FORM-A

(See clause (d) of rule 2 and sub rule (1) of rule 3)

Serial No…………………..

APPLICATION FOR OPENING OF AN ACCOUNT UNDER SENIOR CITIZENS SAVINGS SCHEME, 2004

TO
Paste here a copy of
The Postmaster/Incharge
……………………………………………………(name of the Deposit office) recent

……………………………………………………. photograph.

…………………………………………………….
(Joint Photograph of both the
Depositor & Spouse in case of a
joint account)

*Name of Agent (in case of the account introduced through agent)………………………………………………………………….

Agency Code No…………………………………………….Dated……………………………….valid upto………………………………………

PAN No . (of applicant)……………………………….**.

Sir,

1. I, ……………………………………………………………………, son/daughter/wife of………………………………………… ……, a

permanent resident of…………………………………………………………………………………………………………………………………….….,
aged…………years, hereby apply for opening of an account under the Senior Citizens Savings Scheme, 2004, (hereinafter
referred to as the said scheme), in my name / jointly in my name and my spouse..…………………………………
…………………………………………………………………………….(name and address of spouse with age)* and tender herewith
Rs………………….. (Rupees………………………………………………………………………) in cash / cheque / demand draft, the
particulars of which are filled in the enclosed ‘pay-in-slip’(Form- D), towards deposit in the account.

2. I/we* hereby declare that,-

(i) I/we* have clearly understood the Senior Citizens Savings Scheme Rules, 2004 governing the accounts under
the said scheme, as amended from time to time(hereinafter referred to as the said rules);
(ii) I/we* shall abide by the said rules in letter and spirit;
(iii) the details of other accounts opened earlier by me/us* under the said scheme, are as under:-

Sl. Name of depositor(s) & Type of Name and Addresss Account No. with Amount of Deposit
No. account (Individual/Joint) of the Deposit office date of opening
1
2
3

(iv) I/we* shall adhere to the ceiling on deposits, taking the deposits in all the accounts opened by me/us*
together, as specified in rule 4 and amended from time to time. In case, at any time, any excess deposit is found, such
excess deposit will be refunded to me/us* after recovery of excess interest under sub-rule (8) of rule 7.
3. I nominate the following person / persons, 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 would be payable in accordance with the
provisions contained in rule 6:

TABLE

Sl. Name(s)of the nominee(s) Date(s) of birth of Share of the

No. alongwith relationship with Permanent Address nominee(s) in case nominee(s) in the
the depositor of a minor/ age in amount payable.
other case(s)
(1) (2) (3) (4) (5)

Photograph(s) of the nominee(s) Signature/thumb impression of the nominee(s)

(6) (7)”.

3(a) As the nominee(s) at Serial No.(s)……………………………above is/are minor(s), I appoint

Shri/Smt./Kumari………………………………………………………………………………………………………[name(s) with permanent
address(es) of the person(s) in respect of each minor nominee] to receive the sum due under the said account in the
event of my death during the minority of the nominee(s).

Signature/Thumb impression of the depositor

Witnesses(Signature, name and address):
1………………………………………………………………………

2……………………………………………………………………… Date……………………………At (Place)………………………….

My/our* specimen signatures (thumb impression), are as below:-

(i) First depositor:-

1. 2. ` 3. .

(ii) *Joint depositor:-

1. 2. ` 3. .

