FORM -1

(See Rule 5 of Government Savings Promotion Rules, 2018)

Application for opening an account under National Savings Schemes.
To
The Postmaster/Manager
…………………………………………………
………………………………………………… Paste photograph of applicant/s

Sir,

I/We ………………………..(Applicant/guardian) hereby apply for opening of an

account under______________________________________(Name of the 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 Depositor

……………………………………………………………
Husband/Father /mother’s name or Guardian appointed by Court
……………………………………………………………
Date of Birth ……… ..……… ………………

(DD / MM / YYYY )
(In words)
……………………………………………

2. Name of Second Depositor

……………………………………………………………
Husband/Father /mother’s name
……………………………………………………………
Date of Birth ……… ..……… ………………

(DD / MM / YYYY )
(In words)
……………………………………………

3. Name of Third Depositor

……………………………………………………………
Husband/Father /mother’s name
……………………………………………………………
Date of Birth ……… ..……… ………………

(DD / MM / YYYY )
(In words)
……………………………………………
4. Name of Fourth Depositor
……………………………………………………………
Husband/Father /mother’s name
……………………………………………………………
Date of Birth ……… ..……… ………………
 (DD / MM / YYYY )
(In words)
……………………………………………

5. Aadhar Number
…………………………………………………………..
6. Permanent Account Number (PAN)
…………………………………………………………..
7. Present Address
………………………………………………………….
………………………………………………
…………..

Permanent Address
………………………………………………………….

………………………………………………………….

8. Contact details Telephone

Number……………………………..
Mobile
Number…………………………………..
Email
ID……………………………………………
..

9. Type of Account Single or Joint or through Guardian for

Minor or
person of unsound mind or blind or
differently
abled through authorized person.

10. (*)Details of Birth Certificate

……………………………………………………….
(Applicable in case of minor account
and Sukanya Samriddhi A/c)

a) Certificate No.
……………………………………………………………………..
b) Date of Issue
…………………………………………………………………….
c) Issuing authority
…………………………………………………………………….

11. (*) Name of Guardian (Natural/Legal)

…………………………………………………………
(In case the account is opened on behalf of a
Minor/person of unsound mind)
 12. (*) Aadhaar number of parent/guardian
…………………………………………………………
(Copy may be enclosed)
(b) Permanent Account Number (PAN)
…………………………………………………………

(*) Applicable in case of Minor accounts

13. 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. PAN card
5. Aadhar card 6. Job card issued by NREGA signed by the State Government officer.)

14. The operation of the account will be:- (a) By all the holders
together or the surviving holder/s.
(In case of joint account) (b) By either of the holder/s, or
the surviving depositor/s,

15. My/our specimen Signatures

1………………………… 2……………………………. 3.,……………………………
(Name)…………………………………………………………

1…………………… 2……………………………..3…………………………….. (Name)

…………………………………………………………

1……………………….. 2……………………………
3…………………………….. (Name)…………………………………………………………

1……………………….. 2……………………………
3…………………………….. (Name)…………………………………………………………

I hereby undertake to abide by the scheme provisions and Government Savings

Promotion rules-2018 applicable on National Savings Schemes and amendments issued
thereto from time to time.

Signature or thumb impression of applicant/guardian

Date:……………………

16. I hereby declare details of my existing accounts as on today under different National
Savings Schemes in any of the Post office/Bank in the country.

[Link]. Name of Date of Amount Customer Account Name of Post

 Scheme opening of deposited Identification number office/Bank
account Number
1. Public Provident
Fund (PPF)

2. Sukanya
Samriddhi
Account (SSA)

3. National
Savings Monthly
Income Account
(MIS)
4. Senior Citizen
Savings
Scheme (SCSS)

Nomination
17. 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 Aadhaar Date of birth Share of Nature of
nominee(s) and (s) number of of nominee entitlement entitlement
relationship nominee in case of Trustee or
minor 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 applicant or guardian

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
(See Rule 5 of Government Savings Promotion Rules, 2018)

Pay-in-slip

Deposit (Pay in)

Deposit (Counterfoil)

Name of the Saving

Name of the Saving Scheme.......................................................................
Scheme............................................... ....................................

Name of the Post Office./Bank Name of the Post

Branch.............................................................. Office//[Link].....................................................
.................... ......................................

Date :
……………………...
Account No : Account No. ................................
……………………….................................... ………………………......... ........

Date :
……………………............................................. Paid into the credit of …………………………...
...... …………………………..……….....................

Paid into the credit Rupees In

of..................................................... words…………………..................................................
..................................................

.....................................................................................
......................................................................
Rupees.............................................................
...... Rs. in
figures……………………………………………………
……...............................................
Being deposit or refund or fee
for ..............................
Being deposit or refund or fee
for ................................................................................
..........

