FORM -1
Application for opening an account
To Paste photograph of
The Postmaster/Manager applicant/s
…………………………………………………
…………………………………………………
Sir,
I/We ……………………….. (Applicant/s) hereby apply for opening of an account under Senior Citizen
Savings Scheme in your Post Office/Bank.
I/We tender herewith Rs……………………../-
(Rs…………………………………………………………………………….) in cash/Cheque/DD.
No………………… date………. as initial deposit. My/our particulars are as under:-
1. Name of First Account holder
……………………………………………………………
Husband/Father /mother’s name or Guardian appointed by Court
……………………………………………………………
Date of Birth ……… ..……… ………………
(DD / MM / YYYY)
(In words)……………………………………………
2. Name of Second Account holder (spouse only)
……………………………………………………………
Husband/Father /mother’s name
……………………………………………………………
Date of Birth ……… ..……… ………………
(DD / MM / YYYY)
(In words)……………………………………………
3. Aadhar Number (a) of first account holder
(b) of second account holder
…………………………………………………………..
4. Permanent Account Number (PAN) (a) of first account holder
(b) of second account holder
…………………………………………………………..
5. Present Address ………………………………………………………….
…………………………………………………………..
Permanent Address ………………………………………………………….
………………………………………………………….
6. Contact details Telephone Number……………………………..
Mobile Number…………………………………..
Email ID……………………………………………..
7. Type of Account Single or Joint
8. Details of proof of date of Birth of account holder/s
……………………………………………………….
a) Certificate No.
……………………………………………………………………..
b) Date of Issue
…………………………………………………………………….
c) Issuing authority
…………………………………………………………………….
9. Details of other KYC documents attached 1. Proof of identification
…………………………………………………………
2. Address proof
…………………………………………………………
(The following documents are accepted as officially valid documents for the purpose of identification and
address proof: 1. Passport 2. Driving license 3. Voter’s ID card 4. Job card issued by NREGA signed by the
State Government officer [Link] issued by the National Population Register containing details of
name and address;
1. Specimen Signatures
1………………………… 2……………………………. 3……………………………
(Name)…………………………………………………………
1………………………… 2……………………………. 3……………………………
(Name)…………………………………………………………
I declare that I/we are Resident citizen of India and undertake to inform the account office of any change in
our residency/citizenship status in future.
I hereby undertake to abide by the scheme provisions and Government Savings Promotion rules-
2018 applicable on the Scheme and amendments issued thereto from time to time.
Details of my/our other accounts under the Scheme are as under:
[Link]. Name of Scheme Date of Amount Customer Account Name of
opening of deposited Identification number Post
account Number office/Bank
1. (SCSS)
1. (SCSS)
1. (SCSS)
Signature or thumb impression of guardian
Date: ……………………
Nomination
10. I/we…………………………………………..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
……………………………………..(Name of Scheme) at the time of my death would be payable.
[Link]. Name(s) of the Full address (s) Aadhaar Date of birth Share of Nature of
nominee(s) and number of of nominee in entitlement entitlement
relationship nominee case of minor Trustee or
(optional) owner
1
2
As the nominee(s) at Serial No.(s)…………………………………….specified above is/are minor(s), I appoint
Shri/Smt/Kumari………………………………………………..S/o,D/o,W/o……………………………………………
……………………………..Address………………………………………………………………………………………
……………………………………………………………………….to receive the sum due under the said account
in the event of my death during the minority of the nominee(s).
1. Signature of witness…………………………………….
Name & Address……………………………………………..
2. Signature of witness…………………………………….
Name & Address……………………………………………..
Signature or thumb impression of account holder/s
Place:
Date:
For use of Post Office/Bank
The account has been opened in the name of…………………………………on……………………..with
initial deposit of Rs……………………………………….under……………………………………………..(name of
the scheme) vide Account No.__________________________ dated______________________________.
Customer identification Number………………………………..
