION FOR CLAIMING THE AMOUNT OF RPLI OF THE DEACEASED

INSURANT

1) Full Name of the Insurant :-

2) Number of Policy:-

3) Date of Maturity:-

4) Date of Death of Insurant:-

5) Cause if Death:-

6) Full name of claimant:-

7) Is the claimant a Nominee:-

8) Age of claimant:-

9) Claimant’s Relation and how it can be proved:-

10)What other relative to Insurant:-

11) Ref. To previous loan if any

Loan A/C no. Amt & Date of repayment

12) Description of document in support of claim

1) Insurance Policy Original

2) P.R. Book

3) Death Certificate

13) Name of PO where payment desired

Date:- Signature of the claimant

Certified that I have personally enquired into the truth of the above

statement and that the signature of the claimant is genuine.

Signature of enquiring officer


DEPARTMENT OF POSTS, INDIA

APPLICATION FOR CLAIMING MATURITY VALUE OF ASSURANCE POLICY

1. Policy Number:-

2. Date of maturity:-

3. Full Name of the insurant Shri/Smt.:-

4. Full address where sanction order to be sent:-

5. Name of the Post Office or address of the Account officer at which

premium for last 18 months has been paid in cash or recovered through

salary:-

6. Reference to previous Loan if any:-

1) Loan Account Number:-

2) Amount of payment:-

3) Date of payment:-

7. Name of Post office( with HPO )through which payment is desired:-

Documents forwarded here with: (Please tick mark)

1. Insurance Policy

2. Premium receipt book of disbursing officer certificate (for last 12 month )

Note: - Enclose original copies of all documents.

Date: - Signature of Claimant.



APPLICATION FOR CLAIMING SURRENDER VALUE OF ASSURANCE POLICY

1. Policy Number:-





salary:-

5. Reference to previous Loan if any:-

4) Loan Account Number:-

5) Amount of payment:-

6) Date of payment:-

6. Name of Post office( with HPO )through which payment is desired:-


1. Insurance Policy






APPLICATION FOR CLAIMING SERVIVAL PAYMENT OF

ANTICIPATED ENDOMENT ASSURANCE POLICY

1. Policy Number:-

2. Due Date of installment :-





salary:-


1. Insurance Policy






APPLICATION FOR LOAN ON THE SECURITY OF INSURANCE POLICY

1. Policy No.:

2. Amount of Loan required:

3. Full Name of insurant:

4. Full address (where sanction order to be sent) :

5. Name of post office or address of the Accounts Officer at which premium for

last 12 months has been paid in cash or recovered through salary:

6. Reference to previous loan, if any:

a) Loan account No:

b) Amount and date of repayment (enclose loan passbook)

i) Amount: Date:

7. Name of post office (with its HPO) through which payment is desired:

Documents forwarded herewith

1) Insurance Policy

2) Premium receipt Book or Disbursing officer’s certificate (last 12 months)

Date …………………………………… Signature of claimant


SB 10(B)

APPLICATION FOR TRANSFER OF _____________________ACCOUNT To, The Postmaster, _______________________________ _______________________________ I request that my Account No____________________ standing in the books of the _________________________ Post Office Savings Bank may be transferred to the books of the __________________________ Post Office Savings Bank. The passbook has the balance of Rupees__________________ (in words) ________________________________________________ . Three specimen signatures are given bellow. Dated: - Signature of Depositor. Specimen Signatures:- 1 __________________________ Countersigned Postmaster Date 1 __________________________ Countersigned Postmaster Date 1 __________________________ Countersigned Postmaster Date ------------------------------------------------------------------------------------------------------- Received application for transfer of _____Account No________________ in the name of _____________________________standing on the books of _________________ Post Office Saving Bank ( with the relevant passbook showing ) a balance of Rs ________( Rupees__________________________________ only) The entries in the Passbook have been checked and the passbook returned to the depositor. Date Stamp Signature of the Postmaster


Name of Post office_________________ SB 55

DEPARTMENT OF POSTS, INDIA Serial no………………… NO …………………… UNDER VOVERNMENT SAVINGS BANK AMENDMENT ACT, 1959 (in the case of on account which stands in the books of a sub or Branch Post Office. an application may be made through the Sub or a Branch Postmaster) To The Postmaster, ………………………….. (Through Postmaster ………………… S.O./B.O.) Under provisions of section 3 (1) of the Government Savings Bank (Amendment) Act, 1959, I, the depositor of Post Office Savings Bank A/C, No …………………… hereby nominate the person (s) who is the event of my death. Before closure of the above account, shall be entitled to the payment of the sum due on the above account, to the exclusion of all other persons I hereby declare that I have not made any nomination in respect of the above account. The passbook is enclosed.

Sl. No. Name of the nominee

Full address Date of birth of nominee in case of minor

______________________________________________________________________________ ACKNOWLEDGEMENT

To _______________________ ___________________________ Your application dated ……………………. Nomination in respect of the Savings Bank Account No …………………….. Standing at ………………….. H.O./S.O./B.O. H O. has been registered in this office under No …………. Dated ………………. In favor of persons mentioned on the reverse. The passbook is returned herewith Date Stamp Signature of Postmaster


As the nominee(s) at serial N0 (s) …………………. Is/are minor(s), I appoint Shri …………………………… (Name and full address) as the person to receive the sum due on the Savings Bank Account in the event of my death during the minority of the nominee(s). Address Yours faithfully, (In case of illiterate depositor Signature (Thumb impression if Father’s name should be given) illiterate) of depositor. Witness: Name and address Name and address N.B. In the case of illiterate depositor, the witness shall be persons whose signature(s) are known to the Post Office. Date Stamp Signature of Head/ Sub Postmaster. ______________________________________________________________________________

Sl. No. Name and address of nominee (s) Name and address of person

Appointed to receive payment in case

of minor nominee.

------------------------------------------------------------------------------------------------------------------------------------------


DEPARTME NT OF POSTS SB/CQE-4

APPLICATION FOR THE FACILITY OF MAKING WITHDRAWALS BY CHEQUES FROM SAVINGS BANK ACCOUNTS

Dated- To, The Post Office Savings Bank ____________________ Post Office. Please permit me/us to avail of the facility of making withdrawals by cheques and issue a cheque book for my/our Savings Account No __________________ standing open at your office. I/We hereby declare that I/We have read the conditions governing the issue of cheque books, and withdrawals by cheques from Post Office Savings Bank Accounts, as laid down in Rule 28-a of the Post Office Savings Bank Rule 1881, and that I/We accept all aforesaid conditions, and such amendments thereto as may be issued from time to time, as binding upon me/us. Names(s) of Depositor(s)_____________________________________________ (In Block Letters) The cheque book should be delivered/sent by registered post to :- Name ______________________________ Full address _________________________ ______________________________ ___________________________________ Signature of Depositor(s) ______________________________________________________________________________

TO BEFILLED IN BY POST OFFICE Account No ____________________ Cheque Book containing Cheques Ledger No _____________________Nos. ___________ To____________ issued. Noted in Ledger. Initials with date of Group Initials with date of cheque Book Head Clerk Head Clerk

CERTIFICATE OF IDENTIFICATION I _______________________________________do hereby certify that ___________________________________________ the depositor of Post Office Savings Bank Account No ________________ standing open at __________ Post Office is/are known to me and has/have signed in my presence. IDENTIFICATION ACCEPTED Signature of Identifier Address:-

ACKNOWLEDGEMENT OF DEPOSITOR(S) FOR CHEQUE BOOK

I/We hereby acknowledge the receipt of the cheque book containing cheques No __________________

to ________________ which I/We have counted and found correct and in proper serial order.

Signature of Depositor(s)


SB-83

Application for the purpose of availing the facility of automatic transfer from

SB Account to CTD/RD account

(To be filled in duplicate in case of Account stands at SO)

To,

The Postmaster,

----------. Post Office

Sir,

I/We ………………………………………………………………….. the

holder/holders of SB account No……………………… requested that a sum of

Rs…………….. (Rupees …………………………………………) may be debited

every month/every 6/12 months to the above mentioned account and the same be

credited to the under mentioned RD/CTD account/accounts standing in my/our

names. The name of my spouse/dependent child

Sl. No Name of Depositor Denomination Account No

This facility is not being availed of by me/us at present in respect of any

CTD A/c is in addition to the facility already granted to me/us in respect of CTD

Account No……………………….

I/we hereby declare that the conditions subject to which facility and

automatic transfer is permissible have been read by/to me/us and I/we accept all

the said conditions and all such amendments thereto as may be issued from time to

time as binding upon me/us. The passbooks of the SB and CTD accounts

concerned are enclosed.

Yours faithfully,


APPLICATION FOR DUPLICATE PASS BOOK.

1. Account No. & Type (TD/RD/CTD) Whether

Minor/public/Joint account etc. in respect

Of TD/CTD a/cs. state the category of the account. ~

2. Post Office at which account stands

(With the name of Head Office in brackets if the A/C is not at H.O.)

3. Name(s) of Depositor(s)

4. Name of father/husband or authority operating accounts.

i) Address of the Depositor(s) at the:

Time of opening of the Accounts.

ii) Present Address of the depositor(s):

5. Date of opening account & Office at

Which opened/if different from that Col.2

6. Date & particulars of the last transaction - :

in the account.

7. Balance at credit after the last transaction- :

8. Name of Post Office from which the account-:

was last transferred to the Office shown

at Col.2lwhere applicable.

9. Date& circumstances of loss of PBK &:

result of efforts made to trace it etc.

10. Whether loss was reported to Police &:

If so, with what result.

11. REMARKS.

The particulars given above are true to the best of my/our Knowledge & A

duplicate passbook may please be issued to me/us. I shall surrender the passbook;

if found.*Fee of 10/- has been paid by affixing postage stamps. .

*PLEASE SCORE OUT' IF EMPTION HAS BEEN GRANTED.

STATION:

Date

Signature(s) of Depositor(s)

Guardian/person of Authority

Operating A/C.

N.B.: If accurate information cannot be furnished in respect of Col.No.7 and .8

available particulars may be, given

PART- I


FOR OFFICE USE

1. Has the account been traced in the

ledger/binder, index to ledger cards/

S.O.SB ledger and do the particulars furnished by the applicant tally with

the record.

2. Does the signature(s) of the applicant (s) tally with specimen(s)

on record? If not has he/she been satisfactorily identified.

3. Has the register of undeliverable Passbooks in safe custody

at the H.O. been consulted & is the PBK available in the H.O.

or SBCO or lying undelivered in the Sub office.

4. Do you consider further enquiries called for as laid down in Rule 68

PO SB Man. Vo1. I.

5. If answer to 4.is yes, result, of enquiries made.

6. Recommendation regarding Issue of Duplicate Pass-Book.

DATE:

Signature of APM/Dy. PM/HO/SBWith designation stamp. (IN RESPECT OF APPLICATION RECEIVED FROM S.O.)

1. Have the Particulars of the A/C as given in the application verified

with H.O. record?

2. Has the register of undeliverable Passbook in safe custody at the H 0 been

consulted & is the PBK available in the H.O.?

3. Recommendation of APM/Dy. PM (SB) regarding Issue of the Duplicate

Passbook.. DATE:

Signature of APM/Dy. PM( SB)

H.O. with Designation stamps.

PART III ORDERS OF THE HEAD POSTMASTER

Duplicate Passbook may/may not be issued.

DATE: signature of the Postmaster With Designation stamps.

-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-

Receipt For Duplicate Passbook

Received Duplicate Passbook of Account No ……………………………… with

balance of Rs………………. Rupees

………………………………………………………………………………..)

DATE STAMP OF H.O. SIGNA'T'URE OF1I'HE DEPOSITOR (s}


BINDER TOP SHEET

Sl. No of Binder- Revised No. after re-groping on _________________ Ledger cards of Account Numbers in binder:- From ____________________ to __________________________ From ____________________ to __________________________ From ____________________ to __________________________ From ____________________ to __________________________ From ____________________ to __________________________ From ____________________ to __________________________

Detail of Accounts closed or closed on transfer.

Sl. No Account Nos. Closed/Transferred on

Signature of P.A.

Signature of SPM


SB.71 RD LEDGER CARD NAME OF DEPOSITOR---------------------------- A/C NO-------------------- FULL ADDRESS------------------------------------ TYPE--------------YEARS --------------------------------------------------- INSTALMENT----------- NAME OF NOMINEE -------------------------- DATE OFOPENING---------------- DATE OF BIRTH-------------------------------- MONTH

DATE OF DEPOSIT

AMOUNT

BALANCE

INITIAL

MONTH

DATE OF DEPOSIT

AMOUNT

BALANCE INITIAL

L.A. P.M. L.A. P.M

JAN JAN FEB FEB MARCH MARCH APRIL APRIL MAY MAY JUNE JUNE JULY JULY AUG AUG SEPT SEPT OCT OCT NOV NOV DEC DEC TOTAL TOTAL MONTH

DATE OF DEPOSIT

AMOUNT

BALANCE

INITIAL

MONTH

DATE OF DEPOSIT

AMOUNT

BALANCE INITIAL

L.A. P.M. L.A. P.M

JAN JAN FEB FEB MARCH MARCH APRIL APRIL MAY MAY JUNE JUNE JULY JULY AUG AUG SEPT SEPT OCT OCT NOV NOV DEC DEC TOTAL TOTAL


MONTH

DATE OF DEPOSIT

AMOUNT

BALANCE

INITIAL

MONTH

DATE OF DEPOSIT

AMOUNT

BALANCE INITIAL

L.A. P.M. L.A. P.M

JAN FEB MARCH APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC TOTAL MONTH

DATE OF DEPOSIT

AMOUNT

BALANCE

INITIAL

PARTICULARSOF WITHDRAWAL AND REPAYMENT PAYMENTS MADE ON MATURITY

L.A. P.M.

JAN

FEB MARCH APRIL MAY JUNE JULY AUG

SEPT

OCT

NOV

DEC

TOTAL


M.I.S. INCENTIVE BIL OF ………………………………. S. O. FOR THE MONTH OF 2008

DATE

NO OF TRANSACTIONS

NAME OF SPM

RATE OF INC

AMOUNT OF INC. OF SPM

NAME OF P,A.

RATE OF INC

AMT OF INC. OF P/A

TOTAL AMOUNT OF INCENTIVE

CLD

WDL

NEW TOTAL

- 50 - 1 -

- 50 - 1 -

- 50 - 1 -

- 50 - 1 -

- 50 - 1 -

- 50 - 1 -

- 50 - 1 -

- 50 - 1 -

- 50 - 1 -

- 50 - 1 -

50 - 1 -

- 50 - 1 -

- 50 - 1 -

- 50 - 1 -

- 50 - 1 -

- 50 - 1 -

- 50 - 1 -

- 50 1 -

- 50 - 1 -

- 50 - 1 -

- 50 - 1 -

- 50 1 -

- 50 1 -

- 50 1 -

- 50 1 -

- 50 1 -

- 50 1 -

-


SUMMERY

CERTIFIED THAT:- The official for whom incentive is claimed in the bill has actually earned it by working or rendering working hours of 25% of the normal duty out put. The incentive claimed in the bill has been checked with the initial record and found correct. The incentive is claimed at rate sanctioned by the competent authority. The incentive has been taken into account in the calculating the income tax due from the government servant noted in this bill. The official for whom incentive are claimed have not been granted any compensatory off in lieu thereof. The incentive has been paid to the person to whom due and employment of officials mentioned in this bill has been made only in avoidable exceptional and emergent cases. Each of the officials for whom incentive is claimed in this bill will not receive total amount of such incentive exceeding Rs. 500/- in case of Postal Asstt and Rs 250/- in the case of supervisor during the current month. Ledger posting work of tractions noted in this bill has been completed. Place: - Date:-

SL No

Name Of Official Designation No Of Transaction

Rate Of Incentive

Amount Of Incentive

Remarks


BALANCE REPORT FOR TRANSFER OF …………….. ACCOUNT 1. ACCOUNT NO:-

2. DATE OF OPENING:-

3. NAME OF DEPOSITOR: -

4. TYPE OF ACCOUNT:-

5. DENOMINATION:-

6. AMOUNT OF MONTHLY INTEREST:-

7. BALANCE:-

8. PAID UPTO:-

9. NO OF DEFAULTS:-

10. AMOUNT OF WITHDRAWAL:-

11. NOMINATION:-

Date Stamp Signature of Sub Postmaster.