ByCheque By Cash
No…………………… Details Cash
By/ChequeNo………….............Dated........
Details :
Dated:....................... ................................... …………
………….
Drawn On.................. Drawn On……......................... ................
................
.............
................................... ....................................................

...................................
 Depositor Name & Depositor
Address:........... Name.................................................................Addre
ss...................................................
....................................
....................

.................................... ......................................................Contact...................
.................... ................Signature................................

(Subject to realisation)

SB
Assistant /
SB
Cashier…
Seal/date Stamp Assistant/Cashier.........
Seal/date Stamp ……………
.................................... …………....
..... ........
 FORM -3

(See Rule 20 of Government Savings Promotion Rules, 2018)

Application for Loan/Withdrawal

To,
The Postmaster/Manager
…………………………………………………
…………………………………………………

Sir,

I/We ……………………………………………………………..(Depositor/guardian)
hereby apply for loan/withdrawal from my/our account as per details below:-

Name of
Scheme:…………………………………………………………………………………………………
…..

Account Number:........................................................................................

Amount of Loan/withdrawal applied...........................................................

*Certified, that the amount sought to be withdrawn/loan to be availed is required for the
use of ………………………………………who is alive and still a Minor.

2. Please Credit the amount of loan/withdrawal 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 of cash payment).

3. I/We certify that all the conditions applicable under scheme for grant of withdrawal/loan
have been complied with.

Necessary documents as applicable are attached as under:-

1.
2.

Date:-______________ Signature or thumb impression of Depositors

---------------------------------------------------------------------------------------- Attested
By__________________
(Attestion is applicable in case of thumb impression)

For office use only

Payment detail

Amount available in Account Rs ._____________________________________

Date of Initial Subscription __________________________________________
Date on which last withdrawal/loan was allowed _________________________
Total Amount granted for withdrawal/loan Rs ._________________(In figures)
(In words)________________________________________________________

Date Stamp 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 Depositors

 (Cover Page)

FORM -4

(See Rule 18 of Government Savings Promotion Rules, 2018)

Pass Book

__________________________(Name of the scheme)

Name and address of Post

office/Bank branch

Account Number
 Page No.1
Particulars

Name and address of the

Accounts office

Name and address of

Depositor/s
Name of Scheme

Type of Account Single or Joint-A or Joint-B or account on behalf of minor

Account Number

Date of opening

Date of Maturity

Date of Birth (in minor’s account

or where necessary)
Nomination registration number

Customer Identification number

Name and CA number of
authorized agent if applicable

Seal

Signature of the Postmaster/Manager

Date Particular of Debit Credit Balance Stamp and
transactions Signature

On Back of cover page

(Major provision of the scheme)

 FORM -5

(See Rule 13 of Government Savings Promotion Rules, 2018)

Application for transfer of account under National Savings Scheme

To,
The Postmaster/Manager
…………………………………………………
…………………………………………………
Sir,

I/we request that my/our Account

Number__________________________under_________________________(Name of the
Scheme) with deposit/credit balance of Rupees______________________(in
words)________________________________________standing on the books of
the________________________________(Name of Account office) may be transferred to
the books of the__________________________(Name of Account office).

2. The Passbook/deposit receipt/statement of account in original is attached.

Three specimen signatures are given below:-

Dated: …………………… Signature of Depositor/s

Specimen Signature Name and address of the Depositor/s

1 ………………………….

2 ………………………….

3 ………………………….

Countersigned by Postmaster/Manager

Acknowledgement
Received application for transfer of …………………………..(Name of scheme) Account
No…………………………………….. in the name of …………………………………..standing
on books of the …………………………………………. (Name of Account office) with balance
of Rs……………………………(Rupees....................................................
…………………………………………… only). The particulars/ entries in the
Passbook/deposit receipt/statement of account have been checked and the same is
returned to the account holder/s.

Seal
.........
Date Postmaster/Manager Signature ………………

Stamp

Name of Account office .........……………

 FORM -6

(See Rule 4 of Government Savings Promotion Rules, 2018)

Application for extension of account under National Savings Scheme

To,
The Postmaster/Manager
…………………………………………………
…………………………………………………

Sir,

1. I/we________________________________________am/are depositor of Account

Number_____________________under_________________________(Name of scheme) in
your office. The said account was opened on___________________and has/will mature
on_______________for payment. We hereby request for extension of the account for a
further period of ______ years (as per scheme rule) from the date of maturity of the above
said account i.e. _______________.

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.

