POstal Forms

ANIL WAKANKARS
2011
POSTAL HAND BOOK
PART II (FORMS)

ANIL WAKANKAR
P O S T A L A S S T T . , P A L I , D I S T R A I G A D 4 1 0 2 0 5 ( MA H A R A S H T R A )
POSTAL HAND BOOK (PART II) BY ANIL ANANT WAKANKAR, POSTAL ASSTT., PALI 410205
Page 2

PREFACE
I am very pleased to present a booklet prepared by me
named POSTAL HAND BOOK part II. This is the third edition of
this booklet.
From last some years I have been maintained a set of
forms which is useful while working as Postal Assistant or Single
Handed Sub Postmaster. My first Postmaster Shri Jayant
Kemnaik was very particular in providing service to the
customers. This is the set of forms handed over to me by him at
the time of his retirement. He had kept those forms for his own
use at the time when he was working as Postmaster. At that
time there was not a single Xerox machine at the places of
Tahsil level also. I have only made that set of forms available to
everybody.
I shall be satisfied when this book will helpful to somebody
while working the day today work.
Anil Anant Wakankar,
Postal Asstt.,
Pali,Dist Raigad.
eMail id aawakankar@gmail.com

Page 3

POSTAL HAND BOOK
PART II (FORMS)
INDEX
SL
NO
DESCRIPTION OF FORM PAGE NO
APPLICATION FOR ADVANCES
1 Application for Festival Advance 7
2 Application for Cycle Advance 08
3 Form of Surety Bond required for advances 09-10
4 Application for Purchase of scooter Advance 1-12
5 Application for conversion of GPF advance into withdrawal 13-14
6 Application for LTC advance 14
7 Application for advance/withdrawal from GPF
Genl-30
16-17
RURAL POSTAL LIFE INSURANCE
1 CERTIFICATE OF INVESTMENT IN RURAL P.L.I. Format 18
2 DECLARATION FOR REVIVAL OF RPLI/PLI POLICY Format 19
3 APPLICATION FOR CLAIMING THE AMOUNT OF RPLI OF THE
DEACEASED INSURANT
20
4 APPLICATION FOR CLAIMING MATURITY VALUE OF ASSURANCE
POLICY
LI-9(B) 21
5 APPLICATION FOR CLAIMING SURRENDER VALUE OF ASSURANCE
POLICY
LI-23 22
6 APPLICATION FOR CLAIMING SERVIVAL PAYMENT OF ANTICIPATED
ENDOMENT ASSURANCE POLICY
format 23
7 APPLICATION FOR LOAN ON THE SECURITY OF INSURANCE POLICY LI-35 24
SAVINGS BANK
1 APPLICATION FOR TRANSFER OF SAVINGS BANK ACCOUNT SB10(B) 25
2 APPLICATION FOR NOMINATION IN RESPECT OF P.O. SAVINGS BANK
ACCOUNT
SB-55 26-27
3 Application for the FACILITY OF MAKING WITHDRAWALS BY CHEQUES
from SB Account
SB/CQE4

28
4 Application for the purpose of availing the facility of automatic transfer
from SB Account to CTD/RD account
SB-83

29
5
Application for duplicate passbook
Format 30-31
6 Binder Top Sheet Format 32
7 R.D. Ledger card SB-71 33-34
8 MIS Incentive Bill Format 35-36
Page 4

9 BALANCE REPORT FOR TRANSFER OF .. ACCOUNT Format 37
10 APPLICATION FOR TRANSFER OF MONTHLY INTEREST OF MIS
ACCOUNT TO THE SAVINGS BANK ACCOUNT
Format 38
APPLICATION FOR TRANSFER OF MONTHLY INTEREST OF MIS
ACCOUNT TO THE SAVINGS BANK ACCOUNT(MARATHI)
126
11 BILL FOR CLAIM OF COMMISSION BY GDS SUB/BRANCH POSTMASTERS
FOR DEOSITS IN SAVINGS ACCOUNTS
Format 39
12 BILL FOR CLAIM OF COMMISSION BY GDS SUB/BRANCH POSTMASTERS
FOR DEOSITS IN T.D. ACCOUNTS
40-41
13 APPLICATION FOR THE TRANSFER OF POST OFFFICE TIME DEPOSIT
ACCOUNT(S) AS SECURITY
SB 13(a)