No/ /20 -20 Dated at …………………….. the ………………………………….

To,

The Postmaster/Sub Postmaster,

……………………………………………………………..

…………………………………………………………………

Signature of Sub Postmaster.


APPLICATION FOR TRANSFER OF MONTHLY INTEREST OF MIS ACCOUNT TO THE SAVINGS

BANK ACCOUNT

FROM,

…………………………………………………………….

…………………………………………………………………….

………………………………………………………………………………

To,

The Postmaster/Sub Postmaster,

……………………………………………. Post office.

Subject: - Application for credit of M.I.S. monthly interest to Savings Bank Account.

Respected Sir,

I/We am/are the depositor(s) of the Monthly Income Scheme Accounts, details of which given

bellow; hereby request to your honour to draw the amount of monthly interest from my/our Monthly

Income Scheme Account(s)and credit the same to my/our Savings Bank Account No ………………………….

standing in the books of …………………………………… Post Office Savings Bank.

I/We hereby authorize to your honour to withdraw the amount from my/our account whichever

is credited excess (if any).Passbooks of both account (MIS an SB) are enclosed herewith for passing the

necessary remarks.

SL.No

M.I.S. Account No

Name of Depositor(s)

Due Date Of Interest

Amount of monthly interest

Savings Bank Account No

Remarks

Yours Faithfully,


BILL FOR CLAIM OF COMMISSION BY GDS SUB/BRANCH

POSTMASTERS FOR DEOSITS IN SAVINGS ACCOUNTS

Name of BO/EDSO …………………………………….. Year ……………………………………

Month Deposit in cash

Deposit by

cheque

Total Deposit

With-drawal at BO/EDSO

With- drawal at account

office

Total with-

drawal

Net Deposit

Remarks

April

May

June

July

August

September

October

November

December

January

February

March

Total

Net accretion during the year (In words and figures) ……………………………………………

……………………………………………………………………………………………………………………………….

Total amount of commission claimed (In words and figures) …………………………………

……………………………………………………………………………………………………………………………….

Date …………………………….. Signature of GDS BPM/SPM

Verified for payment of Rs ……………………………………………………………………………………

Date ……………………………………. Signature of PM/SPM

Passed for Rs ……………………………………………………………………………………………………


Received the amount specified above Rs. ……………………………………………………………

Signature of GDS BPM/SPM


BILL FOR CLAIM OF COMMISSION BY GDS SUB/BRANCH

POSTMASTERS FOR DEOSITS IN T.D. ACCOUNTS

Name of BO/EDSO …………………………………….. MONTH ……………………………………

Time Deposit

Account No

Category Amount of Deposit

Rate of commissio

n

Amount of commission

claimed

Remarks

Total

Total amount of commission claimed (In words and figures) …………………………………

……………………………………………………………………………………………………………………………….

Date …………………………….. Signature of GDS BPM/SPM

Verified total deposit for Rs ………………………………………………………………………………

…… ……………………………………………………………………………… ………………………………………


Passed for payment Rs ……………………………………………………………………………………….


Received the amount specified above Rs. ……………………………………………………………

Signature of GDS BPM/SPM


SB 13(a)

APPLICATION FOR THE TRANSFER OF POST OFFFICE TIME DEPOSIT ACCOUNT(S) AS SECURITY

Note 1:- Transfer of Time Deposit Accounts as security to an individual, association, institution,

private company, a body registered as a society under any law for the time being in force, a firm

registered under Indian Partnership Act 1932 (9 of 1932) is prohibited.

Note 2:- Time Deposit Account opened on behalf of minor can be transferred only if the

guardian certifies that the minor is alive and the transfer is for the benefit of the minor.

To The POSTMASTER, ………………………………………… Sir, I/We ………………………………………………………………………………. (Name in Block Letters) am/are required to deposit an amount of Rs …………….. as security to the President of India/ Governor of ………………………. State/Reserve Bank of India/ Scheduled bank/Co-Operative Bank/ Co- Operative Society/Corporation/Government Company/Local Authority. I/We therefore request you to transfer the under mentioned Post Office T.D. account(s) of which I am/We are the holder (s) as security to ……………………………………………………………………… President of India/Governor of State/Reserve Bank of India/ Scheduled bank/Co-Operative Bank/ Co-Operative Society/Corporation/Government Company/Local Authority vide declaration of the pledgee reverse this form. I/We ………………………………………………………………………………………………. hereby declare that on the transfer of the under mentioned Post Office Time Deposit Account(s), the transferee, (pledgee) shall, until it is/ these are re-transferred or released to me/us, be deemed to be the holder of the Account(s). I/We also agree that the amount of the account(s) shall be withdrawn by the pledgee when the security has been forfeited.

Particulars of Time Deposit Account(s)

Sl. No.

Type of Account

Account No. Date of opening Name of office where account stands

Balance Name of Minor if account stands in the name of minor

Address …………………………………….. Yours faithfully, …………………………………………………… …………………………………………………… Signature of Transferor(s)


REVERSE DECLARATION BY TRANSFEREE (PLEDGEE)

I ………………………………………………………….. (Official Designation of Government Officer) hereby accept the savings certificates paricularised on the obverse of this form as security on behalf of the President /Governor of State of ……………… In his official capacity and hereby certify that I ……………………………………………………… (Official Designation of Government officer) am duly authorised under article 299 of the constitution vide Notification No ……………… dated …………… by the Government of India in the …………….. Ministry of …………………… /State Government ………………………… and to execute such instruments or deeds on behalf of the President of India /Governor of State. I ………………………………………………………………………. Official designation of officer of the State/Reserve Bank of India/ Scheduled bank/Co-Operative Bank/ Co-Operative Society/Corporation/Government Company/Local Authority ……………………………………. And hereby certify that I am duly authorized to accept or release of to execute such instruments or deeds on behalf of the State/Reserve Bank of India/ Scheduled bank/Co-Operative Bank/ Co-Operative Society/Corporation/Government Company/Local Authority ……………………………………. Date ………………………………… Signature of the transferee (Pledgee) Official Designation of the Officer

accepting the pledge on behalf of the pledge(Stamp and Seal)

Serial No of Head /Sub Office

To be filled in by the Postmaster of Head /Sub Post office

Sl. No.

Type of Account

Account No.

Name of office where account stands

Date of pledging letter of authority

No and Date of

releasing the

pledge

Date of Payment

Initials of the Postmaster

DATE Signature of Sub/Head Postmaster

Oblong M.O. Stamp of Head/Sub Post Office


L.I.35

Application for the issue of Duplicate Savings Certificates in lieu of the loss, theft, destruction,

mutilation of defacement of the Savings Certificates in the custody of the holder.

To The Postmaster, _________________ Sir, I/we _______________________________________________________(Name in Block Capitals) request you to issue Duplicate Certificates lieu of lost/destroyed/stolen Savings Certificates details given bellow of which I am/we are the holder(s). I am/we are hereby furnishing the following information which is true to the best of my knowledge and belief:- i) PARTICULARS OF CERTIFICATES: A) Name of issue of the certificates: B) Serial numbers of certificates; C) Date of issue; D) Denominations: E) Name of the office of issue: F) Type (Single/Joint-A/Joint-B): G) Registration No: ii) How the above noted particulars of the certificates could be ascertained. iii) Whether the identity slip was issued, if yes, the same is to be enclosed. iv) Circumstances in which the theft/loss/destruction occurred. v) Date of furnishing first report of the certificates to the Police Station / Post Office of registration. vi) Result of police enquiries Date________________ Signature of holder(s) Name _______________________ Address______________________ ___________________________ CERTIFICATE OF IDENTIFICATION I _________________________________do hereby certify that Shri/Smt.________ ________________________________________is/are known to me and has signed this application in my presence. Date______________ Signature of Identifier Full Address Holder(s) known to me /identification accepted. Date_______________ Signature of Postmaste


Report on application for duplicate in lieu of lost/destroyed certificates detailed overleaf.

1. Name of investor in full. (In Block Capital) 2. Serial no of P.O. Certificate(s). (Including Index & Block Letters) Denomination. Office of Issue Date of Issue CERTIFIED That the original application for purchase/transfer has been checked. That the signature has been found to agree with that on record That the particulars of the certificate are correct. That remark regarding the loss/destruction of the savings certificate has been made in the remarks column of the application for purchase or transfer of the certificates against the entry of the certificate under the postmaster’s initials. That the fee of Rs___________ for the issue of the duplicate certificate has been recovered and credited under unclassified receipts on______________ That the certificate(s) stand(s) still undischarged as verified from the application for purchase/transfer. The identity slip was/was not issued; and it has been obtained from the holder and pasted to the original application for purchase/it is also reported to have been lost. That the holder is known to me/identified by ____________________________________ who is known to me. That the indemnity bond referred to in rule 43 of P.O.S.B. Manual Volume II has been obtained from the holder and kept on record. That the certificate(s) is/are not attached by Court of Law. Date___________________ Postmaster/Sub Postmaster Orders of Head Postmaster Date____________________ Head Postmaster


No Co 61

Department of Posts, India (Rule20 (14) of the revised Chapter 9 of the P. & T Manual Vol. VI)

BOND OF INDEMNITY

(To be executed by the holder of …………………. Certificate(s) at the time of discharge of

original certificate(s) or issue of duplicate certificate(s) in lieu of lost, misplaced; spoilt,

destroyed, defaced or mutilated certificate(s) where original application for purchase is missing.)

Know all men by these, presents that I/We (A) …………………………

Holder/Holders of the……………. Certificate(s) am/are held and firmly bound up to the

President of India (hereinafter called the President) in the sum of Rs…………. . . . . . . .. . . . .

.Together with all costs, charges and damages as hereinafter mentioned- to be paid to the

president, his successors or assignees/for which payment well and truly to be made I/We bind

myself /ourselves, my/our heirs, executors and administrators and representatives jointly and

severally firmly by these presents Sealed with my/our seal dated this. . . . . . . . . . . . . . . . . . . . . . .

. day of ……………………… in the year Two thousand ……………………… .

Whereas on . . . . . . . . . . . . day of. . . . . . . . . . . . . . . . . . . . . . ..The said (A)

……………………………………. purchased from………………. Post Office certificate(s)

numbered... . . . . . . . . . . , of the denomination(s) of Rs…… .. . . . . . . .. . ... . . . . ...

(Respectively) and obtained/ did not obtain identity slip(s) in respect of the above mentioned

certificate (s).

. And whereas the original application for purchase of the aforesaid certificate(s) is

missing from the records of the Post Office and whereas the said (A)

……………………………………………..has/have represented to the Postmaster

…………………. P.O. that the aforesaid certificate(s) and the identity slip(s) has/have been lost

or misplaced or spoilt or -destroyed or defaced or mutilated while in the custody of the said (A)

…………………. . .

…………………..

And whereas the said (A) ………………………………….. has/have further represented

to the Postmaster... . . .. . . . . . . . . . . . . . . . . . . . .. P.0. that the aforesaid certificate(s) and the

Identity slip(s) have not been .transferred, sold pledged or deposited or otherwise parted with by

way of security or otherwise and that the aforesaid certificate(s) has/have-not been attached by

any Court of Law.

2

And whereas the said (A) ……………………………….... declares that, he/they/is/are

solely entitled to receive the money due on the above certificate(s) and has/have applied for the

discharge of original certificate(s) /issue of a duplicate certificate (s) in respect of the aforesaid

certificate (s) and whereas the Postmaster (Gazzetted) ………………………. /(Head of the

Postal Division) has on behalf of the President of India acceded to the said application on

condition of the said (A) . . . . . . .. . . . . . . . .. executing such bond as above written and whereas

the said (A) has agreed to execute the said bond with such condition as is hereunder written.

Now the condition (s) of the above-written bond is such that if the said

(A…………………………………… his/their heirs, executors, administrators and

representatives do and shall and when required so to do pay to the President, his successors or

assignees the sum of Rs …………. together with all costs as between attorney and, client and all


charges losses damages and expenses that shall or may have been Incurred by or occasioned to

the President , his successors or assignees or any of the

servants of the Government by reasons of or consequent upon a duplicate certificate(s) in respect

of the aforesaid certificate(s) being issued, and further if the said

(A……………………………… his I their heirs, executors. administrators and representatives,

shall and do from time to time and at all times hereafter well and sufficiently save , defend ,

keep, harmless and indemnified the President , his successors, and assigns and officers and

servants of the Government and each and every of them, from and against all and all manner of

action and actions suit and suits and other legal proceedings, costs, charges, damages and

expenses whatsoever which shall or may at any time or times, hereafter be bought, commenced

or sent by any person or body corporate or whomsoever or whatsoever against the President, his

successors or assignees or any of the officers or servants of the Government for or on account of

in respect of or by reason of a duplicate certificate(s) in respect. of the aforesaid certificate(s)

being issued THEN the above written bond shall be void and of no effect otherwise the same

shall be and remain in full force and virtue provided always and it is hereby expressly declared

and agreed by the said (A) …………………… and to the President, his successors and assignees

that in defense and prosecution of any action suit or other legal proceedings referred to in the

foregoing, clause for Indemnity or maintained in virtue thereof the President. his successors or

assignees shall not be responsible or accountable to the said

(A)………………………………………….. his or either of them their or either of their heirs

executors administrators and representatives for any act, omission, or mistake. in the defense or

prosecution of such action , suit or other leg, al proceedings and that in the defense or

prosecution of such action, suit or other .legal proceedings, the President his successors or

assignees and his and their officers and servants shall be required to do such acts and take such

steps only as shall in that behalf be approved, and advised by the Law Officers of the

Government of India.

This bond is being executed at the request and cost of the Government of India who has

agreed to pay and bear tile Stamp Duty.

Signed, sealed and delivered by the above' named (A) in the presence of

(Two witnesses to sign here)

1…………………………………….

2 …………………………………….

ACCEPTED

Station…………………… Signature ……………………………………….

Date……………………… *Designation …………………………………….

For and on behalf of the President of India.

*by a Gazzetted Officer of the India Post and Telegraphs Department, subject to such conditions

as may be laid down by the Posts and Telegraphs Board vide item 4 (i) of part XXIII of the

Government of India in the Ministry of Law Notification No. G S R. 585 Dated 1st February,

1966.


Form No. NC 54 (A)

DEPARTMENT OF POST

BOND OF INDEMNITY

[To be executed by the holder of certificate (s) with one surety at the time of

the issue of a duplicate certificate (s) in lieu of lost, misplaced, spoilt or

mutilated certificate (s)]

Know all men by these present that I/We (A)………………………………

(holder/holders) of the ……………………… and (B) ……………………………

Surety are held and firmly bound unto the President of India (hereinafter called the

President) in the sum of Rs…………………… together with all costs, charges and

damages as hereinafter mentioned, to be paid to the President, his certain attorneys,

successors or assigns for which payment well and truly to be made we bind

ourselves, our heirs, executors and administrators and representatives jointly * (and

every three of us bind ourselves, our heirs, executors and administrators and

representatives jointly and every two of us bind ourselves, our heirs, executors,

administrators and representatives) and each of us binds himself, his heirs,

executors, administrators and representatives severally firmly by these presents

sealed with our respective seals dated the ……. day of …………………….. In the

year two thousand and ………………………..

* To be altered as required

Whereas on day of the said (A) ………………………………………….

purchased from …………………………… Post Office, a …………….............

Certificates (s) numbered ………………………………… of the denomination of

Rs…………………… (Respectively) and obtained/did not obtain identity slip (s)

in respect of the above mentioned certificates.

And whereas the said (A)……………………………………………….

has/have represented to the Postmaster …………………………. Head Post Office

that the aforesaid certificates and the identity slip (s) have been lost or misplaced

or spoilt or mutilated while in the custody of the said (A) ………………………..

And whereas the said (A) …………………………………………………

has/ have further represented to the Postmaster……………………………… Head

Post Office that the aforesaid certificates(s) and the identity slip have not been

transferred, sold, pledged or deposited or otherwise parted with by way of security

or otherwise and

Whereas the said (A) ……………………………………………… declares

that he/they is/are solely entitled to receive the money due on the above certificates

and has/have applied for the issue of a Duplicate Certificates (s) in respect of the

aforesaid certificate (s); and


Whereas Postmaster ……………………………… Head Post Office has on

behalf of the President acceded to the said application on condition of the said (A)

…………………………… and one sufficient surety executing such bond as above

written and the said (B) …………… …..………………… has accordingly as such

surety agreed to execute the said bond with such condition as is hereunder written.