#Witness……………………………………… #Witness…………………………………… #Witness……………………………………………

(Countersigned Postmaster/Incharge) (Countersigned Postmaster/Incharge) (Countersigned Postmaster/Incharge)

Date……………………….…& office Seal Date……………………………& office Seal Date……………………...…& office Seal

4. I also declare that the information provided by me / us* in the application hereinabove, is true to the best of
my/our knowledge and belief and in case, at any time, any of the information and/or declaration is found false, no
interest on the deposits shall be payable to me/us*, the deposit office shall close the account(s) and refund the deposits
after recovery of the interest, if any, already paid on the deposits.
 Yours faithfully,

(Signature of the applicant)

Date…………………………………

Place……………………………….. (Present Postal Address)

Enclosures:
1. Age proof.
2. Copy of receipted application form for allotment of PAN, if PAN is not allotted.
3. Pay-in-Slip (Form-D), duly filled in alongwith amount of deposit.
4. Certificate from the employer as specified in sub-clause (ii) of clause (d) of rule 2.
--------------------------------------------------------------------------------------------------------------
*: Score out whichever is not applicable.
**: (1)The applicant(s) who are not assessed to income tax, may fur nish a self declaration, that their income from all
sources (including the interest income from the account to be opened vide this application) does not cross the
exemption limit and the applicant is not required to obtain PAN under Income Tax Act, 1961, as amended from
time to time.
(2) All other applicants shall mention the PAN No. compulsorily and in case they have not so far been allotted PAN
by the Income Tax Authorities, attested photocopy of the receipted application form for allotment of PAN should
be attached to the application form.
#: in case of thumb impression.
NOTE: (1) Self attested copies of any of the following documents can be enclosed as age proof:- Birth Certificate
issued by the Municipal authority/ Gram Panchayat/District Office of the Registrar of Births and Deaths; Voter
Identity Card issued by the Election Commission of India; PAN Card; Passport; Ration Card; Date of birth
certificate from the school last attended by the applicant or any other recognised educational institution or
Driving Licence issued by the local licensing authority.
(2) Originals of the documents attached, should also be produced simultaneously for verification and return
immediately.
. .
FOR THE USE OF DEPOSIT OFFICE

The account has been opened on…………………………….with Rs…………………………………….(Rupees…………………

…………………………………………………) under the Senior Citizens Savings Scheme, 2004.
Account No……………………………………..Ledger folio No…………………………………

Agent’s name, agency code number, date and validity have been entered in the ledger folio as well as Pass book(in
case of account introduced through agent).

Pass Book No…………………………………….has been issued.

Date…………………………………….. Signature of the Incharge of Deposit Office

(alongwith name and designation stamp)

. .
 FORM-B
(See sub-rule (3) of rule 4)
Serial No…………………..
APPLICATION FOR EXTENSION OF AN ACCOUNT UNDER
SENIOR CITIZENS SAVINGS SCHEME, 2004
TO
The Postmaster/Incharge,
……………………………………………………(name of the Deposit office)

…………………………………………………….

…………………………………………………….

Subject: Application for extension of an account for three years, with effect
from……………………………….(date/month/year).

Sir,

1. I, ……………………………………………………………………, son/daughter/wife of………………………………………… ……, a

depositor of account No. …………………….….,, (hereinafter referred to as the ‘said account’) hereby apply for
continuation of the account under the Senior Citizens Savings Scheme, 2004 (hereinafter referred to as ‘the said
scheme’), for a further period of three years from the date of maturity of my above-said account.

2. I have understood the terms and conditions applicable to the account during the period of extension under the
Senior Citizens Savings Scheme Rules, 2004 as amended from time to time.

3. I shall close the account immediately on completion of the extended period and get back the deposit standing
at my credit in the account after adjustment of the interest paid in excess, if any, and any other charges recoverable
in connection with the said account.

Date………………………… Signature of the Depositor

Place………………………………… ( name and address)

-----------------------------------------------------------------------------------------------------------------------------------------------
FOR THE USE OF DEPOSIT OFFICE

The account No……………………….. which was opened on…………………………….with Rs…………………………………….

(Rupees………………… …………………………………………………) under the Senior Citizens Savings Scheme, 2004 and
matured on…………………………….., has been extended for a period of three years with effect
from……………………….. to………………………….. Rate of interest at…..……………… per cent per annum as
applicable under the scheme to fresh deposits opened or to be opened on the date of maturity, shall be
applicable during the extended period of the deposit.