42
14 APPLICATION FOR TRANSFER OF MONTHLY INTEREST OF MIS
ACCOUNT TO THE SAVINGS BANK ACCOUNT

Format 127
SAVINGS CERTIFICATES
1 Application for the issue of Duplicate Savings Certificates NC 29 44
2 Report on application for duplicate 44
3 BOND OF INDEMNIT Nc-61 45-46
4 BOND OF INDEMNITY Nc54(a) 47-49
5 BOND OF INDEMNITY Nc54(B) 50-52
6 Certificate of holding of NSC & Discharge of NSC Format 53
7 Application for discharge of savings Certificates at the office other
than office of registration.
Format 54
8
Advice of payment of certificate N.C.-10
55
9 Application for transfer of Post Office Savings Certificates as Security NC-41 56-57
10 Application for transfer of Savings Certificate from one person to
another
NC34 58-59
11 DAILY TOTALS OF KISAN VIKAS PATRAS/6N.S.C.(VIII) ISSUED Format 60
12 DAILY TOTALS OF KISAN VIKAS PATRAS /6NSC (VIII) DISCHARGED 61
13 Form of application of nomination of Savings Certificates NC-51 62-63
14 Application for Cancellation or variation of Nomination previously
made in respect of Postal Savings Certificates
Nc53 64-65
15 APPLICATION FOR TRANSFEROF SAVINGS CERTIFICATE(S) FROM ONE
POST OFFICE TO ANOGTHER
NC 32 66-67
16 Certificate of holding and accrual of annual Interest 68
SENIOR CITIZENS SAVINGS SCHEME
1 Application for opening the Senior Citizens Savings Account Form A 69-71
2 Declaration to be attached with Form A of SCSS Format 72
3 Application for extension of the Senior Citizens Savings Account Form B 73
4 Application for closer of the Senior Citizens Savings Account Form E 74
5 Application for closer of the Senior Citizens Savings Account by spouse
or legal heir.
Form F 75
Page 5

6 Annexure I to form B of SCSS ACCOUNT(Letter of indemnity) 76
7 Annexure II to form B of SCSS ACCOUNT(Affidavit) 77
8 Annexure III to form B of SCSS ACCOUNT(Letter of disclaimer on Affidavit) 78
9 Application for Transfer of the Senior Citizens Savings Account Form G 79
10
Income Tax FORM NO 15(G)
80-81
11
Income Tax FORM NO 15(H)
82-83
12 Application for continue of discontinue of the Senior Citizens Savings
Account by spouse
Format 84
SANCTION OF D.D.CLAIM CASES
1 APPLICATION FOR CLAIM UNDER THE SCHEME OF PROTECTED
SAVINGS
85-88
2 Claim application for settlement of savings certificates of the deceased
holder where nomination has been registered
Format 89
3 Claim application for settlement of the claim to a Savings Bank
account of the deceased Depositor where nomination has been
Registered
90
4 Claim application form for settlement of savings bank account of the
deceased depositor Where the claim is preferred by legal evidence
91-92
5 Claim application form for settlement of savings Certificates of the
deceased holder Where the claim is preferred by legal evidence
93-94
6 Post Office Savings Bank/Savings Certificate claim application where
no nomination exists or legal evidence is not produced
SB-84 95-97
7 Report on The Savings Certificate (s) Belongs to DECEASED HOLDER 98
8 BOND OF INDEMNITY[To be executed by heirs of deceased Savings
Bank Depositors and deceased Holders of P O Savings Certificates]
SB 25

99-101
9 D.D.SANCTION MEMO (SB) Format 102
10 D.D.SANCTION MEMO (NSC/KVP) NC 34 103
11 D.D.SANCTION MEMO (MIS) 104
12 D.D.SANCTION MEMO (TD) 105
13 D.D.SANCTION MEMO (RD) 106
14 REPORT FOR SUB OFFICE SAVINGS BANK DEATH CLAIM CASES 107

MISC.

1 Daily T.D.S. Deduction statement 108
2 Medical Certificate for leave or extension or commutation of leave 109
3 CHARGE REPORT 110
4 Certificate of deduction of tax at source of the Income Tax Act, 1961. IT 16A 111
1 MEMO OF ADMISSION OF PAYMENT MO10(A) 112
2 CERTIFICATE OF PAYMENT OF MONEY ORDER MO10(B) 112
3 Request to forward the paid Money Order Voucher MO35 113
4 MONEY ORDER REDIRECTION SLIP MO12 115
5 NOTICE TO PAYEE MO11 115
6 H.O. Journal of Indian Postal Orders paid MO66 115
Page 6