Now the condition of the above written bond is such that if the said (A)

…………………………. his/their heirs, executors, administrators and

representatives do and shall when required so to do pay to the President, his

successors or assigns the sum of Rs. ………………….. Together with all costs as

between attorney and client and all charges, losses, damages and expenses that

shall or may have been incurred by or occasioned to the President, his successors

or assigns or any of the servants of the Government by reasons of consequent upon

a Duplicate Certificate (s) In respect of the aforesaid certificates being issued and

further if the said (A) ………………………………….and (B) …………………

…………………….. their heirs, executors, administrators, representatives, shall

and do from time to time and at all times hereafter well and sufficiently save,

defend, keep harmless and indemnified the President, his successors and assigns

and officers and servants of the Government and each and every of them from and

against all and all manner of action and actions, suit and suits and other legal

proceedings, costs charges, damages and expenses whatsoever which shall or may

at any time or times thereafter be brought, commenced or sued by any person or

body corporate whomsoever or whatsoever against or happen or be occasioned to

the President, his successors or assigns or any of the officers or servants of the

Government for or on account of in respect of the aforesaid certificate (s) being

issued. THEN the above written bond shall be void and of no effect otherwise the

same shall be and remain in full force and virtue PROVIDED ALWAYS and it is

hereby expressly declared and agreed by the said (A) ……………………………

and (B) …………………………………….. with and to the President, his

successors and assigns that in defence and prosecution of any action, suit or other

legal proceedings referred to in the foregoing clause for indemnity or maintained in

virtue thereof the President, his successor or assigns shall not be responsible or

accountable to the said (A) ………………………………………and (B) …………

……………………………… or any or either of them, their or either of their

heirs, executors, administrators and representatives for any act, omission or

mistake in the defence or prosecution of such action, suit or other legal

proceedings and that in the defence or prosecution of such action, suit or other

legal proceedings the President, his successors, or assigns and his and their officers

and servants shall be required to do such acts and take such steps only, as shall in


that behalf be approved and advised by the Law Officers of the Government of

India.

PROVIDED FURTHER that the liability of the surety hereunder shall not be

impaired or discharged by reason of time being granted or any forbearance act or

omission of the President or any person authorized by him (whether with or

without the consent or knowledge of the surety) nor shall it be necessary for the

President to sue Shri……………………………………… before suing the surety

for amounts due hereunder.

Signed, sealed and delivered by the above name

seal

(A) …………………………………………..

In the presence of (two witnesses to sign here)

1)

Seal

2)

Signed, sealed and delivered by the above-name (B)

in the presence of (two witnesses to sign here)

1)

2)

ACCEPTED

Station Signature

Date *Designation

For and on behalf of the President of India

* Under clause (i) of item 4 of Part XXIII of the Government of India in the

Ministry of Law Notification No. GSR 585 dated 1.2.1966, Postmaster

(Gazzetted)/Senior Supdt. Of Post Offices/ Supdt. Of Post Offices is competent to

sign this bond for and on behalf of the President of Ind


Form No. NC 54 (B)

DEPARTMENT OF POSTS

BOND OF INDEMNITY

[To be executed by the holder of a certificate with a Bank's Guarantee at the time

of the issue of a duplicate certificate (s) in lieu of lost, misplaced, spoiled or

mutilated certificates]

KNOW all men by these present that I/We (A)……………………………

(holder/holders) of the …………. certificate (s) am/are held and firmly bound up

to the President of India (hereinafter called the President) in the sum of Rs………

together with all costs, charges and damages as hereinafter mentioned to be paid to

the President, his certain attorneys, successors or assigns for which payment well

and truly to be made I/ We bind myself/ourselves, my/our heirs, executors and

administrators, and representatives, jointly *(and every three of us bind ourselves,

our heirs, executors, administrators and representatives jointly and every two of us

bind ourselves, our heirs, executors, administrators, and each of us binds himself,

his heirs, executors, administrators and representatives severally firmly by these

presents sealed with my/our seal dated this day……………….. Of ……………..

in the year two thousand and ………………

* To be altered as required.

WHERE AS on …………… day of ………………………………. the said

(A)…………………………………………….. Purchased from …………………

Post Office, a certificate (s) numbered……………………………… of the

denomination (s) of Rs………… (Respectively) and obtained/did not obtain

identity slip (s) in respect of the above-mentioned certificates.

AND whereas the said (A) …………………………………………has/have

represented to the Postmaster ……………………… Head Post Office that the

aforesaid certificates and the identity slip(s) has/have been lost or misplaced or

spoilt or mutilated while in the custody of the said (A) …………………………

AND whereas the said (A) ………………………………………… has/have

further represented to the Postmaster ………………………. Head Post Office that

the aforesaid certificate (s) and the identity slip (s) have not been transferred, sold,

pledged or deposited or otherwise parted with by way of security or otherwise and

WHEREAS the said (A) ……………………………………………..

declares that he/they is/are solely entitled to receive the money due on the above

certificates and has /have applied for the issue of a duplicate certificate (s) in

respect of the aforesaid certificate (s); and

WHEREAS Postmaster …………………Head Post Office has on behalf of

the President acceded to the said application on condition of the said (A) ………


………………………………..executing such bond as above written and

furnishing a Bank's Guarantee as endorsed on this Bond and whereas the said (A)

…………………………………………has agreed to execute said bond with such

condition as is hereunder written.

NOW the condition of the above written bond is such that if the said (A)

……………………………………. his/their heirs, executors, administrators and

representatives do and shall when required so to do pay to the President, his

successors or assigns the sum of Rs…………………together with all costs as

between attorney and client and all charges, losses, damages, and expenses that


or assigns or any of the servants of the Government by reasons of or consequent

upon a duplicate certificate (s) in respect of the aforesaid certificates being issued,

and further if the said (A) ……………………………………………….. his/their

heirs, executors, administrators and representatives, shall and do from time to time

and at all times hereafter well and sufficiently save, defend, keep harmless and

indemnified the President, his successors and assigns and officers and servants of

the Government and each and every of them from and against all and all manner of

action and actions, suit and suits and other legal proceedings, costs, charges,

damages and expenses whatsoever which shall or may it any time or times

hereafter be brought, commenced or sued by any person or body corporate

whomsoever or whatsoever against or happen or be occasioned to the President, his

successors or assigns of any of the officers or servants of the Government for or on

account of in respect of or by reason of a duplicate certificate (s) in respect of the

aforesaid ce11ificate(s) being issued THEN the above written bond shall be void

and of no effect otherwise the same shall be and remain in full force and virtue

PROVIDED ALWAYS and it is hereby expressly declared and agreed by the said

(A) …………………………………………………. with and to the President, his

successors and assigns that in defence and prosecution of any action, suit or other

legal proceedings referred to in the foregoing clause for indemnity or maintained in

virtue thereof the President, his successors or assigns shall not be responsible or

accountable to the said (A) his/or either of them, their or either of their heirs,

executors, administrators and representatives for any act, omission or mistake in

the defence or prosecution of such action, suit or other legal proceedings and that

in the defence or prosecution of such action suit or other legal proceedings the

President, his successors or assigns and his and their officers and servants shall be

required to do such acts and take such steps only, as shall in that behalf be

approved and advised by the Law Officers of the Government of India.


Signed, sealed and delivered by the above-named

(A) ………………………………………. in the presence of

(Two witnesses to sign here)

1)

2)

BANK'S GUARANTEE

In consideration of the President issuing a duplicate certificate in respect of the

aforesaid certificate to the said (A)………………………………… as stated in the

above Bond we (name of the Bank) hereby guarantee to the President, his

successors or assign the payment of the sum of Rs. together with all costs as

between attorney and client and all charges, losses and damages and expenses that


or assigns or any of the servants of government by reasons of or consequent upon a

duplicate certificate in respect of the aforesaid certificates being issued as referred

to in the above Bond. Provided that the liability of the bank hereunder shall not be

impaired or discharged by reason of time being granted or any forbearance, act or

omission of the President or any person authorized by him (whether with or

without the consent or knowledge of the Bank) or any other matter or thing

whatsoever under the law relating to sureties shall, but for this provision, have the

effect of so releasing the Bank from its such liability nor shall it be necessary for

the President to sue Shri………………………………… before suing the bank for

amounts due hereunder.

Dated this: day of …………………………….. 200

(To be executed by the Bank in the manner provided by its Articles of

Association) ACCEPTED

Station ………………………….

Date …………………………….

Signature

*Designation


* Under clause (i) of item 4 of Part XXIII of the Government of India in the

Ministry of Law Notification No. GSR 585 dated 1.2.1966, Postmaster

(Gazzetted)/ Senior Supdt. Of Post Offices/ Supdt. Of Post Offices is competent to

sign this bond for and on behalf of the President of India.

seal


CERTIFICATE OF HOLDING OF NSC

Certified that the following Savings Certificates hold by Shri / Shrimati

__________________________ are registered in this office.

Sl No No and Type of

Certificate

Date of issue

Denomination Registration No

Remarks

Date Stamp Signature of PM/SPM

CERTIFICATE OF DISCHARGE OF NSC

Certified that Shri / Shrimati _____________________________

Has discharged following National Savings certificates at this office.

Sl. no Sl. Nos. of Certificates

Denomination Maturity value of

certificate

Registration No

Remarks

Date Stamp Signature of PM/ SPM


APPLICATION FOR DISCHARGE OF SAVINGS CERTIFICATE AT THE OFFICE OTHER THE OFFICE OF REGISTRATION

To, The Postmaster/Sub Postmaster, ______________ , District :- Raigad Subject: - Application for discharge of Savings certificates at the office other than the office off registration. Respected Sir, I have purchased following KVPs/NSCs at _______________ post office. I wish to discharge those KVPs/NSCs at your office; details of KVPs/NSCs are given bellow.

Sl No

Sl No of KVPs/NSCs

Denomination

Date of Purchase

Registration No

Remarks

1

2 3

4

Thanking You, Yours faithfully, (Name and Address of Purchaser) To, The Superintendent of Post Offices, Raigad Division, Alibag, 402 201. No- / /20 - Dated at the- / /20 Submitted for onward transmission to the office of registration.


N.C.-10

Advice of payment of certificate registered at____________ Head_ post office Sub under ___________________H.O.* and paid at______________ Head_ post office under Sub ___________________ H.O. on the 20

No of certificate

Denomination Date of issue Date of last transfer

Name of holder

Remarks

Date stamp of office of payment No. date Forwarded to the Postmaster Sub/Head Postmaster ------------------------------------------------------------------------------------------------------------------------- N.C.-10 Advice of payment of certificate registered at____________ Head_ post office Sub under ___________________H.O.* and paid at______________ Head_ post office under Sub ___________________ H.O. on the 20

No of certificate

Denomination Date of issue Date of last transfer

Name of holder

Remarks

Date stamp of office Of payment No. date Forwarded to the Postmaster


NC-41

APPLICATION FOR THE TRANSFER OF POST OFFICE SAVINGS

CERTIFICATES AS SECURITY

Registration No …………………….. Serial No and Date of original Application for purchase Of Certificates. To The POSTMASTER, ………………………………………… Sir, I/We ………………………………………………………………………………. (Name in Block Letters) am/are required to deposit an amount of Rs …………….. as security to the President of India/Governor of ………………………. State/Reserve Bank of India/ Scheduled bank/Co-Operative Bank/ Co-Operative Society/Corporation/Government Company/Local Authority. I/We therefore request you to transfer the under mentioned Post Office Savings Certificates/Duplicate Certificates of which I am/We are the holder (s) as security to ……………………………………………………………………………………….. President of India/Governor of State/Reserve Bank of India/ Scheduled bank/Co-Operative Bank/ Co-Operative Society/Corporation/Government Company/Local Authority vide declaration of the pledgee reverse this form. I/We ………………………………………………………………………………………………. hereby declare that on the transfer of the under mentioned Post Office Savings Certificates/Duplicate certificates, the transferee, (pledgee) shall, until it is/ these are re-transferred or released to me/us, be deemed to be the holder of the certificate(s). I/We also agree that the certificate(s) shall be encashable by the pledgee when the security has been forfeited. Particulars of Certificates/Duplicate Certificates

No and Date of letter from the pledge calling for security

Sl No of Certificates

Date of Issue of certificates

Name of office of issue

Registration No of certificates

Denomination of certificates

Total No of Certificates ………………………………. Address …………………………………….. Yours faithfully, …………………………………………………… …………………………………………………… Signature of Transferor(s) (Holders of Certificate(s)


REVERSE

DECLARATION BY TRANSFEREE (PLEDGEE) I ………………………………………………………….. (Official Designation of Govern- ment Officer) hereby accept the savings certificates paricularised on the obverse of this form as security on behalf of the President /Governor of State of ……………… In his official capacity and hereby certify that I ……………………………………………………… (Official Designation of Government officer) am duly authorised under article 299 of the constitution vide Notification No ……………… dated …………… by the Govern- ment of India in the …………….. Ministry of …………………… /State Government ………………………… and to execute such instruments or deeds on behalf of the President of India /Governor of State. I ………………………………………………………………………. Official designation of officer of the State/Reserve Bank of India/ Scheduled bank/Co-Operative Bank/ Co-Operative Society/Corporation/Government Company/Local Authority ……………………………………. And hereby certify that I am duly authorized to accept or release of to execute such instruments or deeds on behalf of the State/Reserve Bank of India/ Scheduled bank/Co-Operative Bank/ Co-Operative Society/Corporation/Government Company/Local Authority …………………………………….

Date ………………………………… Signature of the transferee (Pledgee)

Official Designation of the Officer accepting the pledge on behalf of

the pledge(Stamp and Seal)

Serial No of Head /Sub Office

To be filled in by the Postmaster of Head /Sub Post office

Sl no of certificates with Date

of issue

Deno- mination

Office of issue

Date of Pledging of Certificates

No and date of letter of

authority the

releasing the pledge

Date of Discharge

Initials of the Post- Master/

Sub Postmaster

DATE Signature of Sub/Head Postmaster

Oblong M.O. Stamp of Head/Sub Post Office


NC-34

DEPARTMENT OF POSTS

APPLICATION OF TRANSFER OF SAVINGS CERTIFICATES

FROM ONE PERSON TO ANOTHER (EXCEPT AS PLEDGE)

[A separate application is required for each series of certificate]

To

Postmaster,

.......................................

Sir,

I/We ............................................................... ..(Name in block capital of

person/institution, etc.) Request you to transfer the under mentioned Savings

Certificate(s)*/Duplicate Certificate(s)* held in my/ our*name(s) in the name of

the minor (*) Shri/Kumari..................................................... to ……………....

………………………. under the Rules governing the Certificates

* Delete whichever is not applicable.

* I/We certify that the minor is alive and the transfer is in his/her interest.

* Strike out if the Certificate is not in the name of the minor.

* Circumstances in which transfer is sought..............................................................

………………………………………………………………………………………

* Only if applied within one year from the date of issue.

2. Particulars of Savings Certificates/Duplicate Certificates

Series and Sl. No.

of Certificates

Denomination

Date of Issue

3. Fee of Rs ………………………. is paid herewith.

Date ...............................

Address .....................

Yours faithfully,

……………………………............

Signature of transferor(s)

For certificate(s) held by a minor

to be signed by the parent/guardian.


DECLARATION BY TRANSFEREE(S)

1. I/We ……………………………………………………………………… hereby

agree to the transfer of above mentioned certificate( s) in my/our name( s) and to

abide by the Rules governing these certificates as amended from time to time.

Signature or thumb impression (If illiterate)

of transferee of certificate( s)

Date ...................

----------------------------------------------------------------------------------------------------

FOR USE IN THE POST OFFICE

Registration No,

Sl.No. & date of original Oblong M.O. H.O. /S.O.

Application for purchase stamp

Sub Office Postmaster Head Office Postmaster

PARTICULARS OF CERTIFICATES ISSUED TO TRANSFEREE

Series and Sl.

No. of

Certifi-

cate(s)

Denomin

ation

Date of payment

of interest and

initials of Post

Master

Date of

discharge and

initials of

Postmaster

Remarks

Every change

affecting the certificate such as transfer, issue of duplicate certificate should be noted here under the signature of postmaster

Total number of certificates.................. signature of Postmaster of office

Of Registration

Date ,......