Date Signature of the Depositor/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 -7

(See Rule16 of Government Savings Promotion Rules, 2018)

Application for pledging of account under National Small Savings Scheme

To

The Postmaster/Manager

………………………………………

Sir,

1. I/We …………………………………………………..…. am/are required to deposit an

amount of Rs. ……………………………. as security with ……………………………………
(official designation of the gazetted officer of the Government or name of the Reserve
Bank of India or a Scheduled Bank, Cooperative Bank, Registered Cooperative Society,
Corporation, A Government Company or Local Authority). I/We therefore request you to
transfer the deposit in Account Number_____________________
under_________________________________________(Name of scheme) as security in
favour of ……………………………………………………………… (Official Designation of
the Officer or name of the Branch etc to whom the Account is being pledged as security.)

2. I/We agree that the account(s) can be encashed by the pledgee when the security
has been forfeited. Nomination vide registration number.............................in the account
stands cancelled.

Particulars of Account
Account number Date Name of Account office Amount

The authority mentioned above has agreed to accept the pledge. A pledge acceptance duly
signed by the competent authority as pledgee is attached.

Dated : …………………………………….. Signature of Depositor

Address ...........……………………………

For office use only

Account number__________________ has been pledged vide registration
no....................................dated....................... and necessary entries have been marked in
the record. Passbook/deposit receipt/statement of account has also been marked with
pledge and returned to the account holder.
Signature of Post Master/Manager

Seal
 FORM -8

(See Rule19 of Government Savings Promotion Rules, 2018)

Application for premature closure of account under National Savings Scheme

To,
The Postmaster/Manager
…………………………………………………
…………………………………………………

Sir,

1. I/we wish to prematurely close my/our Account No________________________

having balance of ____________________(Rupees______________________ Only)
opened under______________________________(Name of Scheme) and request you to
pay the amount after deduction of applicable penalty as per details given below:-

2. 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 the_____________________________(Name of scheme) have been
complied with.
Necessary documents as applicable are attached as under:-

1.
2.

Date:-______________ Signature or thumb impression of

Depositor/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 -9

(See Rule 19 of Government Savings Promotion Rules, 2018)

Application for closure of account under National Savings Scheme

Name of Post Office/Bank__________________________

Date___________________

Name of Scheme_______________________________ Account

Number___________________________

1. I/we hereby submit pass book/deposit receipt book 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 depositor/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 Depositor/s

 FORM -10

(See Rule14 of Government Savings Promotion Rules, 2018)

Application for cancellation or variation of nomination in an account

under National Savings Scheme

Name of the Post Office/Bank……………………..... Account

No…………………………………………..

Name of the scheme____________________

To

The Postmaster/Manager

………………………………………………

………………………………………………

1. I/We being the depositor(s)/guardian of_______________________(Name of the

minor/person of unsound mind) hereby nominate the person(s) named below, to be
recipient(s) of the amount standing at the credit of the above mentioned account in the event
of death of my/our/minor’s/person of unsound mind, before closure of the said account.

[Link]. Name(s) of the Full address (s) Aadhar Date of birth Share of Nature of
nominee(s) and Number of of nominee entitlement entitlement
relationship nominee/s in case of
minor Trustee or
owner

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).
The above nomination will have the effect marked below

This nomination supersedes the previous nomination made in respect of the said account
with registration number_____________________ date____________________.

or

No nomination has been previously made in respect of the said account.

The passbook/deposit receipt/statement of account is enclosed

Signature or thumb impression

of depositor(s)

(Thumb impression should be attested by a person known to the Accounts office)

Witnesses

1. Name

Address

Signature

2. Name

Address

Signature

For office use only

Nomination registered at Serial Number________________________.

Date Signature and Seal of

Postmaster/Manager
 FORM -11

(See Rule 15 of Government Savings Promotion Rules, 2018)

Application for settlement of an account of the deceased depositor by nominee or legal heirs
under National Savings Scheme

To

The Postmaster/Manager

……………………………..

1. I/we________________________the nominee(s)/legal heirs of late___________________________,

the depositor to account No._______________________under____________________________(Name of
scheme), apply for withdrawal of entire amount standing to the credit of the deceased in the said account.

In support of the claim, I hereby submit the following documents :-

1. Death certificate of depositor/s.

2. Death certificate of Sh./Smt…………………………,also the nominee(s) appointed by the depositor(s).
(***)
3. Succession certificate//letters of administration with attested copy of probated bill of the deceased
depositor issued by_____________________competent court. (**)
4. Letter of Indemnity(*)
5. Affidavit(*)
6. Letter of disclaimer on affidavit(*)
7. Pass book/deposit receipt/statement of account

Signature/thumb impression of Claimant/s

Address__________________________

(Thumb impression should be attested by a person known to the Accounts office).

