FORM E
[See sub rule(1) of rule 8 and rule 9]
Serial No……………………
APPLICATION FOR CLOSURE OF AN ACCOUNT UNDER SENIOR CITIZEN’S SAVINGS SCHEME 2004

To
The Postmaster/Incharge
………………………………… (name of the Deposit office)
…………………………………
Sub : Application for withdrawal/closure of account
Sir
1 I, ……………………………………….. son/daughter/wife of ……………………………………………..
resident of …………………………………………………………………………………………………………….
and depositor of account no…………………… (hereinafter referred to as the “said account”) hereby apply for
closure of the said account with immediate effect. The interest of Rs……………….. and deposit of Rs………………………………………………………. TOTAL (INTEREST + DEPOSIT) Rs………………………………. (Rupees ………………………………………………………………………) *after adjustment of overpaid interest and/or deduction equal to ……………. percent of the deposit, amounting to Rs………………………….
(Rupees ………………………………………………………………………………) and any other charges,
recoverable from me in respect of the account in question, may kindly be refunded to me immediately.
2 The passbook is enclosed.
Signature or thumb impression of the Deposit
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FOR USE BY THE DEPOSIT OFFICE
ACCOUNT No……………………… DATE OF DEPOSIT ……………. AMOUNT OF DEPOSIT
Rs……………………………….
Withdrawal on account of Interest Rs……………….. and deposit Rs………………………… totalling to Rs……………………………. (Rupees ……………………………………………………………..) is sanctioned in favour of the depositor.
*Recovery of overpaid interest Rs…………………. deduction of Rs…………………………… and other
charges (to be specified) Rs…………………. totalling to Rs……………………….. (Rupees ………………..……………………………………………………………………………..) has been adjusted.
NET AMOUNT PAID Rs………….. (Rupees …………………………………………………………………..)
RECEIPT
Received a sum of Rs…………………. (Rupees …………………………………………………………………)
from …………………………….. (Name of Deposit Office) as per details furnished above.
Signature/Thumb impression of the depositor
* Score out whichever is not applicable