DAILY TOTALS OF KISAN VIKAS PATRAS/6N.S.C.(VIII) ISSUED

AT ______________SO DURING .2006

DATE

RS 100

RS500 RS1000 RS5000 RS10000 TOTAL

NO AMOUNT NO AMOUNT NO AMOUNT NO AMOUNT NO AMOUNT NO AMOUNT

TOTAL

PREVIOUS

GR.

TOTAL

SUB POSTMASTER,


DAILY TOTALS OF KISAN VIKAS PATRAS /6NSC (VIII) DISCHARGED AT ______________S.O.

DURING THE I/II PERIOD OF 200

SUB POSTMASTE

DATE

RS100

RS500

RS1000

RS500

RS10000

TOTAL

N

O

AMT

INT

N

O

AMT

INT

N

O

AMT

INT

N

O

AMT

INT

N

O

AMT

INT

N

O

AMT

INT


N.C. 51


Serial No…………………………… Form of application for Nomination under section 6 of the Government Savings Certificates

Act, 1959. (The form will be filled up by the holder(s) and submitted with savings Certificates to the Postmaster of the office where the savings certificates registered) To, The Postmaster, …………………………………………………………. Under provision of section 6(1) of the Government Savings Certificate Act, 1959, I/We ……………………………………………………………. the holder(s) of Savings Certificate(s) detailed on the reverse, hereby nominate the person(s) mentioned bellow, who shall, on my/our death, become entitled to the Savings Certificate(s) and to be paid the sum due thereon to the exclusion of all other persons. I/We hereby declare that I/We have not so far made any nomination in respect of these certificates. The Certificates are enclosed.

Sl. No Name of Nominee Full Address of Nominee

Date of birth of nominee in case of minor

As the nominee(s) at serial No(s) ………………………. above is/are minor(s) I/We appoint Shri/Smt./Kumari ……………………………………………………………. (Name and Full address) as the person to recover the sum thereon in the event of my/our death during the minority of the nominee(s) ______________________________________________________________________________

ACKNOWLEDGEMENT To, --------------------------------------------- …………………………………………………………. Your application dated ……………………………………… Nomination in respect of the certificates detailed in Colum 1 of reverse in favour of person mentioned in Colum 2 has been registered in this office under No ……………… Dated ………………………..

Date Stamp of Post Office Signature of the Postmaster


Serial Nos. of Certificates

Denomination Date of issue Office of isssue

Address: - Yours Faithfully, In case of illiterate holder Signature of holder(s) (Father’s name should be given) (Thumb impression if illiterate) Witness:- 1) Name and address ………………………………………………………….. …………………………………………………………… …………………………………………………………… 2) Name and address ………………………………………………………….. ………………………………………………………………. ……………………………………………………………………. N.B. In case of illiterate holders the witnesses shall be the persons whose signatures are known to the post office.

ORDERS OF THE POSTMASTER ACCEPTING THE NOMINATION

Date Stamp

Signature of the head/Sub Postmaster ______________________________________________________________________________

Particulars of Certificates Name and address of nominee/person to receive payment on behalf of minor nominee

Sl. No of Savings certificates

Denomination


N.C. 53


Serial No…………………………… Application for Cancellation or variation of Nomination previously made in respect of Postal

Savings Certificates under section 6 of the Government Savings Certificates Act, 1959. (The form will be filled up by the holder(s) and submitted with savings Certificates to the Postmaster of the office where the savings certificates registered) To, The Postmaster, …………………………………………………………. Under provision of section 6(1) of the Government Savings Certificate Act, 1959, I/We ……………………………………………………………. the holder(s) of Savings Certificate(s) detailed on the reverse, hereby cancel the nomination previously made by me in respect of these Certificate(s) and registered in your office under No ………………….. Dated ………………………………. * in place of the cancelled nomination, I hereby Nominate the person(s) mentioned bellow who shall on my death, become entitled to the Savings Certificate(s) and to be paid the sum due thereon to the exclusion of all persons.

Sl. No Name of Nominee Full Address of Nominee Date of birth of nominee in case of minor

As the nominee(s) at serial No(s) ………………………. above is/are minor(s) I/We appoint Shri/Smt./Kumari ……………………………………………………………. (Name and Full address) as the person to recover the sum thereon in the event of my/our death during the minority of the nominee(s) *To be filled in case of variation only. The Certificates are enclosed. ____________________________________________________________________________

ACKNOWLEDGEMENT To, --------------------------------------------- …………………………………………………………. Your application dated ……………………………………… Nomination in respect of the certificates detailed in Colum 1 of reverse in favour of person mentioned in Colum 2 has been registered in this office under No ……………… Dated ………………………..

Date Stamp of Post Office Signature of the Postmaster

Space for postage stamp


Serial Nos. of Certificates

Denomination Date of issue Office of isssue

Address: - Yours Faithfully,

In case of illiterate holder Signature of holder(s) (Father’s name should be given) (Thumb impression if illiterate)

Witness:- 1) Name and address ………………………………………………………….. ………………………………………………………………. ……………………………………………………………………. 2) Name and address ………………………………………………………….. ………………………………………………………………. ……………………………………………………………………. N.B. In case of illiterate holders the witnesses shall be the persons whose signatures are known to the post office.

ORDERS OF THE POSTMASTER ACCEPTING THE NOMINATION

Signature of the head/Sub Postmaster

______________________________________________________________________

Particulars of Certificates Name and address of nominee/person to receive payment on behalf of minor nominee

Sl. No of Savings certificates

Denomination

Date Stamp


NC-32


APPLICATION FOR TRANSFEROF SAVINGS CERTIFICATE(S) FROM ONE POST OFFICE TO

ANOGTHER

To

The Postmaster,

………………………………………………………………..

I/We ……………………………………………………………………………………………….. Request that following Certificate(s)/ Duplicates Certificates held by me/us/Shri/Shrimati/ kum.* ………………….. (Minor) which stands registered at your office be transferred to ………………………….. Post office. *Delete which ever is not applicable.

Full Name of series, serial no and type

Deno- mination

Date of issue

Sl. no of identity slip

If purchased on behalf of minor

Date of birth of minor

Name o guardian authorised to encash

Signature (not thumb impression) Signature of (or thumb impression*) applicant of authorised guardian Address …………………………………………………………………. …………………………………………………………………… *Should be attested by a witness known to the Post office

For use of applicant


FOR THE USE OF TRANSFERING POST OFFICE

INTIMATION OF TRANSFER OF CERTIFICATE(S) Serial No and date of issue

To, 1. Certificate(s)/ Duplicate certificates particularised above is/are transferred to your office after verification of the applicant’s signature and other particulars furnished by him. 2. Nomination under Section 6(1) of the Government Savings Certificates Act, 1959 as extracted bellow stands registered at this office in respect of them:-

Name of the nominee(s)

Full address If nominee is minor Date of

Birth

Name of person with full address of authorised to receive the amount due in the

event of death of the holder during the minority period

Yours faithfully,

Postmaster

For use of transferee Post Office

Oblong MO

stamp

Serial Number of

Transferring office

Certificates issued Payments Remarks like transfer, issue of

duplicate certificate etc. with initials of postmaster

Serial no of certificate(s)

Issue Price Date payment of interest with

initials of PM

Date of encashment

with initials of PM

Signature of Postmaster


DEPARTMENT OF POSTS, INDIA CERTIFICATE OF HOLDING OF 6 NSC (VIII)

This is to certify that following Savings Certificates are held by …………………………………………… …………………………………………… are registered in this office.

Sl. No. Sl. No. and type of certificate

Date of issue Denomination Remarks

Date stamp Postmaster/Sub postmaster


Certificate of accrual of annual interest on 6 NSC (VIII) From, To, ………………………………….. ………………………………… ……………………………………………. …………………………………… No- / 20 - 20 Dated at …………………….. The ……………………………….. This is to certify that an amount of Rs……………………. (Rupees ……………………………... ………………………….. ) has accrue as interest for the year ………………………….. on ………………………………… certificates, Particularized bellow standing in your name at this office. Sl. No. Sl. No. of certificate Denomination(Rs.) Value(Rs.) Interest(Rs.)

Date Stamp Postmaster/Sub Postmaster

Form ‘A’


(See clause (D) of rule 2 and sub rule 3)

APPLICATION FOR OPENING OF AN ACCOUNT UNDER

SENIOR CITIZENS’ SAVINGS SCHEME

To

The Postmaster /Incharge,

……………………………………………………………

…………………………………………………………….

*Name of Agent (in case of the account introduced through agent)……………………… ………………… Agency Code No ……………………… Dated ………………. Valid up to………….

PAN NO of applicant ……………………………………… Sir, 1. I, ……………………………… son/daughter/wife of ……………………………………………… Permanent resident of …………………………………. ……………… aged …………………………… Years, hereby apply for opening of an account under the SENIOR CITIZENS’ SAVINGS SCHEME, 2004 (hereinafter referred to as the said scheme), in my name / jointly in my name and my spouse …………… ……………… …………………………… (Name and address of spouse with age)* And tender herewith Rs ……………………….. (Rupees ……………………………………………………………) In cash/ cheque/ demand draft the particulars of which are filled in the enclosed ‘pay-in-slip (form -D), towards deposit in the account. 2. I/We* hereby declare that, i) I/we* have clearly under stood the Senior Citizens’ Savings Scheme,2004 governing the accounts under the said scheme, as amended from time to time (hereinafter referred to as the said rules); ii) I/we* shall abide by the said rules in letter and spirit; iii) The details of other accounts opened earlier by me/us* under the said scheme, are as under:-

SL No

Name and of depositor and type of account(joint or individual

Name and address of deposit office

Account No with date of opening

Amount of deposit

iv) I/we* shall adhere to the ceiling on deposits, taking the deposits in all the accounts opened by me/us* together, as specified in rule 4.


3. I/we nominate the following person/ persons, mentioned bellow, to whom, to the exclusion of all others persons, in the event of my death the amount standing to my credit in the account should be payable in accordance with the provisions contained in rule 6.

Sl. No

Name(s) of Nominee(s) along with relationship with depositor

Permanent address of nominee(s)

Date(s) of birth of nominee(s) in case of minor/ age in other case(s)

Share of the nominee(s) in the amount payable

3(a) as the nominee(s) at serial no (s) ………………… above is/are minor(s). I appoint Shri / Smt.

/Kumari ………………………………………………………………………………………………….* Name(s) with

permanent address(es) of persons in respect of each minor nominee]to receive the sum due

under the said account in the event of my death during the minority of the nominee(s).

Signature /Thumb impression of the Depositor

Witnesses (Signature, name and address);

1. ……………………………………………………………………………………….

2. ……………………………………………………………………………………… Date ………………… Place …………..........

My/ our* specimen signatures (thumb impression), are as under

i) First depositor:-

1 2 3

ii)*Joint depositor:-

1 2 3

#Witness ………………………………… # Witness ……………………………… # Witness ………………………….......

(Countersigned of Postmaster) (Countersigned of Postmaster) (Countersigned of Postmaster)

Date & office seal Date & office seal Date & office seal


4. I also declare that the information provided by me/ us* in the application hereinabove, is true to the best of my knowledge and belief and in case, at any time, any of the information and/or declaration is found false, no interest on the deposits shall be payable to me/us*, the deposit office shall close the account(s) and refund the deposit after recovery of the interest, if any, already paid on the deposits. Yours faithfully,

(Signature of the depositor) Date …………………………………….Place …………………………………… (Present postal address) Enclosures:- 1. Age Proof. 2. Copy of receipted application form for allotment of PAN, if PAN is not allotted. 3. Pay in slip (form D), duly filled along with amount of deposit. 4. Certificate from employer as specified in sub-clause (ii) of clause (d) of rule 2. * Score out which is not applicable. # In case of thumb impression. (1) The applicant (s) who are not assessed to income tax, may furnish a self declaration, that their income from all sources (including the interest income from the account to be opened vide this application) does not cross the exemption limit and the applicant is not required to obtain PAN under Income Tax Act 1961,as amended from time to time. (2) All other applicants shall mention the PAN NO compulsorily and in case they have not so far been allotted PAN by Income Tax Authorities, attested Photo copy of the receipted application from for allotment of PAN should be attached to the application form. NOTE: - (1) self attested copies of any of the following documents can be enclosed as age proof: Birth Certificate issued by the Municipal authority/ Gram Panchayat /District office of registrar of Births and Deaths; Voter Identity Card issued by the Election of India; PAN card; Passport; Ration Card; Date of birth certificate from the school last attended by the applicant or any other recognized educational institution or Driving License issued by the local licensing authority. (2) Originals of the documents attached, should also be produced simultaneously for verification and return immediately. _____________________________________________________________________________

FOR OFFICE USE ONLY The account has been opened on ……………………… with Rs.……………………. (Rupees …………………… ………………………………………………………) under Senior Citizens Savings Scheme, 2004. Account No ………………………………….. Ledger Folio No …………………………………….. Agent’s name and agency code number, date and validity have been entered in the ledger folio as well as pass book (in case of account introduced through agent). Passbook No …………………………………… has been issued. Date ………………………

Signature of the Incharge of Deposit Office With designation stamp


DECLARATION I/We Shri/Smt. ___________________________________ hereby declare that my/our income from all sources ( including the interest income from the account to be opened vide this application ) does not cross the exemption limit and I/We is not required to obtain PAN under Income Tax Act, 1961 as amended from time to time. Place- Date- Signature of Depositor. (Declaration to be obtained from Depositor of S.C.S.S. Account when PAN card is not produced with application for opening the S.C.S.S. Account)

DECLARATION I/We Shri/Smt. ___________________________________ hereby declare that my/our income from all sources ( including the interest income from the account to be opened vide this application ) does not cross the exemption limit and I/We is not required to obtain PAN under Income Tax Act, 1961 as amended from time to time. Place- Date- Signature of Depositor. (Declaration to be obtained from Depositor of S.C.S.S. Account when PAN card is not produced with application for opening the S.C.S.S. Account)


FORM B (Sub-rule (3) of rule 4)

Serial No....................... APPLICATION FOR EXTENSION OF AN ACCOUNT UNDER,

SENIOR CITIZENS SAVINGS SCHEME, 2004

TO

The postmaster/ Incharge,

………………………………… (Name of the Deposit office)

.............................................................

Subject: Application for extension of an account for three years, with effect From …………….. (Date/ month/ year). Sir, 1. I, …………………… son/daughter/wife of , …………………………………… depositor of account No . ………………….." (Here in after referred to as the 'said account') hereby apply for continuation of the account under the Senior Citizens Savings Scheme, 2004

(hereinafter referred to .as’ the said scheme'), for a further period of three years from the date of maturity of my above-said account. 2. I have understood the terms and conditions applicable to the account during the period of extension under the Senior Citizens Savings Scheme Rules, 2004 as amended from time to time. 3. I shall close the account immediately on completion of the extended period and get back the deposit standing at my credit in the account after adjustment of the interest paid in excess, if any, and any other charges recoverable in connection with the said account. Date …………………. Signature of the Depositor Place ……………. (Name and address) _________________________________________________________________________________________________________

FOR THE USE OF DEPOSIT OFFICE

The account No which was opened on with Rs, ...................... (Rupees

……………………………………) under the Senior Citizens Savings Scheme, 2004 and

matured on , has been extended for a period of three years with effect from to Rate of interest at

per cent per annum as applicable under the scheme to fresh deposits opened or to be opened on

the date of maturity, shall be applicable during the extended period of the deposit.

Necessary entries have been made in the Pass Book No and relevant Ledger folio No ………

accordingly.

Date. ……………………… Signature of .the In charge of Deposit Office

(Along with name and designation stamp)


FORM - E

(See sub rule (1) of rule 8 and rule 9) Serial No.......................

APPLICATION FOR CLOSURE OF AN ACCOUNT UNDER SENIOR CITIZENS SAVINGS SCHEME, 2004

TO

The postmaster/ In Charge

…………………………. (Name of the Deposit office)

Subject: Application for withdrawal/closure of account.

Sir,

1. I, ………………………………………..,son/daughter/wife of ……………….……………

resident of.... ................................. and depositor of account No……………….. (Here in after

referred to as the said account') hereby apply for closure of the said account with immediate

effect. The interest of Rs……….. And deposit of Rs …… TOTAL (INTEREST+DEPOSIT)

Rs............. (Rupees), *after adjustment of overpaid interest and/or deduction equal to per cent of

the deposit, amounting to Rs............... (Rupees) and any other charges, recoverable from me in

respect of the account in question, may kindly be refunded to me immediately.