7 Application for revival of SB a/c (Marathi) 117
8 STATEMENT OF D.A. ARREARS PAID TO SWEEPER AND WATERMAN 118
9
cv D@ [& j/j pmj H$ HvJu k v cuv Hj Mkl.
119
10
Format of letter to Issue of duplicate money order.
120
11
UNSOLD STOCK STATEMENT OF 6 NSC (VIII)/kvps/IPOS
121-122
12 APPLICATION FOR CHANGE OF NOMINATION OF PLI 123
13
Intimation for drawing of crossed Cheque.
124
14
APPLICATION FOR LEAVE
SR 1 125

Page 7

APPLICATION FOR FESTIVAL ADVANCE
Name of Festival ________________________________
1. Name of official:-
2. Designation:-
3. Basic Pay:-
4. Amount of advance required:-
5. Whether Temporary or Permanent:-
6. Date from continuously in service:-
7. Whether the recovery of previous advance is till outstanding:-
8. Whether on leave or suspension(state nature of leave):-

Date: - Signature of Applicant
I certify that neither I have drawn any festival advance during the current
year not any previous Festival Advance is still outstanding against me, If this
statement proves fails, disciplinary action may be taken against me.

Date: - Signature of Applicant
Declaration in case of temporary servants
I hereby agree to stand surety for the above Advance or part there of
being found unrecoverable, I agree to pay the same in on lump sum or in
installments may be decided by the Department.

Date:- Signature of surety
Name and Designation

Page 8

APPLICATION FOR CYCLE ADVANCE
1) Name and Designation of the applicant:-
2) Basic Pay:-
3) Whether Permanent or Temporary:-
4) Amount of Advance required:-
5) Whether such advance was sanctioned previously,
if so give details:-
6) No and date of sanction if any
7) No of installments in which repayment is desired:-
8) Reason why cycle advance is necessary:-
Certified that, I have not received cycle advance during preceding three
years.
Place:-
Date: - Signature of applicant.
I verified the particulars of serial No 1 to 3 and 8and recommended / not
recommended the grant of advance.
Appointing Authority.
N.B. In case of temporary officials, Surety bond in the prescribed form is
necessary.

Page 9

Form GFR 21
(See Rule 181)
Form of Surety Bond
KNOW ALL MEN BY THESE PRESENTS THAT I,
Son of ., resident of . in the District of
at present employed as a permanent in the
.. (Hereinafter called the surety ) am held and firmly
bound into the President of India (hereinafter called the Government which
expression shall include his successors and assignees) in the sum of Rs ..
(Rupees
only ) with interest as hereinafter specified and
all cost between attorney and client and all charges and expenses that shall or
may have been incurred by or occasioned to the Government to be paid to the
Government FOR WHICH PAYT to be well and truly made I hereby bind myself, my
heirs, executors, administrators and representatives firmly by these presents. As
witness my hand this day of . two thousand and
..
WHEREAS the Government has agreed to grant to ., sib if
., a resident of . in the district of
at present employed as temporary
in the (Hereinafter called, the borrower at the borrowers
own request an advance of Rs (Rupees
Only) for the . AND WHEREAS THE BORROWER has
undertaken to repay the said amount in .. Equal monthly
installments with interest as calculated at the rate and in the manner prescribed
under rule 198 and Government of Indias Decisions (1) and (2) there under of the
General Financial Rules, 1963, thereon or on so much thereof as shall for the time
being remain due and unpaid calculated at fixed Government rates in force for
Government loans from the day of the advance.
AND WHERAS in consideration of the Government having agreed to grant
the aforesaid advance to the Borrower the Surety has agreed to execute the
above bond with such condition as hereunder is written.
NOW THE CONDITION OF THE ABOBVE - WRITTEN Bond is that if the said
Borrower shall, while employed in the said .DULY and
regularly pay or cause to be paid to the Government the amount of aforesaid
advance owing to the Government my installments with interest as calculated in
the aforesaid manner thereon or on so much thereof as shall for the time being
Page 10

remain due and unpaid calculated at fixed Government rates in force for
Government loans from of day of advance until the said sum of aforesaid manner
shall be duly paid, then this bond shall be void, otherwise the shall be and remain
in full force and virtue.
BUT SO NEVERTHELESS that if the Borrower shall die or become insolvent
or at any time cease to be in the service of the Government, the whole or so
much of the said principal sum of Rs .
(Rupees ..only) thereof as
shall then remain unpaid and the interest due on the said principal sum calculated
in the aforesaid manner from the day of the advance shall immediately become
due and payable to the Government and be recoverable from the Surety in one
installment by virtue of this bond.
The obligation undertaken by the Surety shall not be discharged or in any
way affected by an extension of time or any other indulgence grantee by the
Government to the said borrower whether with or without the knowledge or
consent of the Surety.
The Government has agreed to bear the stamp duty, if any, for this
document.
Signed and
delivered by .
the said .. (Signature of the Surety)
. Designation .
at Office to which attached
this .
Of in presence of
20 (1) .
Signature,
Address (2)
Of the witnesses

