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MPKBY Agent Self Declaration Form

Mrs. Amisha Rajendra Chindarkar, an MPKBY Agent, submits a self-declaration stating that she could not provide AAS-5 cards for certain RD accounts due to non-supply from the Appointing Authority. The document lists multiple accounts along with depositor names, account numbers, opening dates, and monthly deposit amounts. She acknowledges full responsibility for the funds of the depositors she serves.

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15 views1 page

MPKBY Agent Self Declaration Form

Mrs. Amisha Rajendra Chindarkar, an MPKBY Agent, submits a self-declaration stating that she could not provide AAS-5 cards for certain RD accounts due to non-supply from the Appointing Authority. The document lists multiple accounts along with depositor names, account numbers, opening dates, and monthly deposit amounts. She acknowledges full responsibility for the funds of the depositors she serves.

Uploaded by

amishachindarkar01
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Self Declaration

(to be submitted by MPKBY Agents for non mentioning of AAS5 card numbers in the RD Schedule (Bulk List)

I, Mrs Name:- AMISHA RAJENDRA CHINDARKAR (Name of the MPKBY Agent) W/o/D/o

Certificate of Authority No. [Link] 00006538

valid up to (date) 18/07/2025 residing at Address:- HARBHART ROAD, SANGLI


declare that the following accounts have been canvassed by me and I could not provide [Link]-5 cards to the Depositions as
the [Link]-5 cards were not supplied to me by the Appointing Authority of MPKBY Agent.
Account No. Name of Depositor Date of Opening Monthly Deposit
Account Amount
[Link]
1. RENU RAJAN
020047043085 21/02/2022 4,000.00 Cr.
RAMCHANDRE
2. MEGHNATH DILIP
020047058474 30/09/2021 500.00 Cr.
NARVEKAR
3. ASHOK GANPATI
020047143266 12/09/2020 1,500.00 Cr.
METKARI
4. JAYASHREE ASHOK
020047144634 29/06/2023 1,000.00 Cr.
METKARI
5. SARITA SURESH
020047144943 21/02/2022 1,000.00 Cr.
CHINDARKAR
6. DATTATRAY SAKHARAM
020047145166 30/09/2021 500.00 Cr.
BHATKAR
7. MAHESH NARAYAN
020047797960 12/09/2020 1,000.00 Cr.
DEVARUKHKAR
8. KISHOR SAKHARAM
020047798917 29/06/2023 1,000.00 Cr.
BHATKAR
9. SHIVANI ASHAY
020047970623 21/02/2022 1,500.00 Cr.
CHINDARKAR
10. 020053481070 AMOL TANAJI KENCHE 30/09/2021 1,500.00 Cr.
11. ASANKUWAR
020056085033 BHOOPATSINGH 12/09/2020 5,000.00 Cr.
RATHORE
12. V GEETA VISHAL
020075183732 29/06/2023 1,500.00 Cr.
MAGDUM
2.1 declare that I am fully responsible for the money of the money of the Depositors of the RD Accounts to whom I am serving as agent.

Signature of the MPKBY Agent

Date stamp of the Post Office

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