Necessary entries have been made in the Pass Book No………………………… and relevant Ledger folio
No……………………… accordingly.

Date…………………………………….. Signature of the Incharge of Deposit Office

(along with name and designation stamp)
 FORM-C
(See rule 6)
Serial No…………………..

APPLICATION FOR NOMINATION/CHANGE/CANCELLATION OF NOMINATION UNDER SENIOR CITIZENS

SAVINGS SCHEME, 2004

TO
The Postmaster/Incharge,
……………………………………………………(name of the Deposit office)
…………………………………………………….
…………………………………………………….

Subject: Application for Nomination or Change/Cancellation of Nomination.

Sir,

1.* I,………………………………………………hereby nominate the following person / persons, 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 No………………………would be payable in accordance with the provisions contained in
rule 6 of Senior Citizens Savings Scheme Rules, 2004.

TABLE

Sl. Name(s)of the nominee(s) Date(s) of birth of Share of the

No. alongwith relationship with Permanent Address nominee(s) in case nominee(s) in the
the depositor of a minor/ age in amount payable.
other case(s)
(1) (2) (3) (4) (5)

Photograph(s) of the nominee(s) Signature/thumb impression of the nominee(s)

(6) (7)”.

2.* As the nominee(s) at Serial No.(s)……………………………above is/are minor(s), I appoint

Shri/Smt./Kumari………………………………………………………………………………………………………[name(s) in full with complete
address(es) of the person(s) in respect of each minor nominee] to receive the sum due under the said account in the
event of my death during the minority of the nominee(s).

3.* This is in supercession of the nomination(s), made by me earlier at the time of opening of account/vide my
application dated……………………………… .

4.* I…………………………………………………, hereby request to cancel the nomination made by me earlier vide my
application dated…………………………..

Witnesses(Signature, name and address):

1………………………………………………………………………… Signature of the depositor

(Name and address)
2………………………………………………………………………….
Date……………………………At (Place)………………………….
*Score out whichever is not applicable.
FOR THE USE OF DEPOSIT OFFICE

The above nomination has been registered on…………………………………….. AND/OR the earlier
nomination dated………………………………………has been changed/cancelled.
Necessary entries have been made in the Pass Book (No…………………………) and relevant Ledger folio
No………………………… accordingly.

Date…………………………………….. Signature of the Incharge of Deposit Office

(alongwith name and designation stamp)
 FORM-D
(See sub-rule (1) of rule 3 and rule 10)
Serial No…………………..
PAY – IN – SLIP FOR DEPOSITS
UNDER SENIOR CITIZENS SAVINGS SCHEME, 2004
Counterfoil (1) Counterfoil (2)

Depositor’s copy Deposit Office’s copy

Name of Deposit Office Name of Deposit Office
Name of depositor…………………………………………. Name of depositor………………………………………….
Address: Address:

Father’s/Husband’s name: Father’s / Husband’s Name:

*Name of Agent (in case of account n i troduced through *Name of Agent (in case of account introduced through
agent) with agency code No., date and validity……………… agent) with agency code No., date and validity…………………
…………………………………………………………………………………….. ……………………………………………………………………………………..
Account No…………………….. Date…………………... Account No…………………….. Date…………………...
(to be filled in by deposit office) (to be filled in by deposit office)
Ledger Folio……………….(to be filled by deposit office) Ledger Folio……………….(to be filled by deposit office)

Amount of Deposit (Rs.)# Amount of Deposit (Rs.)#

Cheque/Demand Draft Cheque/Demand Draft
realisation charges (Rs.)## realisation charges (Rs.)##
Account Transfer Fee (Rs.)## Account Transfer Fee (Rs.)##
Fee for issue of Duplicate Pass Book Fee for issue of Duplicate Pass Book
(Rs.)## (Rs.)##
Other charges, if any. (Rs.)## Other charges, if any. (Rs.)##
TOTAL AMOUNT (Rs.) TOTAL AMOUNT (Rs.)