ACCEPTED
For and on behalf of President of India

Page 11

APPLICATION FOR ADVANCE FOR PURCHASE OF SCOOTER
1. Name of Applicant:-
2. Designation of applicant:-
3. Name of office where working:-
4. Pay substantive officiating special:-
5. Anticipated prize of Scooter:-
7. Date of superannuation or retirement or date :-
of expiry of contract in case of contract officer
8. No of installments in which the advance is
Desired to be repaid:-
9. Whether advance for similar purpose was
obtained previously and if so:-
a) Date of drawal of the advance:-
b) The amount of advance and or interest
thereon still outstanding if any:-
10. Whether the intention is to purchase:-
a) A new or old motor car/ cycle:-
b) If the intention is to purchase motor
car/ cycle through a person other than
a regular or reputed dealer or agent.
Whether previous sanction of the competent
authority has been obtained as required
under Rule 15(20 of C.C.S. (Conduct)
Rule 1964.
c) Date of entry in the department:-
d) Length of service:- Years Months Days

Page 12

11. Whether the officer is on
leave/ is about to proceed on leave.
a) Date of commencement or leave:-
b) The date of expiry of leave:-
12. Are any negotiation of preliminary
enquiries being made so of the Motor
Car/Cycle within one month from the
date of drawal of the advance.

13. a) Certified the information given above is complete and true.
c) Certified that I have not taken delivery of the Motor Car/ Cycle on a/a of
which I apply for the advance that I shall complete negation for
purchase of pay finally and take possession of the motor car/ cycle
before the expiry of one month from the date of drawal of the advance
and that I shall ensure it from the date of taking delivery of it.

Signature of the applicant

Recommended of head of Division/Unit.

Signature of the head of Division/Unit.

Page 13

DEPARTMENT OF POSTS, INDIA.
FORM OF APPLICATION FOR CONVERSION OF AN ADVANCE INTO FINAL
WITHDRAWAL
Name of the Subscriber:-
Designation:-
Pay :-
Name of the provident Fund and Account No: - General Provident Fund.--
Balance at credit on the date of application:-
Opening Balance-
Subscription:-
Refund of advance:-
Total:-
(-) Advance taken:-
Net Balance:-
(a) Balance outstanding to be converted
in to final withdrawal :-
(b) Interest due on the amount of advance taken.
7. (a) Purpose for which Advance was taken :-
(b) Date of payment of the advance:-
(c) Amount of Advance Sanctioned:-
8. Particulars of communication under which advanced was sanctioned:-

Whether any advance of final withdrawal has been drawn previously
for the purpose mentioned above, if so, particulars thereof:-
(a) Total service, including broken periods, if any, on the date of
this application:-
Period of service, left on the date of this application:-
Date of superannuation:-

Place:-

Date:-
Signature of Applicant
The above particulars have been verified to be correct:-

Signature and Designation of recommending Authority
Page 14

SANCTION OF THE COMPETANT AUTHORITY
_____________________________________________________________
No. / B-2 / / Dated at Alibag the
_____________________________________________________________

Sanction of the Supdt. Of Post Offices, Raigad Division is hereby conveyed
under Rule 16(A) of the G.P.F.(C.S.) Rules, 1960 for the conversion into final
withdrawal of an amount of Rs. ________ (Rupees_________________________
___________) being the outstanding balance out of G.P.F. Advance of Rs _______
(Rupees ______________________________________ ) sanctioned on ________

And drawn in Bill no. of Alibag for the purpose of
______________________________

To Shri/Smt __________________________________ of the office of the
___________

G.PF. Account No____________________

Supdt. Of Post offices,
Raigad Division, Alibag 402201 .
------------------------------------------------------------------------------------------------------------
No- B-2

Page 15

DEPARTMENT OF POSTS, INDIA
APPLICATION FOR ADVANCE OF LEAVE TRAEL CONCESSION.

