FORM-1 - Form of Application For Purchase of National Savings Certificates (IX Issue) - National Savings Certificates (IX-Issue) Rules, 2011

FORM-1 (See Rule 6) Serial No. . . . . . . . . . . . . . . . . . . . . . . . . .. FORM OF APPLICATION FOR PURCHASE OF NATIONAL SAVINGS CERTIFICATES (IX ISSUE) To The Postmaster Sir, I/We hereby tender Rs. . . . . . . . . . . . . . . . . . . . .(Rupees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .only) in cash/by cheque No . . . . . . . . . . . . . . . . . . . . . . . . . . . for purchase of National Savings Certificates IX Issue of the type Single/Joint A/Joint B. (a) in the name(s) of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . and . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (b) in case of minor, his/her date of birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . encashable by the minor's parent/guardian Shri/Smt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. I/We nominate the person(s) named below who shall on my/our death, receive payment. Sl. No. Name of Nominee Full Address Date of birth of minor nominee 3. I/We hereby agree to abide by National Savings Certificates (IX Issue) Rules, 2011. 4. The Certificates may be made over to my/our agent Shri/Smt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Authority No. . . . . . . . . . . . . . . or messenger who presents the application. Signature/Thumb impression of Investor Signature and address of Witnesses to nomination Date. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Received the certificate(s) Delete whichever is not applicable Signature of Investor/messenger/authorised agent. Date. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. TO BE COMPLETED BY THE POST OFFICE S.No. of Certificates Issue Price (Rs.) Date of encashment Initials of the Postmaster Remarks like transfer, issue of duplicate, etc. with initials Date. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature of Head/Sub Postmaster