Total Amount in words (Rupees……………………………. Total Amount in words (Rupees…………………………….

……………………… …………………………………………….) ……………………… …………………………………………….)

Details of CASH DEPOSIT: AMOUNT Details of CASH DEPOSIT: AMOUNT
1000 x 1000 x
500 x 500 x
100 x 100 x
50 x 50 x
20 x 20 x
10 x 10 x
05 x 05 x
02 x 02 x
01 x 01 x
COINS COINS
TOTAL (CASH): TOTAL (CASH):
Cheque /Demand Draft No. and date: Cheque /Demand Draft No. and date:
……………………………………………….. ………………………………………………….
Bank / Branch on which drawn: Bank / Branch on which drawn:

………………………………………………….. …………………………………………………
AMOUNT (RUPEES) : AMOUNT (RUPEES) :
By (Depositor’s signature) By (Depositor’s signature)
 ( P. T. O.) . ( P. T. O.)

Continued from prepage…………………. Continued from prepage………………….

TO BE COMPLETED BY DEPOSIT OFFICE TO BE COMPLETED BY DEPOSIT OFFICE

Head of Government Account(to be entered by Deposit Head of Government Account(to be entered by Deposit
Office)# / ##................................................................... Office)# / ##....................................................................
……………………………………………………………………………………... …………………………………………………………………………………….
Received Rs………………….. (Rupees……………………… Received Rs………………….. (Rupees……………………..
…………………………………………………………………….) ……………………………………………………………………..)
as detailed hereinabove. For deposit in Account as detailed hereinabove. For deposit in Account
No…………………………………….. No…………………………………..
*Agent’s Commission at the rate of.........per cent of deposit *Agent’s Commission at the rate of.........per cent of deposit
amounting to Rs………… (Rupees……………………………..)### amounting to Rs………… (Rupees …………………………… )###
has been paid at source (under receipt). has been paid at source (under receipt).

Cashier’s scroll No………………………….. Cashier’s scroll No…………………………..

Signature of Cashier Signature of Cashier
(with name and office seal) (with name and office seal)

Supervisor/Incharge Supervisor/Incharge
of Deposit office alongwith office seal of Deposit office alongwith office seal

NOTE: 1. The cheque/demand draft should be in favour of NOTE: 1. The cheque/demand draft should be in favour of
the Deposit Office, or in favour of the depositor duly the Deposit Office, or in favour of the depositor duly
endorsed in favour of the deposit office. endorsed in favour of the deposit office.
2. Cheques / Demand Drafts are subject to realisation of 2. Cheques / Demand Drafts are subject to realisation of
the proceeds. the proceeds.

* Score out if not applicable * Score out if not applicable

#: In respect of Deposits:-Major Head:8001-National #: In respect of Deposits:-Major Head:8001-National

Savings Deposits. Savings Deposits.

##: In respect of various charges:- Major Head: ##: In respect of various charges:- Major Head:
8008- Income and Expenditure of [Link] 8008- Income and Expenditure of [Link]
Incomes. Incomes.
### :In respect of agency commission to agents: ### :In respect of agency commission to agents:
Major Head: 8008- Income and Expenditure of Major Head: 8008- Income and Expenditure of
NSSF.03.104 NSSF.03.104
 FORM – E
(See sub rule (1) of rule 8 and rule 9)
Serial No…………………..
APPLICATION FOR CLOSURE OF AN ACCOUNT UNDER SENIOR CITIZENS SAVINGS SCHEME, 2004
TO
The Postmaster/Incharge,
……………………………………………………(name of the Deposit office)
…………………………………………………….

Subject: Application for withdrawal/closure of account.

