FORM B
Department of posts
[See rule 10A]
Serial No. .
Form of application for nomination under section 6 of the Government Savings Certificates Act, 1959
[This form will be filled in by the holder(s) and submitted with the certificates to the Postmaster of the office where the certificates stand registered]

To
The Postmaster,
Under provisions of section 10A of the Government Savings Certificates Act, 1959,
I/we the holder(s) of certificates detailed below, hereby nominate the persons mentioned below, who shall on my/our death, become entitled to the certificate(s) and to be paid the sum due thereon to the exclusion of all other
persons.
I/We hereby declare that I/we have not so far made any nomination in respect of these certificates.
Sl. No. Name of the nominee(s) Full Address Date of birth of nominee
in case of minor
2. As the nominee(s) at serial number(s) above is/are minor(s).I/We appoint
Shri/Smt./Kumari (name and full address) as the person to receive the sum due thereon in
the event of my/our death during the minority of the nominee(s).
3. The certificates detailed below are enclosed.
Sl. Nos. of
certificates
Denomination Date of issue Office of issue
Address: Yours faithfully,
Signature (or thumb impression,
if illiterate) of holder(s)
(Address of illiterate holder, father's
name should be given)
Witnesses :
Name(1) :
Address :
Name(2) :
Address :
N.B. - In the case of illiterate holders, the witnesses shall be persons whose signatures are known to the
post office.
Order of the Postmaster accepting the nomination.
Date stamp of, Post Office Signature of Head/Sub Postmaster