FORM F
[See sub paragraph (3) of paragraph 12]
Cancellation of Variation of Nomination previously made in respect of Account
No…………. under Public Provident Fund Scheme, 1968

To Date ………………….
The Agent/Manager
State Bank …………………..
I…………………………………………………. the subscriber to Public Provident Fund Account
No……………………… hereby cancel the nomination dated ……………………. Made by in respect of the aforesaid Public
Provident Fund Account.
* In place of the cancellation nomination, I hereby nominate the person(s) mentioned below who shall
on my death, become entitled to the payment of the sum due on the above account to the exclusion of all other persons.
Serial No
Name(s) of the
nominee(s)
Full address
Date of birth of
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 Sri/Smt/Kumari
…..…………………………………….……………………………..………………………………. (Name and full address)
to receive the sum due on the account in the event of my death during the minority of the nominee(s).
@ Delete if not applicable
Subscriber’s Address Signature/Thumb impression of
Subscriber
(1) Witness :
Name :
Address :
(2) Witness :
Name :
Address :
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TO BE USED BY THE ACCOUNTS OFFICE
The above cancellation/variation of the nomination has been registered in the ledger and entered in the Passbook.
Date …………………… Signature of Accounts Officer
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(Forms E and F amended vide Ministry of Finance (DEA) Notification No.F3(8)-PD/84 dated 22/07/1985)