Sir,
1. I,……………………………………………………………………,son/daughter/wife of……………………………………… ……
resident of ………………………………………………………………………………………………………………………… …………………,
and depositor of account No. …………………….….….. (hereinafter referred to as the ‘said account’) hereby apply
for closure of the said account with immediate effect. The interest of Rs…………………………. and deposit of
Rs……………………………………………………………………………..TOTAL(INTEREST+DEPOSIT) Rs…………………………..
(Rupees………………………………………………………… ………………………), *after adjustment of overpaid interest
and/or deduction equal to …………per cent of the deposit, amounting to Rs………………………………..
(Rupees……………………………………...………………………… ……………………) and any other charges, recoverable
from me in respect of the account in question, may kindly be refunded to me immediately.

2. The Pass Book is enclosed.

Signature or thumb impression of the Depositor
----------------------------------------------------------------------------------------------------------------------------------------
--------------
FOR USE BY THE DEPOSIT OFFICE

ACCOUNT No…………………………DATE OF DEPOSIT……………………………AMOUNT OF DEPOSIT:

Rs……………………………….
Withdrawal on account of Interest Rs………………………….. and deposit Rs…………………………………………..totalling
to Rs.……………………………………… (Rupees………………………………………………………………………………………………...)
is sanctioned in favour of the depositor.
*Recovery of overpaid interest Rs…………………………………, deduction of Rs.……………………………………………. and
Other Charges (to be specified) Rs…………………………… totalling to Rs………………………………….
(Rupees…………………..……………………………………………………………………………………………) has been adjusted.

NET AMOUNT PAID Rs………………… (Rupees……………………………………………………………………)

RECEIPT

Received a sum of Rs…………………………………… (Rupees…………………………………………………………….……………….)

from…………………………………………………………..(Name of Deposit office) as per details furnished above.

Signature / Thumb impression of the depositor

Signature of in-charge of Deposit Office

(Alongwith name and designation stamp)

*: Score out whichever is not applicable.

 FORM – F
(See sub-rules (3) and (4) of rule 8)
Serial No…………………..
APPLICATION FOR CLOSURE OF ACCOUNT UNDER SENIOR CITIZENS SAVINGS SCHEME, 2004
BY SPOUSE(JOINT HOLDER) / NOMINEE(S)/LEGAL HEIRS
TO
The Postmaster/Incharge,
……………………………………………………(name of the Deposit office)
…………………………………………………….

Subject: Application for withdrawal /closure of account.

Sir,
I/WE* …………………………………………………………………… the spouse (Joint holder) / nominee(s) /legal heirs of
late……………………………………………. , the depositor to the Senior Citizens Savings Scheme, 2004 account
No…………………………………………….. wish to withdraw the entire amount standing to the credit of the deceased
in the said account.

Please find enclosed:-

(i) A certificate in regard to the death of the Depositor.
(ii)*A Certificate in regard to the death of Shri/ Shrimati…………………………………………………………………….and
Shri/Shrimati………………………………..……………………… also the nominee(s) appointed by the Depositor.
(iii)** Succession Certificate/Letter of Administration with attested copy of probated will of the deceased
depositor issued under the provisions of the Indian Succession Act, 1925.
(iv) Pass Book of the Depositor.
(v)# Letter of Indemnity.
(vi)# Affidavit.
(vii)# Letter of disclaimer on affidavit

Signature or thumb impression of claimant(s)

Witness……………………………………………
…………(Signature, name and address)………..

Date………………………………………………………………..

Place……………………………………………………………….

FOR USE BY THE DEPOSIT OFFICE

Withdrawal of Rs…………………………………… (Rupees………………………………………………………………………….…….)

is sanctioned.

Adjustments made (to be specified) Rs………………………………………….

(Rupees…………………………………………………..)

NET AMOUNT PAYABLE Rs………………..………………

(Rupees……………………………………...…………………………………)
 RECEIPT TO BE SIGNED BY THE CLAIMANT(S)

Received a sum of Rs……………………………………. (Rupees………………………………………………………………………….)

from………………………………………………………….. (Name of Deposit office) as per details furnished above, in full
settlement of our claim.

