FORM B
Certificate deposit
[See paragraph 4(4)]

State Bank of India, Branch [Site Restoration Fund Scheme, 1999]
Name of the deposit office
Receipt No. Received from (name and address of the depositor) whose Permanent Account Number is Rupees (in figures)(Rupees )(in words) for credit into the
Deposit Account No.
Signature of Officer-in-Charge
Place:
Date :

(Seal)