FORM 1
[See para 4]

Name and address of Bank Serial No

Form of application for opening an account under Deposit Scheme for Retiring Employees of Public Sector Companies, 1991

Name and Agency No. of Agent introducing the Account
Signature of Agent
To
The Manager,
(Name of the Bank)
(Address)
Sir,
1. I hereby apply for opening an account under the Deposit Scheme for Retiring Employees of Public Sector Companies, 1991 in my name and tender herewith Rs (Rupees) through cheque/pay order/demand draft as the initial deposit Permanent address of depositor
2. I agree to abide by the provisions of the above scheme.
3. I hereby declare that I am not maintaining any other account under the scheme.
4. A copy of certificate from employer indicating retirement benefits is enclosed*. An affidavit on stamped paper, indicating retirement benefits is enclosed (applicable where deposits not exceeding rupees five lakhs).
5. I nominate the persons mentioned below to whom, to the exclusion of all other persons, in the event of my death, the amount standing to my credit in the account would be payable :
Serial
No.
Name(s) of the
nominee(s)
Full Address Date of birth of
nominee(s) in the case of
minor
Proportionate amount for
each nominee
As the nominee(s) at Serial No.(s) above is/are minor(s) I appoint
Shri/Smt./Kumari to receive the sum due under the said account in the event of my
death during the minority of the nominee(s).
Signature of witness . .
Name and address Depositor
Date .
FOR THE USE OF ACCOUNTS OFFICE
The account has been opened on with Rs. under Deposit Scheme for Retiring Employees of Public Sector Companies, 1991. Account No.
Pass Book No. has been issued.
.
Date . Authorised Officer
Delete whichever is not applicable.