2. The Pass Book is enclosed.

Signature or thumb impression of the

______________________________________________________________________________

FOR USE BY THE DEPOSIT OFFICE

ACCOUNT NO…………. DATE OF DEPOSIT ………………AMOUNT OF DEPOST Rs..................................... Withdrawal on account of Interest…………… Rs…………… and deposit Rs ………………… totaling to Rs………… (Rupees ……………………………)is sanctioned in favour of the depositor…………………………………………. "'Recovery of overpaid interest Rs …………….. Deduction of Rs…………… and Other Charges (to be specified) Rs ………………totaling to RS……...... (Rupees ……………… ..............................) has been adjusted. NETAMOUNT PAID Rs............... (Rupees …………………………………..)

Signature of In charge of Deposit office

______________________________________________________________________________

RECEIPT

Received a sum of Rs ………… (Rupees ………………………………………….) From ……………………………… (Name of Deposit office) as per details furnished above.

Signature/ Thumb impression of the depositor

*: Score out whichever is not applicable.


FORM -- F (See sub-rules (3) and (4) of rule 8)

Serial No: …………………..

APPLICATION FOR CLOSURE OF ACCOUNT UNDER SENIOR CITIZENS SAVINGS SCHEME, 2004, BY SPOUSE (JOINTHOLDER) / NOMINEE(S)/LEGAL HEIRS.

TO The Postmaster /Incharge,

…………………………… (Name of the Deposit office)

Subject: Application for withdrawal /closure of account. Sir,

I/WE …………………………………………………………………….. the spouse (Joint holder) / nominee(s) /legal heirs of late ………………………………………………. the depositor to the Senior Citizens Savings Scheme, 2004 account No ………………….. wish to withdraw the entire amount standing to the credit of the deceased in the said account. Please find enclosed:- (i) A certificate in regard to the death of the Depositor. (ii)A Certificate in, regard to the death of Shri/ Shrimati ………………………………… and Shri/Shrimati…………………………………………………………………………. also the nominee(s) appointed by the Depositor. (iii) Succession Certificate/Letter of Administration with attested copy of probated will of the deceased depositor issued under the provisions of the Indian Succession Act, 1925. (iv)Pass Book of the Depositor. (v) Letter of Indemnity. (vi) Affidavit. (vii) Letter of disclaimer on affidavit

Signature or thumb impression of claimant(s) Witness...........................

(Signature, name and address)...........

Date:

Place........................

_____________________________________________________________________________

FOR USE BY THE DEPOSIT OFFICE

Withdrawal of Rs ……………………… (Rupees ……………………………………………….)

is sanctioned.

Adjustments made (to be specified) Rs................. (Rupees ………………………………………)

NET AMOUNT PAYABLE Rs.......................... (Rupees ..............................................................)

______________________________________________________________________________

RECEIPT TO BE SIGNED BY THE CLAIMANT(S)

Received a sum of Rs ……… (Rupees ……………………………………………...) from

……………………….(Name of Deposit office) as per details furnished above, in full

Settlement of our claim. .

Signature / Thumb impression of the claim


ANNEXURE-I TO FORM - F

(Letter of indemnity) TO The Postmaster / Incharge, …………………………………… (Name of the deposit office)

In consideration of your payment or agreeing to pay me/ us. ................................. ........................................................................................... [Name(s) of Legal heir(s)] the sum of Rs (Rupees..................................................................)standing in the account No ……………… under SENIOR CITIZENS SAVINGS SCHEME~ 2004 with your office in the name of ................................................................ without production of letters of administration or a succession certificate to the estate of the deceased (name of the depositor), I/We ……………………………………………………………………….. And we ……………………………………………………………………….(sureties) do hereby for ourselves and our heirs, legal representatives, executors and administrators jointly and severally undertake and agree to indemnify you and your successors and assigns against all claims, demands, proceedings, losses, damages, charges and expenses which may be raised against or incurred by you by reason or in consequence of having agreed to pay/or paying me/us the sum as aforesaid.

In witness where of we have here unto set my/our hands at this ……….. Day of …………………………………… in the presence of witnesses, Signed and delivered by the above named heir/heirs of the deceased. Signed and delivered by the Above named sureties (Signature, names and address) 1………………………………… 2………………………………… Signature, names and address of witnesses: 1………………………………….. 2 …………………………………..

Attested

NOTARY PUBLIC


ANNEXURE-II TO FORM -F

(Affidavit)

TO

The Postmaster / Incharge,

……………………………(Name of the deposit office)

I / We .................................. .Husband of / wife of late..........................................................

aged ……… aged ……… aged …………… sons/daughters of the said

late.............................................................................. resident of ……………... do hereby declare

and solemnly affirm as under :-

(1) That I / we am/are the only heir(s) of the deceased who died at,......................

on ……………… 1/ We alone represent the estate of Shri/ Smt. ...................................................

(2) That the deceased did not leave any will and therefore 1/ we are the only successor(s) to the

estate of the said deceased.

1.

2.

3.

DEPONENTS

VERIFICATION: I / We, the above-named deponents do hereby verify on solemn affirmation

in....................................... (Name of place) that the contents of this affidavit are true to the best

of my/our knowledge and nothing material has been concealed.

Dated…………….

1.

2.

3. ATTESTED

DEPONENTS

OATH COMMISSIONER


ANNNEXTURE-III TO FORM - F (Letter of disclaimer on Affidavit)

TO The Postmaster / Incharge, ………………………………. (Name of the deposit office) 1I/ We (i) ………………Husband of / wife of ..................................................................... Resident of.............................................................. (ii) ...................... son/daughter of. .................................................... (iii) …………….... son/daughter of …………………… do hereby declare and solemnly affirm as follows :- (1) That Shri/Smt. ………………………………………….. died intestate on ...................... leaving behind us ……………………………………………………………his/her only heirs. (2) That we …………………………………………………………………… heirs of our late father/mother for our selves and on behalf of our heirs, executors, representatives and assigns to hereby relinquish our claims to the balance of RS ………………. which may be credited to the account sought by our mother/father to be opened in the deposit office in the name of the estate of the said..................................................................... deceased father/mother after the realization of Draft NO ………………………. on …………………………. issued by (name of the deposit office) and we have no objection whatsoever in the balance in the above-referred account No ……………… together with interest, if any, accrued thereon being paid by the Deposit office to our mother/father Mrs. /Mr.………………………………….. 1. 2. 3.

DEPONENTS VERIFICATION: I / We, the above-named deponents do hereby verify on solemn affirmation that the contents of this affidavit are true to, the best of my/our knowledge and nothing material has been concealed. Dated................ 1. 2. 3.

DEPONENTS

I identify the deponent(s) who is/are personally known to me and who has/have signed in my presence. Dated………………..

Oath Commissio


FORM- G(See rule 11)

'Serial No ........ APPLICATION FOR TRANSFER OF ACCOUNT UNDER SENIOR CITIZENS SAVINGS

SCHEME 2004

TO

The Postmaster/ Incharge,

………………………………………….. (Name of the Deposit office)

Subject: Application for Transfer of account to another Deposit office.

Sir,

1. I…………………………………………………. son/daughter/wife of, ……………………, Resident

of …………………………………... a depositor of account No…………………………….., hereby

apply for TRANSFER OF MY ACCOUNT No ………………………………. with a deposit, of Rs

……………………. (Rupees ……………..) under the Senior Citizens Savings Scheme, 2004. To ......

…………………………… (Name and full address of the transferee deposit office)

2. The Pass Book is enclosed. ..

Signature or thumb impression of the Depositor

Witness *……………………………………

Signature, name and address)..............

specimen signature/thumb impressions, as available In the record of transferer deposit office, are as

below:-

(I)1ST

Depositor:-

1

2

3

*Witness …………………….*Witness ……………………….. *Witness………………………

(i) Joint Depositor:-

1

2

3

Countersigned Countersigned Countersigned

(Postmaster/Incharge (Postmaster/Incharge (Postmaster/Incharge

of Transferer office) of Transferer office) of Transferer office)

Date…………& office Seal Date & ……………...office Seal Date ………… & office Seal

.

Forwarded to…………………………………………. (Transferee Deposit 0ffiIce) and necessary entries

passed in the office record

Date …………………………… Signature & office seal (Transferer Deposit office)

----------------------------------------------------------------------------------------------------------------------------

FOR USE BY THE TRANSFEREE DEPO.S.I.T OFFICE

Received application for, transfer of account No………………… opened on :........................ under

SENIOR CITIZENS SAVINGS SCHEME"2004~".in the' name of ……………………

…………………………. & ……………………………….... .(Joint holder, if any) standing on the books

of the.................................... (Name and address of the Transferer deposit office) showing a deposit of Rs

………………….. (Rupees ……………………………………..), due to mature on

…………………………

The entries in the pass book have been checked, necessary entries indicating transfer, have been made

and pass book has been returned to the depositor,

Passbook received in original Signature of Postmaster/Incharge

(With office seal) transferee office

Signature/ Thumb impression of Depositor Date ……………………………..


FORM NO 15(G) [See rule 29C]

Declaration under Sub Section (1) and (1A) of section 197A of the Income Tax Act 1961 to be made by an individual or a person ( not being a company or a firm) claiming certain receipts without deduction of tax. I/We* ……………………………………………………………………….. *son/daughter /wife of ………………………… …………………………………….. Resident of …………………………………………………@ do hereby declare: 1. That the securities or sums, particulars of which are given in Schedule III bellow, stand in *my/our name and beneficially belong to*me/us, and the *interest in respect of such securities is not includible in the income of any other person under section 60 to 64 of the Income Tax act, 1961; 2. That *my/our present occupation is ……………………………………………………….. ; 3. That the tax on the estimated total income computed in accordance with the provisions of Income the Income Tax Act,1961, for the financial year ending on ………………………… will be nil; 4. The aggregate amount of interest credited or paid or likely to be credited or paid during financial year is not more than the maximum amount which is not chargeable to tax (Rs 1,00,000/- for male and Rs 1,25,000/- for female tax payers) ; 5. That *I/We have not been assessed to income-tax at any time in the past but I fall within the jurisdiction of the Chief Commissioner or Commissioner of Income Tax …………………………………. ; OR That *I/We *was/were last assessed to income tax for the assessment year ……………………. by the Assessing Officer …………………………………………….. Circle/Ward/District and the permanent account number allotted to me is ………………………………………………….. ; 6. That I *am /am not resident in India within the meaning of Section 6 of the Income Tax Act, 1961; 7. Particulars of securities in respect of w2hich the declaration is being made. Are as under:- SCHEDULE – III

Name and address of the person to whom the sums are given in interest

Amount of such sums

Date on which sums were given on interest

Period for which such sums were given on interest

Rate of Interest

**Signature of the declarant.


VERIFICATION

*I/We ………………………………………………………………………………………………….. Do hereby declare that to the best of *my/our knowledge and belief what is stated above is correct, complete and truly stated. Verified today, the ……………….. Day of ……………………….. Place: ………………………… ** Signature of the declarant Notes:-

1. @ Give complete Postal address. 2. The Declaration should be furnished in duplicate. 3. * Delete whichever is not applicable 4. **Before signing the verification, the declarant should satisfy himself that the information

Furnished in the declaration is true, correct and complete in all respects. Any person making a false statement in the declaration shall liable to prosecution under section 277 of the Income Tax Act. 1961, and on conviction be punishable:-

(i) In a case where tax sought to be evaded exceeds one lakh rupees with rigorous imprisonment which shall not be less than six months but which may be extended to seven years and with fine.

(ii) In any other case, with rigorous imprisonment which shall not be less than three months but which may extend to three years and with fine.

PART – II

(For use by the person to whom the declaration is furnished) 1. Name and address of the person responsible for paying the income, mentioned in paragraph 1

of the declaration. 2. Date on which the declaration was furnished by the declarant. 3. Date of payment of interest from account number …………………………………….. Under Senior

Citizen Savings Scheme. 4. Period in respect of which interest is being credited or paid 5. Amount of interest received from Senior Citizen Savings Scheme. 6. Rate at which interest credited/paid. Forwarded to the Chief Commissioner or Commissioner of Income Tax …………………………………….. Place …………………………………….. Date ………………………………………

Signature of the person responsible for paying the income referred to in paragraph 1


FORM NO 15(H) [See rule 29C (1A)]

Declaration under Sub Section (1C) of section 197A of the Income Tax Act 1961 to be made by an individual who is of age of sixty-five years or more claiming certain receipts without deduction of tax. I/We* ……………………………………………………………………….. *son/daughter /wife of ………………………… …………………………………….. Resident of …………………………………………………@ do hereby declare: 1. That particulars of my account under the Senior Citizen Savings Scheme and the amount of quarterly interest are as per the schedule bellow :-

SCHEDULE

Description and details of investment

Amount of investments

Date of sums were investment / opening account

Estimated Income Rate of Interest

2. That *my/our present occupation is ……………………………………………………….. ; 3. That I am of the age of ……………. Years; 3. That the tax on my estimated total income, including income/incomes computed in accordance with the provisions of Income the Income Tax Act,1961, for the previous year ending on ………………………… relevant to the assessment year …………………………….will be nil; 5. That *I/We have not been assessed to income-tax at any time in the past but I fall within the jurisdiction of the Chief Commissioner or Commissioner of Income Tax …………………………………. OR That *I/We *was/were last assessed to income tax for the assessment year ……………………. by the Assessing Officer …………………………………………….. Circle/Ward/District and the permanent account number allotted to me is ………………………………………………….. ; 6. That I *am /am not resident in India within the meaning of Section 6 of the Income Tax Act, 1961;

**Signature of the declarant.

VERIFICATION

*I/We ………………………………………………………………………………………………….. Do hereby declare that to the best of *my/our knowledge and belief what is stated above is correct, complete and truly stated. Verified today, the ……………….. Day of ……………………….. Place: ………………………… ** Signature of the declarant


Notes:- 5. @ Give complete Postal address. 6. The Declaration should be furnished in duplicate. 7. * Delete whichever is not applicable 8. **Before signing the verification, the declarant should satisfy himself that the information

Furnished in the declaration is true, correct and complete in all respects. Any person making a false statement in the declaration shall liable to prosecution under section 277 of the Income Tax Act. 1961, and on conviction be punishable:-

(iii) In a case where tax sought to be evaded exceeds one lakh rupees with rigorous imprisonment which shall not be less than six months but which may be extended to seven years and with fine.

(iv) In any other case, with rigorous imprisonment which shall not be less than three months but which may extend to three years and with fine.

PART – II

(For use by the person to whom the declaration is furnished) 7. Name and address of the person responsible for paying the income, mentioned in paragraph 1

of the declaration. 8. Date on which the declaration was furnished by the declarant. 9. Date of payment of interest from account number …………………………………….. Under Senior

Citizen Savings Scheme. 10. Period in respect of which interest is being credited or paid 11. Amount of interest received from Senior Citizen Savings Scheme. 12. Rate at which interest credited/paid. Forwarded to the Chief Commissioner or Commissioner of Income Tax …………………………………….. Place …………………………………….. Date ………………………………………

Signature of the person responsible for paying the income referred to in paragraph 1


APPLICATION FOR CONTINUE/DISCONTINUE BY JOINT HOLDER OF THE SENIOR CITIZEN SAVINGS ACCOUNT

FROM:- _______________________ ________________________ _______________________ To:- The Postmaster/ Sub Postmaster, __________________________ Subject:-Application for Continue/Discontinue the Senior Citizen Savings Account by joint holder of SCSS Account No________________ Standing at __________________ Post Office. Respected Sir, I am the joint holder of the Senior Citizen Savings Account No___________ Standing at your office in the name of Late Shri/Smt. ____________________________ Who has died on _________________( death certificate is enclosed herewith). I wish to continue/Discontinue the said account till maturity. I hereby declare that my total deposit in the Senior Citizen Savings Account after continuing this account shall not exceed the prescribed limit of Rs 15, 00,000 /- Rs Fifteen Lakh only. So please permit me to continue the above mentioned account. Thanking You, Yours faithfully,


APPLICATION FOR CLAIM UNDER THE SCHEME OF PROTECTED SAVINGS

To The Postmaster, ________________________ Respected Sir, In connection with the settlement of the claim in respect of the 5-year Post Office Recurring Deposit Account particularized bellow, I/We the undersigned _______________________________________________________ hereby claim the full maturity value under the Scheme of Protected Savings. Particulars of the Account:-

1. Name of Depositor in full _______________________________________

(In BLOCK letters)

2. Name of father/husband of Depositor:- _____________________________

3. Last address of Depositor :- _______________________________________

________________________________________

4. Date of Death of Depositor:- ______________________________________

5. Place of death of Depositor :- _____________________________________

6. Declared Date of birth of Depositor ________________________________

At the time of opening the account.