Signature / Thumb impression of the claimant(s)

Signature of in-charge of Deposit Office

(Alongwith name and designation stamp)

*: Delete whichever is not applicable.

**: Strike off if there is a valid nomination.
#: To be produced by legal heirs, in the absence of nomination(s) for claims upto Rs. 1 lakh.
 ANNEXURE- I TO FORM - F
(Letter of indemnity)

TO

The Postmaster / Incharge,

……………………………………… (Name of the deposit office)

In consideration of your payment or agreeing to pay me /

us…………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………
………………..
[Name(s) of Legal heir(s)] the sum of Rs………………………… (Rupees……………………………………………………
……………………………………………………..) standing in the account No…………………………………………under SENIOR
CITIZENS SAVINGS SCHEME, 2004 with your office in the name of ……………………………………………………….
…………… ……………… …………without production of letters of administration or a succession certificate to the
estate of the deceased……………………………………………………………………(name of the depositor),
I/We……………………………………………………………………………………………………………………… and
we…………………………………… ……………………………………………….. (sureties) do hereby for ourselves and our
heirs, legal representatives, executors and administrators jointly and severally undertake and agree to indemnify
you and your successors and assigns against all claims, demands, proceedings, losses, damages, charges and
expenses which may be raised against or incurred by you by reason or in consequence of having agreed to
pay/or paying me/us the sum as aforesaid.

In witness whereof we have hereunto set my/our hands at this……………..day of………………………………in

the presence of witnesses,

Signed and delivered by the above named

heir/heirs of the deceased.

Signed and delivered by the

above named sureties (Signature, names and address)

1.

2.

Signature, names and address of witnesses:

1.

2.
ATTESTED

NOTARY PUBLIC
 ANNEXURE- II TO FORM - F
(Affidavit)

TO

The Postmaster / Incharge,

………………………………………(Name of the deposit office)

I / We……………………………………………….Husband of / wife of late……………………………………..………………………………

aged………….. aged………….. aged………….. sons/daughters of the said late……………………………………………………………………
resident of………………………………………………………………………….do hereby declare and solemnly affirm as under :-

(1) That I / we am/are the only heir(s) of the deceased………………………………………….who died at……………………………..
on……………………………………. I / We alone represent the estate of Shri/Smt……………………………………………………

(2) That the deceased…………………………………..did not leave any will and therefore I / we are the only successor(s) to
the estate of the said deceased.

1.

2.

3.

DEPONENTS

VERIFICATION: I / We, the above-named deponents do hereby verify on solemn affirmation in…………………………………
(name of place) that the contents of this affidavit are true to the best of my/our knowledge and nothing material has been
concealed.

Dated………………….

1.

2.

3.

DEPONENTS
ATTESTED

OATH COMMISSIONER
 ANNEXURE- III TO FORM - F
(Letter of disclaimer on Affidavit)

TO

The Postmaster / Incharge,

………………………………………(Name of the deposit office)

I / We (i) …………………………………………….Husband of / wife of …………………………………………..…………………………….

Resident of…………………..……………………………………………………………………………………………………………………………………………
(ii) ……………………………………………………….………… son/daughter of ………………………………………….………………………………
(iii) …………………………… ………………………………………son/daughter of ……………………………………….……………………………………

do hereby declare and solemnly affirm as follows :-

(1) That Shri/Smt………………………………………………………………………………….died intestate on…………………………….……

leaving behind us……………………………………………………………………………………………..his/her only heirs.