1. Name of the official/officer:-
2. Designation and office to which attached:-
3. Basic Pay:-
4. Whether permanent or temporary:-
5. Whether completed one year of service:-
6. Whether surety is attached:-
7. Period of leave:-
8. Date of commencement of outw2ard journey:-
a) Whether proposed to All India Tour LTC :-
b) Whether proposed to avail a Home Town LTC:-
c) Place of LTC:-
9. Home Town given in Service Book:-
10. Actual fare and approximate distance:-
11. Date and Block of years when last LTC availed:-
12. Block of Two/Four years for which LTC is being applied:-
13. Whether staying with family, particulars of the family
members availing the LTC with age and relation:-

I hereby certify undertaken to produce Railway receipt or cash receipts
from S.T., etc. for the journey to be under taken by me within 10 days of the
drawal of advance failing which I shall refund the advance in full or same may be
deducted from my pay. The final LTC bill will be submitted within one month from
completion of return journey.

Date Signature of the official.

Recommendations of supervising officer.

Page 16

Genl-30
Application for Advance/Withdrawal for GPF Account.
1. Name of the Subscriber:
2. Account No:
3. Designation:
4. Pay:
5. (A) Amount of Advance required:
(B) Whether advance or final withdrawal:
6. (a) Purpose for which the advance is required:
(b) If advance is required for House Building etc.
the following information may be given.
i) Location and measurement of the plot:
ii) Whether the plot is free hold or on lease:
iii) Plan for construction:
iv) If the flat or plot is being purchased from a
House Building Society, the name of the
Society, the location and measurement etc.:
v) Cost of construction:
vi) If purchase of plot is from D.D.A. or any housing Board
etc. the location, diamantine may be given:
(C) if advance is required for education of Children, following details may be given.
i) Name of son/daughter:
ii) ii) class and institution/ college where studding:-
iii) Whether a day scholar a hostler:-
Page 17

(D) If advance is required for treatment of allying family
members following details my be given.
i) Name of the patient and relationship:
ii) name of the hospital/dispensary/doctor where
the patient is under going treatment;
iii) Whether outdoor/indoor patient:
iv) Whether reimbursement available or not:
(7) Amount of consolidated advance and number (and amount)
of monthly installments in which consolidated advance is
proposed to be recovered.:
(8) Full particulars of the pecuniary circumstance of the
subscriber justifying the application for temporary withdrawal:
I certify that particulars given above are correct and completed to the best of my
knowledge and belief and that nothing has been concealed by me.
Date Signature and designation of applicant
OFFICE REPORT
1) Balance at credit of the subscriber on the
date of application as bellow.
i) Closing Balance as per statement for the year
ii) Credit from To Subscription
iii) Refund of advance/advances
iv) Withdrawal during the period from .. to ..
v) Net Balance
2) Amount of advance/advances outstanding
Amount of advance taken on the date Balance outstanding Rs ..
of sanction Rs.
3) Rule under which the request is covered

P/A APM, Accounts

Page 18

CERTIFICATE OF INVESTMENT IN RURAL P.L.I.

It is certified that Shri ___________________________________has
invested Rs _____________________________________________Only in Rural
P.L.I. /P.L.I. in the name of his spouse and himself during the period from April 0
to March 06details of which are given bellow.

Sl
no
Name of Insurant Policy no Amount
of
monthly
Premium
Total
Amount
invested
during
April.. .
to
March
Remarks
1
2
3

Date stamp Signature of PM/SPM

Page 19

DECLARATION FOR REVIVAL OF RPLI/PLI POLICY
I ____________________________________ Holder of PLI/RPLI policy No
_________________ hereby declare that there has been no adverse change in my
personal or family history or my occupation,

Signature of Insurant __________________
Present Address ______________________
____________________________________

MEDICAL CERTIFICATE
I have carefully examined Shri/Smt.______________________________________
Holder of PLI/RPLI Policy No _____________________________________. I am
of this opinion that he/she is not suffering from disease likely to shorten &that
he/she had not suffered from any serious disease.
Signature ___________________________
Name & Address of Dr. ________________
____________________________

Page 20

DEPARTMENT OF POSTS, INDIA.
APPLICATION FOR CLAIMING THE AMOUNT OF RPLI OF THE DEACEASED
INSURANT
1) Full Name of the Insurant :-
2) Number of Policy:-
3) Date of Maturity:-
4) Date of Death of Insurant:-
5) Cause if Death:-
6) Full name of claimant:-
7) Is the claimant a Nominee:-
8) Age of claimant:-
9) Claimants Relation and how it can be proved:-
10)What other relative to Insurant:-
11) Ref. To previous loan if any
Loan A/C no. Amt & Date of repayment
12) Description of document in support of claim
1) Insurance Policy Original
2) P.R. Book
3) Death Certificate
13) Name of PO where payment desired
Date:- Signature of the claimant
Certified that I have personally enquired into the truth of the above
statement and that the signature of the claimant is genuine.