7. Date of opening of Account :- _____________________________________

8. R.D. Account No :- ______________________________________________

9. Denomination Rs _______________________________________________

10. Name of Post Office Where account stands :- ________________________

11. Head Post Office:- ______________________________________________

12. Date of Claim :- _______________________________________________

13. Particulars of claimant :-

Sl No Name and Address of Claimant Relationship with Depositor

14. Particulars of Near Relatives of Depositor

Sl No Name and address Age Relationship with Depositor


To my/our knowledge, the deceased has the following other Recurring Deposit Accounts in the

Post Office on which I/we shall not claim the benefit under the Scheme of Protected Savings

but shall claim only proportionate amount payable under the R.D. RULES:-

SL NO

ACCOUNT NO

HEAD POST OFFICE

DATE OF OPENING

DENOMINATION NAME OF NOMINEE

In support of the claim I/We submit the Death Certificate in respect of the

Depositor issued by ________________________________________

I/we are the nominee of the deceased depositor as per nomination registered in

your records.

I/We certify that I/We have not made any claim in respect of any other R.D.

Account standing in the name of the deceased depositor under the Scheme of protected

Savings nor shall we do so in future.

Address of Claimant(s) Yours Faithfully

i) __________________________ Signature ______________________

__________________________ Name _________________________

ii) _________________________ Signature ______________________

__________________________ Name _________________________

CERTIFICATER BY TWO WITNESSS

We hereby certify that claimant(s) who has/have signed above are known to

us the particulars furnished above by him/them are correct.

Dated 1. Signature______________________________

Name __________________________________

Address _________________________________

Dated 1. Signature______________________________

Name __________________________________

Address _________________________________

ORDERS BY THE POSTMASTER


VERIFICTION OF CLAIM UNDER THE SCHEME OF PROTECTED SAVINGS

From To The Postmaster, Postmaster General …………………………………….. …………………………………………… No ……………………………. dated at ……………………… the ………………………………………….. Subject: - REGISTRATION OF CLAIM UNDER THE PROTECTED SAVINGS SCHEME . Sir, We have received a claim for the payment of the full maturity value of the Recurring Deposit Account standing open in the books of this office, as particularised bellow:- i) Name of Depositor in full ………………………………………………………………………… (In block letters) ii) Name of Depositor’s father/husband ……………………………………………………… iii) Last address of Depositor ………………………………………………………………………. iv)Date of death of Depositor ……………………………………………………………………… v) Place of death of Depositor ……………………………………………………………………. vi) Declared age/ date of birth of …………………………………………………………………. Depositor at the time of opening of account. vii) Date of opening of Account ……………………………………………………………………… viii) R.D. Account No ……………………………………………………………………………………… ix) Denomination Rs ……………………………………………………………………………………… x) Post Office …………………………………………………………………………………………………. xi) Head Post Office ………………………………………………………………………………………. xii) Date of Claim …………………………………………………………………………………………… xiii) Particulars of claimant(s)

Sl no Name and address of claimant Relationship with depositor


It is certified that, I have verified the particulars given above from the postal record and the admissible documents submitted by the claimant(s). The account had not become a discontinued account at the time of death of the Depositor.

The first twenty four monthly deposits have been made without default, and no withdrawal has been made from account during the first twenty four months.

I have satisfied myself about the death of the Depositor and about the right of the claimant(s) to the full maturity value of Account.

This intimation is sent in duplicate for verification if any claim under the Scheme of Protected Saving has already been registered in the name of the above mentioned deceased.

Yours faithfully,

Postmaster

Office of the Postmaster General No …………………………………… dated at ……………………… the ……………………………. Certified that no claim has been previously registered in this office in

respect of the deceased shri/smt./kum. ……………………………………………………………… holder of Recurring Deposit Account particularised on the previous page, who died on ………………………………… at ……………………………………… The claim may be admitted if otherwise in order. Registration Number ……………………… dated ……………………………

OR Certified that a claim has been previously registered in this office in respect

of CTD/RD Account standing in the name of the deceased shri/smt./kum …………… ………………………………………………. vide particulars furnished bellow. CTD/RD NO…………………………… Denomination …………………….. Opened at post office …………………………………. on ………………………….. Name of claimant(s) …………… ……………………………………………….. Registration No …………………………………… (Delete whichever certificate is not applicable) Seal of circle office

Signature and Name of the Officer of the circle office


DEPARTMENT OF POSTS

Claim application for settlement of savings certificates of the deceased holder who died on ___________________ where nomination has been registered. To, The Postmaster, ______________________ Sir, In connection with settlement of Post Office Savings Certificate(s) standing in the name of deceased ____________________________________ in the books of _______________ (Name of Post Office), I hereby claim the payment of the value of Post Office Savings Certificate(s) as details given bellow. The payment may be made by cash/cheque or money order (after deducting commission). In support of the claim, I hereby submit, (i) death certificate of the deceased, (ii) death certificate of nominee(s), if any. The nomination was registered at ______________ Post Office under No _________ Dated _______________ Details of Savings Certificates

Sl No Sl No of certificates Denomination Date of issue Registration No

Remarks

Yours Faithfully

Signature of claimant

Name and address of claimant

________________________________________________________________________

This is to certify that claimant Shri/Smt. is known to me and he/she has signed in my presence. Signature of Identifier, Name and address of identifier__________________________________

____________________________________ ____________________________________


DEPARTMENT OF POSTS Claim application for settlement of the claim to a Savings Bank account of the deceased Depositor who died on___________________ where nomination has been registered. To, The Postmaster, ______________________ Sir, I/We hereby claim the payment of the balance at credit at of savings Account No ……………............standing in the name of the deceased …………………………………………………… in the books of ……………………………… (Name of the Post Office). In support of the claim, I / we hereby submit :- 1) Passbook of Account No ………………………………………. 2) A certificate of death of the depositor. 3) A certificate of death of other nominee, if any. The nomination was registered at ……………………………………….. Post office under the No ………………………………. dated ……………………………

Yours Faithfully

Signature of claimant

Name and address of claimant ________________________________________________________________________

This is to certify that claimant Shri/Smt. is known to me and he/she has signed in my presence. Signature of Identifier, Name and address of identifier__________________________________

____________________________________ ____________________________________


DEPARTMENT OF POSTS

Claim application form for settlement of savings bank account of the deceased

depositor

(Where the claim is preferred by legal evidence of heir ship.)

To,

The Postmaster,

……………………………….

Sir,

In connection with the settlement of savings account standing in the name of

(deceased) ……………………………… in the book of ……………………

(Name of post office). I a ,……….. (State the full relationship) of the deceased

who died on hereby claim the payment of the balance at credit of the savings

account No. in support of the claim, I …………………………………… hereby

submit the original/certificate/attested copy of the following documents:

a) A succession certificate granted by ……………………... under No. …………...

dated …………………….

b) Probate of will granted by…………………………………………. dated ……

c) Letters of administration of estate of the deceased granted by ………………….

No. ………………… dated ……… ….. Under No. ……………………..

Under ………………………….

Address:

Dated …………………… (Signature of claimant)

Certificate by two witnesses

We hereby certify that the person who has applied and put his signature to the

application for the payment is the real claimant and same person in whose favour

the succession certificate/probate of will/letters of administration has been granted

by the court.

Date:

Signature, name and address

Date:


TO BE FILLED IN BY POST OFFICE.

Certified that I am satisfied that the legal evidence of heir ship produced by the

claimant is Genuine and that certificate/probate of will/letter of administration.

Date stamp Signature of postmaster


DEPAARTMENT OF POSTS

Claim application form for settlement of savings Certificates of the deceased

holder (Where the claim is preferred by legal evidence of heir ship.)

To,

The Postmaster,

……………………………….

Sir,

In connection with the settlement of Post Office Savings Certificates standing in

the name of (deceased) ……………………………… in the book of ……………

(Name of post office). I ……………………………………… a,……………….

(State the full relationship) of the deceased who died on hereby claim the payment

of the value of the Post Office Savings Certificates details of which given bellow. Details of Savings Certificates

Sl No Sl No of certificates Denomination Date of issue Registration No

Remarks

In support of the claim, I …………………………………… hereby submit the

original/certificate/attested copy of the following documents:

a) A succession certificate granted by ……………………... under No. …………...

dated …………………….

b) Probate of will granted by…………………………………………. dated ……

c) Letters of administration of estate of the deceased granted by ………………….

No. ………………… dated ……… ….. Under No. ……………………..

Under ………………………….

Address:

Dated …………………… (Signature of claimant)


Certificate by two witnesses

We hereby certify that the person who has applied and put his signature to the

application for the payment is the real claimant and same person in whose favour

the succession certificate/probate of will/letters of administration has been granted

by the court.

Date:


Date:


TO BE FILLED IN BY POST OFFICE.

Certified that I am satisfied that the legal evidence of heir ship produced by the

claimant is Genuine and that certificate/probate of will/letter of administration.

Date stamp Signature of postmaster


SB-84 ANNEXURE-5

[See Para 56 (4) (i)]

DEPARTMENT OF POSTS

Post Office Savings Bank/Savings Certificate claim application where no

nomination exists or legal evidence is not produced

Instructions for filling up the form

(1). The form must be filled in by the person who is entitled under the Hindu

Succession Act or Indian Succession Act or any act under the Mohammadan Law.

(2) The consent/dissent statements of all near relatives should be attached to the

claim. (3) Payment will be made only at the office where the account/certificate

stands. (4) Amount can be remitted by crossed cheque on the request of the

claimant.

1. I, ……………………………………………………. (name of the claimant)

hereby claim the proceeds of P.O. Savings / MIS /RD/TD//NSS Account

No....................P.O. Savings Certificate Type No(s) amounting to Rs………….

Rupees ………………………………………………………. standing/registered

at ………………P.O. ………………………. under HPO in the name(s)

of......................................................................

(Deceased holder(s) who died on ……………… at place………………………….

1. The particulars of the near relatives (including claimant) left behind by the

deceased depositor/holder are given below:-

2.

SI.

No.

Name Age Relationship to

the deceased

depositor/holder

Address

The minor(s) at item No.(s) above are living with …………………………………

and maintained by ........................................


3. The documents listed below are attached in support of my claim.

(i) Pass Book/Savings Certificates or receipt for the Pass Book/Savings

Certificates.

(ii) Death Certificate of the depositor/holder from a Municipal/Local Authority

/Hospital/Police Station. When death occurs at a place where none of these

institutions or authorities exist, a certificate from a Gazzetted Officer, MP/MLA or

Panchayat Officer or Mukhiya, Village Police Patel or certificate from a last

employer or the doctor or Hakim who last attended the deceased depositor, in case

where the balance does not exceed Rs 250/-

(iii) Statements of consent from the near relatives left behind by the depositor as

mentioned against item NO.2 above. (iv) A guardianship certificate OR behalf of

the minor relatives of the deceased depositor (if the claimant is not a guardian

under the law applicable to him).

4. To the best of "my information, the deceased did not operate/hold any other

account certificate (if he had one, give details).

5. In case of Account/Certificate pledged as Security Deposit, I am enclosing

Release Authority NO …………………., dated ……………… of the pledgee.

Date ……………… Signature of claimant ……………………………

Name (in Block Letters) .......................................

Address …………………………………………

DECLARATIION

I, the above said do here by declare on oath/solemn affirmation that each and all

the particulars stated above are true and correct to the best of my knowledge and

belief and that nothing has been concealed therein.

Date…………… Signature of claimant …………………….

Name (in capital letters).............................

Above said Shri/Smt. ……………….. …………………. is personally known to

me/identified before me by Shri/Smt. …………………………….. and has made

before me the above declaration on oath/solemn affirmation this ……… day of

20........

Signature .............................................

Name (in block letters).......................

Designation stamp ""''''''''''''''''''


Note 1:- The above declaration may be made before (a) Postmaster/Departmental

Sub Postmaster/Superintendent of Post Offices/Regional Director Postal

Services/Head of the Circle.

Note 2:- The claimant’s statement should also be signed in the presence of the

authority before whom the declaration is made. If the above declaration is not

made, the statement of the claimant should be attested by one of the authorities

mentioned in Note-3 below in the following form and also the certificates and

statements accompanying should be attested by that authority. Certified that the claimant is known to me and the above statement made by

him is, to the best of my knowledge and belief Correct.

Date ………………….. Signature .................................................

Name (in block letters)............................

Designation stamp...................................

Address ..................................................

Note 3:- The above certificate may be signed by a Gazzetted Officer,

President (of the Local Municipal Board, Gram Panchayat, Block Development

Officer, Sarpanch, Chief Executive Officer of the Municipality, Corporation,

Justice of Peace, Member of Parliament, member of Legislative Assembly or a

Postal officer not below the rank of an Inspector of Postal Offices.

Certified the signature of the attesting authority Shri..............................................

Signature…………………………………

Name (in block letters)..............................

Designation stamp.....................................

Of the Postal Officer

Date...........................................................

Note 4:- In case the claimant makes a declaration on oath/solemn affirmation

before the sanctioning authority or a Judge, Magistrate or other authority

empowered under the law to administer oath or take evidence. The statement need

not be certified by any of the above persons. The certificate is necessary only in

cases the claimant is unable to make a declaration on oath/solemn affirmation. The

documents mentioned in item-3 of the application form should also be attested by

the certifying authority.


CONSENT/DISSENT STATEMENT I ……………………………………………….. (Name of the deponent) son

of Shri ……………………………………… (Here state the full relationship)

…………….. to Shri (name of the deceased holder) depositor of

P.O. Savings Bank Account No......................... Postal Certificates No. (s)

………….. ...... ......................................... issued from …………………… (Post

Office) of the total value of Rs ………………….. hereby consent/dissent* to the

payment of the amount being made to (name of the claimant).

My age is …………….. Years.

The above statement has been made in presence of two under noted witnesses.

* State the nature of objections prescribed below.

Date ……………………………. Signature ……………………………

Of the Deponent

Name (in block letters) .................................

Address .........................................................

The above statement was made by (name ………………………………………………..

(Name of the Deponent ) who is personally known to us.

Witnesses :-

1. Signature…………………… 2. Signature…………………… ………….

Name (in block letters)................ Name (in block letters) .................................

Address ............. Address. ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

…………………………………… ……………………………………………

Date........................................ Date ……………………………………..


REPORT ON THE SAVINGS CERTIFICATE (S) BELONGS TO DECEASED HOLDER

1) Name of Post Office where certificate(s) stands:- 2) No of certificate(s):- 3) Registration No and date of issue:- 4) Full name and address of deceased holder:- 5) Current balance of the savings certificate(s) 6) Whether certificate(s) pledged as security:- 7) Whether certificates attached by court of law:- 8) Whether savings certificate(s) stands undischarged:- 9) Whether savings certificate(s) lying with claimants:- 10) Whether any nomination is in force in respect of the savings certificate(s):- Date: - Signature of the Sub Postmaster


Form No. SB 25

DEPARTMENT OF POSTS

BOND OF INDEMNITY

[To be executed by heirs of deceased Savings Bank Depositors and deceased

Holders of Post Office Savings Certificates]

Know all men by these presents that we (a)*…………………………………

………………………………*(a) Principal ………………………………………

and (b) ……………………………………………………….. *(b) Surety and (c)

**……………………... Surety and held and firmly bound unto the President of

India in the sum of rupees ………………………. …………………………of

lawful money of the Indian Union to be paid to the said President of India, his

certain attorneys, successors, or assigns for which payment well and truly to be

made we bind ourselves, our heirs, executors, administrators and representatives

jointly and every two of us bind ourselves, our heirs, executors, administrators and

representatives jointly and each of us bind himself, his heirs, executors,

administrators and representatives severally firmly by these presents sealed with

our respective seals dated this……………………………. day of ………………in

the Christian year two thousand and ………………………

Whereas the above bounden (a) ……………………………………………

hath caused to be represented to the said President of India that he is*……………

to ………………………………………………………………. of

………………………… deceased who died on the …………………………. day

of 20….. , leaving an amount of ……… ………………………………………Post

Office Savings Bank Account No……………………. Rs…………………… in

Post Office Savings Certificate (s) No. (s) ……………………………… at

……………………………… Post Office and whereas the said (a)- has applied to

the Postmaster General/Director of Postal Services for the payment to him as such

as aforesaid of the amount so standing to the credit of the said ……………………

…………………………deceased in Post Office Savings Bank Account No . . . .…

standing at "…………………..,Post Office Savings certificate (s) No. (s)

……………………………………………………………………….. Post Office as

aforesaid the President of India has on the aforesaid representation of the (a)

………………………………………………… acceded to the said application on

condition of the said (a)………………………………………………………….

and two sufficient sureties executing such bond as above written and the said (b)

……………………………………………. and (c) ………………………………

have accordingly as such sureties agreed to execute the said bond with such

condition as hereunder written.


