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