FORM F
[See sub-paragraph (3) of paragraph 12]
STATE BANK OF .
Cancellation or variation of nomination previously made in respect of Account No.
Under the Public Provident Fund Scheme, 1968

Date .
To
The State Bank of
I, the subscriber in Public Provident Fund Account No., hereby cancel the nomination dated made by me in respect of the aforesaid Public Provident Fund Account
In place of the cancelled nomination, I hereby nominate the person(s) mentioned below who, shall on my death, become entitled to the payment of the sum due in the above account to the exclusion of all other persons :-
Sl.No. Name of the
nominee
Full address Date of birth
of the nominee
in case of
minor
Proportionate
amount for each
nominee
To be filled in case of variation only.
@ As the nominee(s) at Serial No.(s) is/ are minor(s), I appoint Shri/
Shrimati/ Kumari [name and full address] as the person to receive the sum due in the above account in the event of my death during the minority of the nominee(s).
@ Delete if not applicable .
Signature/ thumb impression of subscriber
Subscriber’s address:
(1) Witness:
Name:
Address:
(2) Witness:
Name:
Address:
FOR THE USE OF ACCOUNTS OFFICE
The above cancellation/ variation of the nomination has been registered in the ledger and entered in the pass book.
Date .
Signature of the Accounts Officer