Now the condition of the above written bond is such that if the above

bounden (a)……………… …………………. his heirs, executors, administrators

and representatives do and shall when required so to do repay to the said President

of Indian, his successors or assigns the amount so paid to the said (a) together with

all cots as between Attorney and Client and all charges, losses damages and

expenses that shall or may have been incurred by or occasioned to the said

President of India, his successors or assigns or any of the servants of the

Government by reason of or consequent upon the payment to the said

(a) of the amount so standing to the credit of the said deceased in the above

mentioned Savings Bank Account ………………………….. Post Office Savings

Certificate (s)………………………. and further if the said (a) ……………………

and (b)……………………… …………………….. and (c) ………………………

their heirs, executors, administrators and representatives, shall and do from time to

time and at all times hereafter well and sufficiently save, defend, keep harmless

and indemnified and said President of India, his successors and assigns and the

officers and servants of the government and each and every of them or from and

against all and all manner of action or actions, suit and suits and other legal

proceedings, costs, charges, damages and expenses whatsoever which shall or may

at any time or times hereafter be brought, commenced or sued by any person or

body corporate whomsoever or whatsoever against or happen or be occasioned to

the said President of India his successors or assigns or any of the officers or

servants of the Government for or on account or in respect of or by reason of the

amount so standing to the credit of the said ………………………………………

deceased in the above mentioned. Saving bank Account/Post Office Savings

Certificates (s) been paid to the said (a) then the above written bond shall be void

and of no effect otherwise the same shall be and remain in full force and virtue

provided always and it is hereby expressly declared and agreed by the said

(a)…………………………………… and (b) ……………………………………

and (c)………………………………………… with and to the said President of

India, his successors and assigns that in the defence and prosecution of any, action,

suit or other legal proceedings referred to in the foregoing clause for indemnity or

maintained in virtue thereof the President of India, his successors or assigns shall

not be responsible or accountable to the said (a) …………………………………

and (b) ………………………………and (c) …………………………………… or

any or either of them, their or any or either of their heirs, executors, administrators

and representatives for any act, omission or mistake in the defence or prosecution

of such action, or other legal proceedings and that in the defence or prosecution of

such action, suit or other legal proceedings the said President of India, his

successors or assigns and his and their officers and servants shall be required to do


such acts and take such steps only, as shall in that behalf be approved and advised

by the Law Officers of the Government.

Signed, sealed and delivered by the Seal

Above named (a) ………………………………………………

in the presence of (To witnesses to sign here)


Above named (b) in the presence of(Two witnesses to sign here)


Above mentioned (c) in the presence of (Two witnesses to sign here)

ACCEPTED

Station

Date Signature

* Designation


* The Postmaster (Gazzetted)/Senior Supdt. of Post Offices/Supdt. of Post Offices

is competent to sign this Bond for and on behalf of the President of India.[D.G. P

& T letter No. 35-30/84-SB dated 24.7.1984]

Note 1: Indemnity Bond will be for the total amount payable on the date of

discharge or on the date of maturity or at the end of extended period of maturity

permissible under rules as the case may be. The checks prescribed in Note (1)

below Rule 43 (2) shall apply mutates mutandis.

[D.G. P & T letter No. 93-5/81-SB dated 4-3-1983]

Note 2: The surety should be adequately solvent. The Postmaster may require

production of solvency certificate where he is not personally satisfied. Solvency of

a surety if he is an employee of the Central or State Government or of a local body,

Government aided educational institution, the Reserve Rank of India, a public

sector undertaking or any other body controlled by the government, to the extend

of his salary for 12 months excluding allowances, as certified by the employer is

acceptable. In other cases, the solvency certificate should be from the revenue

authority having jurisdiction over the estate of the surety.

[D.G. P & T letter No. 93-5/81-SB dated 9.11.1982


DEPARTMENT OF POSTS

Sanction Memo

To, _____________________ From, _____________________

_______________________ _______________________

NO: SB/ /DD/ 20 - Dated at ………………….. The / / 200

Sir/Madam, Date: ________________

Sanction of the undersigned is hereby accorded to the payment to you of Rs -------

(Rupees________________________________________________________) Only being the balance

inclusive of interest at credit of the post office Savings Account No ______________standing at …………..

Post Office in the name of late ___________________________________ who is reported to have died

on ______________________.

2) The amount mentioned together with interest which has since accrued thereon on the

account (up to the close of the last month) will be paid to you on your making application direct to

Postmaster concerned through …………………. post office on surrendering the original sanction order.

3) Interest will also be allowed on the account of the deceased depositor from the beginning of

the month in which the sanction is issued up to, the close of the month preceding the one in which

payment is actually effected only if the balance in the account of the deceased or the share thereof to

which you are entitled together with balances, if any in other savings accounts held in your name or

balances of your share in joint accounts held by you does not exceed Rs. 1,00,000/-and you should

furnish a declaration to the post office that the amount payable out of the balances in the account of

the deceased together with the balances of your account or share in joint accounts held by you does not

exceed Rs. 1,00,000/- The passbook of Savings bank account no ----------- is enclosed herewith.

4) The pass book is returned herewith. This is valid for one year from the date of issue.

Yours faithfully,

(Sanctioning Authority)

Copy forwarded to:

1) The Postmaster____________________ for information and necessary action. This has a

reference to his letter No ___________________________dated _____________The date of

payment should be reported.2) The Sub Postmaster ______________________ for necessary

and reporting the date of payment. 3) The I/C S.B. Control organization _______________ Head

Post Office. No other accounts in the name of the deceased depositor failing under the

Government Savings Banks Act, 1873 have come to notice.

Sanctioning Authority


NC-35

DEPARTMENT OF POSTS

Sanction Memo (KVP/NSC)

To, From,

_____________________ _____________________

_____________________ _____________________

NO:

Sir/Madam, Date: ________________

Sanction of the undersigned is hereby accorded to the payment to you the amount due on the

postal savings certificate(s) detailed below standing in the name of

___________________________________ who is reported to have died on ______________________.

The amount due will be paid to you on your presenting the savings certificate(s) duly receipted

for payment at the _________________ post office on surrendering the original sanction order.

You are however, at liberty not be accepted payment of amount due on savings certificate(s)

before the date of maturity entered therein in which case the savings certificates(s) in question shall be

transferred to your name subject to the conditions laid down in the rules governing the savings

certificate(s) in question.

The sanction is valid for accepting payment or for getting the certificate(s) transferred in your

name for a period of one year only from the date of its issue.

Sr.

No.

Sr. Nos. of postal

savings certificates

Denomination Date of issue Registration

No. (s)

Office of

registration

Yours faithfully,


Copy forwarded to:

i) The Postmaster/SPM ____________________________ Post Office. The date payment may be communicated as soon as the payment is effected.

ii) The director/Dy. Director of Postal Accounts ______________. The current value of PO certificate(s) does not exceed Rs. ________________ (Limit of sanctioning authority) as per claimant’s statement.



DEPARTMENT OF POSTS

Sanction Memo (MIS)

To, From,

_____________________ _____________________

_____________________ _____________________

NO: SB/ /DD/ 20 - Dated at ……………… the / / 200

Sir/Madam, Date: ________________



inclusive of interest at credit of the post office MIS Account No ______________standing at

………………….. Post Office in the name of late ___________________________________ who is reported

to have died on ______________________.

The amount mentioned together with interest which has since accrued thereon on the account

(up to the close of the last month) will be paid to you on your making application direct to Postmaster

concerned through DASGAON post office on surrendering the original sanction order.

You are entitled to the interest up to the month proceeding the MIS month the account will be closed

on receipt of this sanction. MIS rules do not have the provision to continue the account by the

nominee/Legal heir. Bonus on maturity is also admissible irrespective of the fact that the account holder

is/was alive or not on the date of maturity. Post maturity interest is applicable at savings account rate

for a maximum period of two years from the date of maturity. The passbook of MIS account no -----------

is enclosed herewith.

This sanction is valid for a period of one year from the date of issue.

Yours faithfully,


Copy forwarded to:

1)The Postmaster____________________ for information and necessary action. This has a reference to

his letter No ____________________________dated _____________The date of payment should be

reported.

2) The Sub Postmaster ______________________ for necessary and reporting the date of payment.

3)The I/C S.B. Control organization _______________Head Post Office. No other accounts in the name

of the deceased depositor failing under the Government Savings Banks Act, 1873 have come to notice.



DEPARTMENT OF POSTS

Sanction Memo (TD)

To, From,

_____________________ _____________________

_____________________ _____________________

NO: SB/ /DD/ 20 - Dated at …………………. the / / 200

Sir/Madam, Date: ________________



inclusive of interest at credit of the post office Time Deposit Account No ______________standing at

…………………….. Post Office in the name of late ___________________________________ who is

reported to have died on ______________________.

The amount mentioned together with interest which has since accrued thereon on the account

(up to the close of the last month) will be paid to you on your making application direct to Postmaster

concerned through DASGAON post office on surrendering the original sanction order.

You are entitled for the interest applicable to the time deposit account for the period for which the

deposit has remained with the Post Office. Interest is also admissible up to 24 months beyond the

maturity date at the rate applicable to saving account. The passbook of TD account no ----------- is

enclosed herewith.

The sanction is valid for a period of one year from the date of issue.

Yours faithfully,


Copy forwarded to:



reported.



of the deceased depositor failing under the Government Savings Banks Act, 1873 have come to

notice.Sanctioning Authority


DEPARTMENT OF POSTS

Sanction Memo (RD)

To, From,

_____________________ _____________________

_____________________ _____________________

NO: SB/ /DD/ 20 - Dated at ……………………… the / / 200

Sir/Madam, Date: ________________



inclusive of interest at credit of the post office Recurring Deposit Account No ______________standing

at ………………… Post Office in the name of late ___________________________________ who is

reported to have died on ______________________.

You will be entitled to receive interest as per provision of Rule 12 of Recurring Deposit Rules 1981.You

may also continue the account if desired on furnishing an application in form SB-3with specimen

signature slips. The passbook of RD account no ----------- is enclosed herewith.

This sanction is valid for a period of one year from the date of issue.

Yours faithfully,


Copy forwarded to:



reported.



of the deceased depositor failing under the Government Savings Banks Act, 1873 have come to notice.



REPORT FOR SUB OFFICE SAVINGS BANK DEATH CLAIM CASES 1. Name of Post office where the account stands:- 2. Account No:- 3. Is it an ordinary account? 4. Is it a minor account? 5. Is it a Security Deposit account? 6. Is it interest bearing account? 7. Full Name and Address of the deceased Depositor 8. Balance (including Interest of credit of the account on date of death of the depositor’s i.e. ……………………….. 9. Is the balance of credit attached with Court of Law? 10. What is the present balance up to the end of the month of submitting the claim to sanctioning authority? 11. What is the date of last tranction? 12. Whether the account is treated as silent and if so from when? 13. Full particulars of Govt. Security (if any) held by the deceased depositor. 14. If any nomination in force in respect of the account, if so full particulars there should be furnished. Date ……………………… Date stamp Signature of Postmaster. ------------------------------------------------------------------------------------------------------------- No- /20 -20 /dated at …………………….. the ……………………… Forwarded to the …………………………………………………. ………………………………………………………….

Signature of Postmaster.


Daily T.D.S. Deduction statement Dated ………………… Name of Agent: ………………………………………………… Agency No: ……………..….. Valid up to: ………………………………….. Name of PO where amount deposited ……………………………….

Particulars of deposit

Amount of deposit

Amount of commission paid

Amount of TDS credited

Signature of SPM

N.SC.

K.V.P.

MIS

T.D

S.C.S.S

R.D.

TOTAL

Certified that the amount of TDS shown above has been recovered from above agent and credited to Government account on (date) Dated: Place: Signature of Sub Postmaster

Daily T.D.S. Deduction statement

Dated ………………… Name of Agent: …………………………………………………… Agency No………………… Valid up to: ………………………………….. Name of PO where amount deposited:

Certified that the amount of TDS shown above has been recovered from above agent and credited to Government account on (date) Dated: Place: Signature of Sub Postmaster

Particulars of deposit

Amount of deposit

Amount of commission paid

Amount of TDS credited

Signature of SPM

N.SC.

K.V.P.

MIS

T.D

S.C.S.S

R.D.

TOTAL


Est.-95

Signature of Applicant___________________________

Medical Certificate for non-gazzetted officers recommended for leave or

extension or commutation of leave

I ____________________________ after careful examination of the case hereby certify that Shri/Smt. ___________________________________ whose signature is given above is suffering from ______________ and I consider that a period of absence from duty of _________ days with effect from -------------- is absolutely necessary for the restoration kof his health. Date_________________ Govt. Medical Attendant Or Registered Medical Practioner (No ---------)

Signature of Applicant _____________________

Medical Certificate of fitness to return to duty

I __________________________ civil surgeon of/ registered Medical Practioner of do hereby certify that I have carefully examined Shri/Smt. _________________________________ of department of Posts, India whose signature is given above and find that he has recovered from his illness and is now3 fit to resume his duties in Government Service. I also certify that before arriving at this decision I have examined the original Medical Certificates and statements of the case ( or certificated thereof ) on which leave was granted or extended and have taken these into consideration is arriving at my decision. Date ___________________ Govt. Medical Attendant Or Registered Medical Practioner (No _______


CHARGE REPORT This is to certify that charge of the office of Was made over by (name) To (name) at (place) on the (date) Fore/ after noon in accordance with No. Dated from Certified that the balance of this date of the several books (including stock book and registers) and accounts of the office have been checked and found correct. Certified that the balances as detailed bellow were handed over to me by the relieved officer and I accept responsibility for the same. A) Cash Rs. B) Stamp imprest Relieved Officer Relieving Officer No- / /20 -20 /dated at …………………… the ……………………………….. Forwarded to 1) 2) 3) 4)


FORM NO 16A

[See rule 31(1) (B)] Certificate of deduction of tax at source under section 203 of the Income Tax Act, 1961.

For interest on securities; dividends; interest other than interest of securities; winnings fro lottery or crossword puzzle; winning from horse race; payments to contractors; and sub contractors; insurance commission; payments to non resident sportsman/sports associations; payment in respect of deposits under National Savings Scheme; payments on account of repurchase of units by Mutual fund or Unit Trust of India; commission, remuneration or prize on sale of lottery tickets; rent; fees for professional or technical services; income in respect of units; other sums under section 195;income of foreign companies referred to in section 196 a(2); income from units referred to section 196B; income from foreign currency bonds or shares of an Indian company referred to in section 196C; income from foreign institution Investors from securities referred to in section196D.

Name and address of the person deducting tax

TDS circle where Annual Return under section 206 is to be delivered

Name and address of the person to whom payment made or in whose

account it is credited

TAX DEDUCTION A/C NO OF THE DEDUCTOR

NATURE OF PAYMENT PAN/GIR OF PAYEE

PAN/GIR NO OF DEDUCTOR FOR THE PERIOD …………………… TO ………………………

DETAILS OF PAYMENT, TAX DEDUCTION AND DEPOSIT OF TAX INTO CENTRAL GOVERNMENT ACCOUNT

Date of Payment /credit

Amount paid / Credited Rs.

Amount of Income Tax deducted (Rs.)