Date …………………………..

(*) To be produced by legal heirs, in the absence of nomination for claims upto Rs.5 lakh.
(**) Strike off if there is a valid nomination.
(***) Strike off if not applicable
 For office use only

Withdrawal of
Rs.___________________(Rupees_________________________________only) is
sanctioned.

Signature of Postmaster/Manager

Date

Acquittance

(to be filled by claimant/s)

Received Rs ._____________(In figures)______________________ (in words) By

cash/cheque/DD bearing no…………………………………….dated…………………./by
transfer to Account No............................... in full settlement of my/our claim.

Date Signature/thumb impression of claimant/s

 FORM -12

(See Rule 11 of Government Savings Promotion Rules, 2018)

Letter of authority to open or operate an account under National Savings

Schemes on behalf of depositor suffering from physical infirmity including
blindness

To

The Postmaster/Manager

………………………………..

Sir

I/we_________________________________depositor of account
number________________________ under___________________(Name of scheme)
hereby authorise Sh./Smt./Ms.____________________w/o,s/o,d/o___________________in
whom I confide and whose photograph and signature are attested below to operate the said
account for the following purposes.

1.

2.
Paste
3. Photograph
of authorised
4.
person

Specimen signature of authorised person

1.

2.

3.

……………………… …………….
…………………………….

Signature of Witness Signature or thumb impression of

Depositors

(Thumb impression should be attested by a person known to the Accounts office).

Name & Address:

Date
 FORM -13

(See Rule15 of Government Savings Promotion Rules, 2018)

Affidavit

To,
The Postmaster/Manager
…………………………………………………
…………………………………………………

Sir,

1. I/We…………………………………………………………………………………………………
…………………………………………………husband of/wife of/son of/daughter of
late…………………………………………………………………..(deceased depositor)
resident of…………………………………………………………… do hereby declare and
solemnly affirm as under:-
(1) That I/we am/are the only heir(s) of late……………………………………. (deceased
depositor) who died at…………………..on…………………………………… I/We alone
represent the estate of late ………………………………………………….(deceased
depositor).
(2) That late……………………………………………….. (deceased depositor) did not leave
any will and therefore I/we am/are the only successor(s) to the estate of the said
deceased depositor/s.

1. …………………………………………(Signature)
2.
3.
4.

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 my/our knowledge
and nothing material has been concealed.

Dated:-

1. ……………………………………….(Signature)
2.
3.
4.

Deponents

Attested

Oath Commissioner/Notary Public

 FORM -14
(See Rule15 of Government Savings Promotion Rules, 2018)
Letter of disclaimer
To,
The Postmaster/Manager
…………………………………………………
…………………………………………………

Sir,

1. I/We……………………………………………………………………………………………
………………………………………………………husband of/wife of/son of/daughter of
late…………………………………………………………………..(deceased depositor)
resident of…………………………………………………………… do hereby declare
and solemnly affirm as under:-

(1) That late …………………..……………………………………………..(deceased

depositor) died intestate on………………………………. Leaving behind us as his/her
only heirs.
(2) That I/we…………………………………….heirs of
late………………………………………….(deceased depositor) for ourselves and on
behalf of our heirs, executors, representatives and assigns do hereby relinquish our
claims to the balance of Rs………………………….. payable to the heirs of
late……………………………………………(the deceased) which may be credited to
the account sought by Mr./Ms.………………………………………….(claimant). our
………………………………(mention relation). 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 Bank to said
Mr./Ms…………………………………………(claimant)

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 our knowledge.

Dated:-

Deponents

I identify the deponent(s) who is/are personally known to me and who has/have signed in my
presence.

Dated:-

Attested
Oath Commissioner/Notary Public
 FORM -15
(See Rule15 of Government Savings Promotion Rules, 2018)
Letter of indemnity
To,
The Postmaster/Manager
…………………………………………………
…………………………………………………

Sir,

1. In consideration of your paying or agreeing to pay

me/us…………………………………………………………………………………………………….(Name
of legal heirs) the sum of Rs……………………………………..standing
in…………………………………..(Name of scheme) account No…………………………….with
your…………………………………..(name of Accounts office) in the name
of……………………………………………………………….without production of letters of
administration or succession certificate to the estate of the
deceased………………………………………..(name of the subscriber) or a certificate from the
Controller of Estate Duty to the effect that estate duty has been paid or will be paid or none is due,

1. I/We……………………………………………………………………………………………………..a
nd 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, demand,
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.

3. In witness whereof we have hereunto set my/our hand at……………………………on

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

1.
2.

Signature, names and addresses of witnesses:

1.
2.
Attested
Notary Public