FORM G
[See sub-paragraph (1) of paragraph 13]
(To be submitted by the depositor)
[Name of the Deposit Office]
Serial No

Application for closing the account under the Capital Gains Accounts Scheme, 1988 by the depositor

To
The Manager
[Name and address of the Deposit Office]
I, [Name of the Depositor/ Applicant], son of residing at
[Address of the applicant/ depositor] hereby apply in terms of sub-paragraph (1) of paragraph 13 of the Scheme, to close the account/ accounts mentioned below, which is/ are maintained, with your office in my name/ in the name of [Name and address of the depositor]
2. Details of Account/Accounts :
(i) Account-A No Pass book No (ii) Account-B No Deposit Receipt No.
3. I tender herewith the Pass book/ Deposit Receipt mentioned here in above.
4. The application is made by me as guardian on behalf of aforesaid depositor who is a minor and whose date of birth is
5. The application is made by me as authorised officer of the aforesaid depositor, the firm / company/association of persons/body of individuals
6. The application is made by me as karta of the aforesaid depositor a Hindu undivided Family

Signature/Thumb impression of the Depositor/ the Guardian/Karta/Authorised Officer of the
Depositor
Date
Place : Additional specimen
Signature/Thumb impression of the eligible
assessee as referred to in section 54GB of the Act
[applicable in case of section 54GB only]
APPROVED
[Signature (with date) and stamp of Assessing Officer having jurisdiction]
FOR THE USE OF DEPOSIT OFFICE
(Details of Account/ Accounts closed and total amount paid may be recorded)
Date
Officer-in-charge
Notes:
1. Delete whatever is not applicable.
2. Columns 4, 5, 6 pertain to deposit made on behalf of a minor, firm, company, association of persons, body of individuals, a Hindu undivided family. Hence, in case of individual depositor, these columns may be scored out. In other cases, only one respective column may be retained and the remaining two may be scored out.
FORM G - Page No
3. In case the account to be closed pertains to an eligible company as referred to in section 54GB, the from shall also be signed by the eligible assessee referred to in the said section.