Rate at which deducted

Date and challan no of deposit of tax into Central Government Account

Name of Bank and branch where tax deposited

Certified that a sum of Rs…………………. (Rupees ……………………………………………………………………………………….) has been deducted at source and paid to the credit of the Central Government as per details given above. Signature of person responsible for deduction of tax Place ……………………………………………… Full Name ……………………………………………………………………. Date ………………………………………………. Designation …………………………………………………………


M.O. 10(A)

Month Stamp

Oblong MO Stamp A.O. Stamp

MEMO OF ADMISSION OF PAYMENT

1. Office of Issue………………………………………………………......................................................................

2. No. and Date of lost Money Order …………………………………………………………………………………………..

3. Amount of Order …………………………………………………………………………………………………………………….

______________________________________________________________________________

4. Name of Remitter (If Known) …………………………………………………………………………………………………

5. Name of Payee ………………………………………………………………………………………………………………………

6. Office of Payment ……………………………………………………………………………………………………………………

7. Date of Payment of original Order …………………………………………………………………………………………..

Counter Signed

Postmaster of ……………………….. (Office Payment)

I admit that I have received the amount of the money order noted on the reverse.

* Signature of Witness Signature of Payee

*When payee is illiterate, not known to the post office or postman or lives in village outside the

post-town.

Date Stamp of office of issue

Date Stamp of office of Payment

Oblong MO stamp on payment


MO 10 (B) DEPARTMENT OF POSTS, INDIA.

To,

Shri/Smt. ……………………………………………………..

…………………………………………………………………………….

(Name and address of Remitter of MO)

Name Stamp of office of Dispatching Office

______________________________________________________________________________

CERTIFICATE OF PAYMENT

Your letter No………………….. Dated the …………………………………………

I hereby certify that Money Order NO …………………………………. dated the ………………………

for Rs. ………………………………………… issued by ……………………………………… Post office was paid on

………………………………………….

Date Stamp of office of Payment Signature of Postmaster.


MO 35

From,

The ……………………………………………….

…………………………………………………………………..

To,

The Director /Dy. Director, Audit and Accounts,

Posts and Telegraphs…………………………………………………

No ………………… dated ……………………….. the ……………………………………………..

sir,

I am to request you kindly to forward the paid Money Order described bellow of this

office.

Name and office of issue(When the office of issue is a S.O., its B.O. should be added in brackets after it)

No and Date of Money Order

Amount Office of Payment

Date of Payment

(if known)

Rs. Ps.

Yours faithfully,


MO 12

______________________________________________________________________________

MO 11 NOTICE TO PAYEE

A money order for Rs ………………………………… issued by the ………………………… Post office

in your favour has been received by the office. Please call personally or send an agent

authorised in writing to sign the money order, to receive payment of the above amount. the

acknowledgement for the money order ( to be returned to the remitter) is sent herewith, and

should be presented at the Post Office along with this notice by yourself or by your agent when

Appling for payment of the order.

Should you preferred to return this notice duly endorsed with a receipt of payment,

together with the acknowledgement duly signed through an ordinary messenger, the amount

of the money order will be paid to the person who presents these documents on your behalf.

Payment of the money order will be made only after Postmaster is satisfied about the

identity of the payee.

Yours faithfully,

Money Order Stamp Postmaster

Round MO stamp of

Redirecting office

MO 12 DEPARTMENT OF POSTS, INDIA

Redirected Money Order

To

The Postmaster,

-------------------------------------------------------------

Round MO stamp of

office of Payment.


MO 66


H.O. Journal of Indian Postal Orders paid during the month of …………………………….. 20

Date Denomination Sl. No. Value of order

Value of Postage stamps affixed to make up broken

amount

Number of Indian Postal Order

Total Value (Total of

columns 4 and 5)

1 2 3 4 5 6 7


Òçí<çkçÀ:-

ÞççÇ/ÞççÇcççÆlç

----------------------------

----------------------------

çÆovççbkçÀ;-

ÒççÆlç:-

cççvççÆvç³ç [çkçÀHççuç,

DççÆuçyççiç ÒçOççvç [çkçÀIçj,

DççÆuçyççiç-jç³çiç[ 402201.

çÆJç<ç³ç:- mçáHlç Kççlçí Hçávç: ®ççuçá kçÀjCçí yççyçlç.

cçnçío³ç,

cççP³çç vççJççJçj -------------- [çkçÀIçjçcçO³çí Kççlçí ¬çÀcççbkçÀ

--------------- ®çí yç®çlç Kççlçí Dççní. l³çç Kççl³ççcçO³çí cçççÆiçuç çÆlçvç DçççÆLç&kçÀ Jç<çç&bcçO³çí kçÀçíCçlççnçÇ J³çJçnçj vç

kçíÀu³ççcçáUí yçbo Hç[uçí Dççní.l³çç yç®çlç Kççl³ççcçO³çí cççÇ Hçjlç J³çJçnçj ®ççuçá kçÀ© F®sçÇlç Dççní. lçjçÇ kçÀ=Hç³çç cçuçç

mçoj Kççlçí Hçávç: ®ççuçá kçÀ©vç çÆcçUçJçí nçÇ çÆJçvçblççÇ.

DççHçuçç/DççHçuççÇ çÆJçéççmçá


STATEMENT OF D.A. ARREARS PAID TO SWEEPER AND WATERWOMAN AT…………………………..

FOR PERIOD FROM ………………….TO ……………………………….

Name of

Sweeper/Water

woman

Basic

Allowance

Amount

of D.A.

Paid

Amount of

D.A. Due

Difference

between

amount

paid and

due to pay

Amount

of

arrears

paid

Total

arrears paid

1 2 3 4 5 6 7 8 9 10

TOTAL


Òçí<çkçÀkçÀç vççcç Dçíçíj Hçlçç

-----------------------------

-------------------------------

---------------------------------------

ÒççÆlç,

cççvççÆvç³ç GHç[çkçÀHççuç,

----------------[çkçÀIçj.

çÆJç<ç³ç:-cçvççÇDçç@[&j/jçÆpçmìj Hç$ç HççvçíJççuçíkçÀçí vç çÆcçuçvçíHçj çÆMçkçÀç³çlç.

cçnçío³ç,

cçÌvçí DççHçkçíÀ [çkçÀIçjmçí cçvççÇDçç@[&j/jpççÇmìj Hç$ç Yçípçç/YçípççÇ Lçç/LççÇ çÆpçmçkçÀç y³ççÌjç çÆvç®çí çÆo³çç nÌ

Jççí HççvçíJççuçíkçÀçí DççpçlçkçÀ çÆcçuçç/çÆcçuççÇ vçnçÇ nÌ

1) cçvççÇDçç@[&j/jpççÇmìj Hç$ç ¬çÀcççbkçÀ:-

2) YçípçvçíkçÀçÇ çÆovççbkçÀ:-

3) cçvççÇDçç@[&jkçÀçÇ jkçÀcç:-

4) HççvçíJççuçíkçÀç vççcç DççÌj Hçájç HçÊçç:-

kç=ÀHç³çç DççHç FmçkçÀçÇ pçç®ç kçÀjí DççÌj Jçn cçvççÇDçç@[&j/jçÆpçmìj lçájblç çÆcçuçvçíkçÀç ÒçyçbOç kçÀjí

DççHçkçÀç YçJççÆo³ç

To:- The Manager, Computerized Customer Care Centre, Alibag-Raigad ,402 201. No/ / / Dated / /20 Forwarded for necessary action please. Sending particulars :- 2) Number of Money Order/Register Letter:- 3) Date of booking :_ 4) Name of Office of booking:- 5) Amount of Money Order:- 6) Name and address of Remitter / Sender :- 7) Name and address of Payee / Addressee :-


From:-

To: - The Sub Postmaster/Postmaster,

_________________________

__________________________

________________________________________________________________________

No- / / Dated at _____________the

________________________________________________________________________

Subject: - Issue of duplicate money order.

Reference: -The Superintendent of Post offices Raigad Division, Alibag, Dist, Raigad, No-

Respected Sir,

Please find herewith a duplicate money order no dated

For Rs ______/-(Rs___________________________________________ ) in favor of Payee/Remitter

Shri/Smt._________________________________________________

_____________________________________________________________________

At your risk. Please read rule no 74 of Post Office Manual VI Volume II and act the needful.

PLEASE AVOID DOUBLE PAYMENT and intimate the date of payment to The

Superintendent of Post offices Raigad Division, Alibag, Dist, Raigad 402 201. and also to this office.

Thanking you,

Yours faithfully,

Copy to: -

1) The Superintendent of Post offices Raigad Division, Alibag, Dist, Raigad, 402201.for information with reference to his above mentioned letter.

2) The Superintendent /Senior Superintendent of Post Offices, _______________________________________________________________

3) Office copy.


UNSOLD STOCK STATEMENT OF 6 NSC (VIII) AT …………………… S.O.

FOR THE MONTH OF __________200

PLACE-DASGAON

DATE-- SUBPOSTMASTER, …………………..

------------------------------------------------------------------------------------------------------------

UNSOLD STOCK STATEMENT KISAN VIKAS PATRAS AT………………… S.O.

FOR THE MONTH OF __________200

PLACE-DASGAON

DATE-- SUBPOSTMASTER,……………………………………….

DENOMINATION SL NOS OF CERTOFICATES TOATL IN STOCK

RS 100

RS 500

RS1000

RS 5000

RS 10000

TOTAL

DENOMINATION SL NOS OF CERTOFICATES TOATL IN STOCK

RS 100

RS 500

RS1000

RS 5000

RS 10000

TOTAL


UNSOLD STOCK STATEMENT OF INDIAN POSTAL ORDERS

AT …………………………..S.O. FOR THE MONTH OF_________200

DENOMINATION SL NOS OF IPOS TOTAL

00.50

1.00

2.00

5.00

7.00

10.00

50.00

100.00

PLACE-

DATE-- SUBPOSTMASTER,……………………….

------------------------------------------------------------------------------------------------------------

UNSOLD STOCK STATEMENT OF INDIAN POSTAL ORDERS

AT ………………… S.O. FOR THE MONTH OF_________200

DENOMINATION SL NOS OF IPOS TOTAL

00.50

1.00

2.00

5.00

7.00

10.00

50.00

100.00

PLACE-

DATE-- SUBPOSTMASTER, …………………


FORM”A”

APPLICATION FOR CHANGE OF NOMINATION

(To be copied on the back of the policy document)

I (Full Name) ___________________________________________________________

The assured under within written policy hereby nominate in terms of Section 39 of the

Insurance Act. Mr/Mrs (Full Name)

__________________________________________________ Relationship

_______________________________________________________ aged _______________

years residing at ________________________ to be the person to whom money secured by the

within policy shall be paid in the event of my death lieu of (Name within policy)

_____________________________

(Full Name) Named in the endorsement of the policy No ______________________________

dated at (Place) ________________ the ____________ day of ______________________ 200

Witness Signature:-

Full Name :- _______________________________ Signature of Policy holder

Occupation :- ______________________________ Signature of the New Nominee.

Address __________________________________

___________________________________


DEPARTMENT OF POSTS, INDIA OFFICE OF THE Sub Post Master, …………………., Dist. - Raigad To, The Branch Manager, STATE BANK OF INDIA, ………………………………………….. BRANCH. No- / / dated at …………………… the Subject: - Intimation for drawing of crossed Cheque. Respected Sir, Following crossed cheques have been drawn as per details given bellow today.

Sl. No

Sl. No of Cheque Date of issue

Name of Payee Amount of Cheque Remarks

Yours faithfully

Copy to The Postmaster, Alibag


OFFICE OF THE Sub Post Master, …………………., Dist. - Raigad To, The Branch Manager, STATE BANK OF INDIA, ………………………………………….. BRANCH. No- / / dated at …………………… the Subject: - Intimation for drawing of crossed Cheque. Respected Sir, Following crossed cheques have been drawn as per details given bellow today.

Sl. No

Sl. No of Cheque Date of issue

Name of Payee Amount of Cheque Remarks

Yours faithfully

Copy to The Postmaster, Alibag


FORM FOR APPLICATION FOR LEAVE

(See supplementary rule 216)

Note:- Items 1 to 11 must be filled in by the applicant whether gazetted or non-gazetted

1. Name of applicant:-

2. :eave rules applicable:-

3. Post held:-

4. Department, Office, and section:-

5. Pay:-

6. House rent allowance, conveyance allowances, or compensatory

7. Nature and period of leave applied for and date from which required:-

8. Sundays and holidays, if any proposed to be prefixed/suffixed to leave

9. Ground on which leave is applied for:-

10. Date of return from last leave, period of that leave:-

11. I propose/do not propose to avail myself of leave travel concession in the block years ----

---- during the ensuring leave.

1. I undertake to refund the difference between the leave salary drawn

during leave on average pay/commuted leave and that admissible

during leave on half average pay/half pay leave, which would not

has been admissible had the provision F.R. 81(b)(ii) of the revised

Leave Rules, 1933, not been appl9ed in the event of my

retiarement from service at the end or during the currency of the

leave.

2. I undertake to refund the leave salary drawn during “leae not due”

which would not hae been admissible had A.R 81(c)/rule 11(d) of

the Revised Leave Rules, 1933 noty been applied, in the event of

volantary retirement of resignation from, at any time until I eatrn

half pay leave not less that the amount of leave not due availed of

by me. Date …..........................

Signature of applicant

Remarks and or “recommendation” of the controlling officer.

Date …................................ Signature…..................................................

Designation …................................................

CERTIFICATE REGARDING ADMISSIBILIGTY OF LEAVE

certified that …................. (Nature of leave for …......................... To

….................... is admissible under rule …................. of the …................................... rules.

Date …................................ Signature…..................................................

Designation…................................................

Orders of the sanctioning authority:-

Date …................................ Signature….......................................

Designation …...


YççjçÆlç³ç [çkçÀ çÆJçYççiç

ÒççÆlç,

cççvççÆvç³ç GHç[çkçÀHççuç/ÒçOççvç [çkçÀHççuç,

.........................................

çÆJç<ç³ç:- cçççÆmçkçÀ ÒçççqHlç ³ççípçvçç Kççl³çç®çí ojcçnç çÆcçUCççjí J³ççpç yç®çlç Kççl³ççlç pçcçç kçÀjCçí yççyçlç.

cçnçío³ç,

cççPçí/Dççcç®çí vççbJççJçj ..................... HççímìçcçO³çí cçççÆmçkçÀ ÒçççqHlç ³ççípçvçí®çí/®ççÇ Kççlçí/KççlççÇ

Dççní/Dççnílç,l³çç®çç lçHççÆMçuç KççuççÇ çÆouçç Dççní.mçoj Kççl³çç®çí/Kççl³ççb®çí ojcçnç çÆcçUCççjí J³ççpç

cççP³çç/Dççcç®³çç vççJççJçj ......................... HççímìçcçO³çí DçmçCçç-³çç yç®çlç Kççl³ççcçO³çí pçcçç kçÀjçJçí nçÇ

çÆJçvçbçÆlç.J³ççpç pçcçç kçÀjlççvçç pçj ®çákçáÀvç pççmlç jkçwkçÀcç cççP³çç/Dççcç®³çç yç®çlç Kççl³ççcçO³çí pçcçç PççuççÇ Dççní Dçmçí

Dçç{Uuçí lçj lççÇ pççoç jkçwkçÀcç cççPçí Kççl³ççcçOçávç kçÀç{ávç IçíC³çç®çç DççÆOçkçÀçj cççÇ ³çç Dçpçç&Üçjí DççHçCççmç oílç

Dççní.

cçççÆmçkçÀ ÒçççqHlç ³ççípçvçç Kççl³ççb®çç lçHççÆMçuç

Dçvçá

¬çÀcççbkçÀ

cçççÆmçkçÀ ÒçççqHlç

³ççípçvçç Kççlçí ¬çÀcççbkçÀ

J³ççpç oí³ç

çÆovççbkçÀ

ojcçnç çÆcçUCçç-³çç

J³ççpçç®ççÇ jkçwkçÀcç

yç®çlç Kççlçí

¬çÀcççbkçÀ

1

2

3

4

5

6

7

8

9

10

11

kçÀUçJçí,

DççHçuçç/DççHçuçí çÆJçéççmçá

.................................................

.................................................

(Kççlçíoçjç®ççÇ mçnçÇ, vççbJç Jç HçÊçç )