Form A (White)
[See rule 7(1)]
Form of application for purchase of Kisan Vikas Patra (by direct investment)

Serial No.
To
The Postmaster Post Office
I/We hereby tender Rs. (Rupees only) in cash/by cheque No. for the purchase of Kisan Vikas Patra of the type Single/Joint A/Joint B.
(a) In the name(s) and .
(b) In the case of minor, his date of birth encashable by the minor's
parent/guardian Shri/Smt .
(c) The investment is not through any agent
2. I/We nominate the persons named below, who shall, on my/our death, receive payment.
Sl. No. Name of nominee Full address Date of birth of minor
nominee
3. I/We hereby agree to abide by the Kisan Vikas Patra Rules, 1988.
4. The certificates/identity slip may be made over to my/our messenger who presents this application.
Signature/thumb impression of investor
Date .
Signature and address of Address .
witness to nomination
Received the certificate(s) and identity slip
Signature of investor/messenger
Date .
Delete whichever is not applicable.
Identity slip
Specimen signature of holder/holders
To be completed by the Post Office
Serial Nos. of
certificates
Issue price Rs. Date of encashment Initials of the
Postmaster
Remarks like transfer,
issue of duplicate, etc.
with initials
Total
Date : .
Signature of Postmaster.