FORM 4
[See para 8]
Nomination under the Deposit Scheme for Retiring Employees of Public Sector
Companies, 1991

To
The Manager,
(Name of the Bank)
(Address)
I, hereby nominate the person(s) mentioned below to whom, to the
exclusion of all other persons, in the event of my death, the amount standing to my credit in the account under Deposit Scheme for Retiring Employees of Public Sector Companies, 1991. Account No. at the time of my death would be payable.

Serial
No.
Name(s) of the
nominee(s)
Full Address(es) Date of birth of nominee(s) in
the case of minor
Proportionate amount
for each nominee
As the nominee(s) at Serial No.(s) specified above is/are minor(s), I appoint
Shri/Smt./Kumari address to receive the sums due under the said account in the
event of my death during the minority of the nominee(s).
Signature of witness : Signature or Thumb
Name and address : impression of depositor
FOR THE USE OF ACCOUNTS OFFICE
The above nomination has been registered on and an entry made in the Pass
Book.
Date Signature of Authorised Officer
Delete if not applicable.