Nomination has been registered vide
No……………………………………..dated………………………………………..
Signature and seal of competent authority.
FORM -2
Application for extension of account
To,
The Postmaster/Manager
…………………………………………………
…………………………………………………
Sir,
1. I/we________________________________________ am/are account holders in Account
Number_____________________ under Senior Citizen Savings Scheme in your office. The said account was
opened on___________________ and has matured on _______________for payment. I/We hereby request
for extension of the account for a further period of three years (as per scheme rule) from the date of maturity
of the above said account.
2. I/We have understood the terms and conditions applicable to the account during the period of
extension under the said scheme as amended from time to time and shall abide by them.
3. I/we continue to be resident citizen/s of India on the date of commencement of block period of three years.
Date Signature of the account holder/s
Place (Name and address)
----------------------------------------------------------------------------------------------------
For the use of Accounts Office
The account no………………………. which was opened on …………….. with Rs………………….
(Rupees………………………………………………..) under__________________(Name of scheme) and
matured on ……………………, has been extended for a period of ______ years with effect from
……………….. to ………………….under rule..............of the.....................scheme.
Necessary entries have been made in the records and pass book/deposit receipt/ statement of
account.
Date Signature of Postmaster/Manager
Seal
FORM -3
Application for premature closure of account
To,
The Postmaster/Manager
…………………………………………………
…………………………………………………
Sir,
1. I/we wish to prematurely close my/our Account No________________________
having balance of ____________________(Rupees______________________ Only)
opened under Senior Citizen Savings Scheme and request you to pay the amount after
deduction of applicable penalty, as per details given below:-
Please Credit the amount to my SB Account no.________________________
standing at___________________________________ (Name of Account office).
or
Please issue a Demand Draft/account payee cheque
or
Please pay in cash (applicable if the amount is below permissible limit)
3. I/We hereby declare that the conditions under which the account can be closed
before maturity under Senior Citizen Savings Scheme have been complied with.
Necessary documents as applicable are attached as under:-
1.
2.
Date:-______________ Signature or thumb impression of account holder/s
-----------------------------------------------------------------------------------
(Thumb impression of the depositor should be attested by a person known to the accounts
office)
For office use only
Payment detail
Eligible balance in Account._______________________________________
Less Penalty amount _____________________________________________
Total Amount to be paid ________________________________(In figures)
(In words)________________________________________________________
Date Stamp Signature of Postmaster/Manager
--------------------------------------------------------------------------------------
Acquittance
(to be filled by account holder/ messenger)
Received Rs ._____________(In figures)______________________ (in words) By
cash/cheque/DD bearing No.)__________________dated_____________/by transfer to
Account No______________________________________________.
Date Signature/thumb impression of Depositor/s
FORM -4
Application for closure of account
Name of Post Office/Bank__________________________
Date___________________
Account Number___________________________
1. I/we hereby submit pass book/deposit receipt and apply for closure of my/our
above mentioned account matured on_________________.
2. Please Credit the amount of eligible balance in my matured account to my SB
Account no.________________________ standing at______________________(Name of
Account office).
or
Please issue a Demand Draft/account payee cheque
or
Please pay in cash (applicable if the amount is below permissible limit).
Signature or thumb impression of account holder/s
(Thumb impression should be attested by a person known to Accounts office)
Payment Order
(For office use only)
Date......................
Payment detail
Principal amount Rs.____________________________________________
(+) Interest due Rs. _____________________________________________
(-) Recovery of overpaid interest Rs._______________________________________________________
Deduction if any Rs_____________________________________________
Total Amount due Rs_____________________________________________
Pay Rs.____________________(in
figurers)_____________________________________(in words)
Date
Signature of Postmaster/Manager
Acquittance
(to be filled by depositor)
Received Rs_____________(In figures)______________________ (in words) By
cash/cheque/DD bearing no…………………………………….dated…………………./by
transfer to Account No...............................
Date Signature/thumb impression of account
holder/s