(2) That we…………………………………………………………………………………………………..heirs of our late father/mother for

ourselves and on behalf of our heirs, executors, representatives and assigns to hereby relinquish our claims to the balance
of Rs………………………………………………………which may be credited to the account sought by our mother/father to be
opened in the deposit office in the name of the estate of the said………………………………………………………………………………...
deceased father/mother after the realisation of Draft No…………………………………………………on ………………………………….
issued by …………………………………………………………………………………………………….. (name of the deposit office) and we
have no objection whatsoever in the balance in the above-referred account No………………………………………together with
interest, if any, accrued thereon being paid by the Deposit office to our mother/father
Mrs./Mr……………………………………………………………

1.

2.

3.

DEPONENTS

VERIFICATION: I / We, the above-named deponents do hereby verify on solemn affirmation that the contents of this
affidavit are true to the best of my/our knowledge and nothing material has been concealed.

Dated………………….
1.

2.

3.
DEPONENTS

I identify the deponent(s) who is/are personally known to me

and who has/have signed in my presence.

Dated…………………………
Oath Commissioner
 FORM – G
(See rule 11)
Serial No…………………..

APPLICATION FOR TRANSFER OF ACCOUNT UNDER SENIOR CITIZENS SAVINGS SCHEME, 2004

TO

The Postmaster/Incharge,
……………………………………………………(name of the Deposit office)
…………………………………………………….

Subject: Application for Transfer of account to another Deposit office.

Sir,

1. I, ……………………………………………………………………, son/daughter/wife of…………………………………………………… ……,

Resident of …………………………………………………………………………………………………………………………………………………………, a
depositor of account No. …………………….….….hereby apply for TRANSFER OF MY ACCOUNT No…………………………with a
deposit, of Rs………………(Rupees……………………………… ………………………… ………………………) under the Senior Citizens
Savings Scheme, 2004 to……………………………………………………………………..……………………………………………………………………
…………………………………………………………………………………………..(Name and full address of the transferee deposit office)
2. The Pass Book is enclosed.
Signature or thumb impression of the Depositor
Witness……………………………………………*
………(signature, name and address)…………..
My specimen signature/thumb impressions, as available in the record of transferer deposit office, are as below:-
(i) Ist Depositor:-

1. 2. ` 3. .

*Witness……………………………………… *Witness…………………………………… *Witness……………………………………………

(i) Joint Depositor:-

1. 2. ` 3. .

Countersigned Postmaster/Incharge (Countersigned Postmaster/Incharge (Countersigned Postmaster/Incharge

of Transferer office) of Transferer office) of Transferer office)
Date……………………….…& office Seal Date……………………………& office Seal Date……………………...…& office Seal

Forwarded to:…………………………………………………………….………(Transferee Deposit office) and necessary entries passed

in the office record(s).
Signature & office seal (Transferer Deposit office)
Date……………………………………
FOR USE BY THE TRA NSFEREE DEPOSIT OFFICE

A. Received application for transfer of account No…………………………………………………opened on……………………………..

under SENIOR CITIZENS SAVINGS SCHEME, 2004, in the name of …………………………………………………………
&………………………………………………(joint holder, if any) standing on the books of the………………………………
…………………………………………………………………………….(name and address of the transferer deposit office) showing a
deposit of Rs……………………….(Rupees…………………………..………………………………………), due to mature on………………………
B. The entries in the pass book have been checked, necessary entries indicating transfer, have been made and pass book
has been returned to the depositor.

Pass Book received in Original. Signature of Postmaster / In-charge

. . (with office seal)Transferee Deposit Office.
#(Signature/thumb impression of the depositor )
Date…………………………………………
Date……………………………
*: In case of thumb impression.

#: to be signed on receipt of the pass book at the transferee deposit office.

THIS IS FOR PUBLIC INFORMATION:

Given hereinabove is the electronic version of the Senior Citizens Savings Scheme Rules, 2004. The
accuracy of conversion to the electronic medium is subject to usual constraints. Hence, nothing in
the above document may in any case be construed as an authority. For legal purposes and/or
ruling position, the nearby post office or a designated branch of a bank operating the scheme, may
be contacted.

***