Signature of enquiring officer
Page 21

APPLICATION FOR CLAIMING MATURITY VALUE OF ASSURANCE POLICY
1. Policy Number:-
2. Date of maturity:-
3. Full Name of the insurant Shri/Smt.:-
4. Full address where sanction order to be sent:-

5. Name of the Post Office or address of the Account officer at which
premium for last 18 months has been paid in cash or recovered through
salary:-

6. Reference to previous Loan if any:-
1) Loan Account Number:-
2) Amount of payment:-
3) Date of payment:-
7. Name of Post office( with HPO )through which payment is desired:-

Documents forwarded here with: (Please tick mark)
1. Insurance Policy
2. Premium receipt book of disbursing officer certificate (for last 12 month )
Note: - Enclose original copies of all documents.
Date: - Signature of Claimant.

Page 22

APPLICATION FOR CLAIMING SURRENDER VALUE OF ASSURANCE POLICY
1. Policy Number:-

salary:-

5. Reference to previous Loan if any:-
4) Loan Account Number:-
5) Amount of payment:-
6) Date of payment:-
6. Name of Post office( with HPO )through which payment is desired:-

1. Insurance Policy

Page 23

APPLICATION FOR CLAIMING SERVIVAL PAYMENT OF
ANTICIPATED ENDOMENT ASSURANCE POLICY
1. Policy Number:-
2. Due Date of installment :-

salary:-

1. Insurance Policy

Page 24

APPLICATION FOR LOAN ON THE SECURITY OF INSURANCE POLICY
1. Policy No.:
2. Amount of Loan required:
3. Full Name of insurant:
4. Full address (where sanction order to be sent) :
5. Name of post office or address of the Accounts Officer at which premium for
last 12 months has been paid in cash or recovered through salary:

6. Reference to previous loan, if any:
a) Loan account No:
b) Amount and date of repayment (enclose loan passbook)
i) Amount: Date:
7. Name of post office (with its HPO) through which payment is desired:
Documents forwarded herewith
1) Insurance Policy
2) Premium receipt Book or Disbursing officers certificate (last 12 months)

Date Signature of claimant

Page 25

SB 10(B)
APPLICATION FOR TRANSFER OF _____________________ACCOUNT

To,
The Postmaster,
_______________________________
_______________________________
I request that my Account No____________________ standing in the books of
the _________________________ Post Office Savings Bank may be transferred to
the books of the __________________________ Post Office Savings Bank.
The passbook has the balance of Rupees__________________ (in words)
________________________________________________ .
Three specimen signatures are given bellow.

Dated: - Signature of Depositor.
Specimen Signatures:-

1 __________________________ Countersigned Postmaster

Date

Date

Date
-------------------------------------------------------------------------------------------------------

Received application for transfer of _____Account No________________
in the name of _____________________________standing on the books of
_________________ Post Office Saving Bank ( with the relevant passbook
showing ) a balance of Rs ________(
Rupees__________________________________ only) The entries in the
Passbook have been checked and the passbook returned to the depositor.

Date Stamp Signature of the Postmaster
Page 26

Name of Post office_________________
SB 55
Serial no
NO UNDER VOVERNMENT SAVINGS BANK AMENDMENT ACT, 1959
(in the case of on account which stands in the books of a sub or Branch Post Office. an
application may be made through the Sub or a Branch Postmaster)
To
The Postmaster,
..
(Through Postmaster S.O./B.O.)
Under provisions of section 3 (1) of the Government Savings Bank (Amendment) Act,
1959, I, the depositor of Post Office Savings Bank A/C, No hereby nominate the
person (s) who is the event of my death. Before closure of the above account, shall be entitled
to the payment of the sum due on the above account, to the exclusion of all other persons I
hereby declare that I have not made any nomination in respect of the above account.
The passbook is enclosed.

Sl. No. Name of the
nominee
Full address Date of birth of nominee in case
of minor

______________________________________________________________________________
ACKNOWLEDGEMENT
To
_______________________
___________________________
Your application dated .
Nomination in respect of the Savings Bank Account No ..
Standing at .. H.O./S.O./B.O. H O. has been registered in this office under No
. Dated . In favor of persons mentioned on the reverse.
The passbook is returned herewith

Date Stamp Signature of Postmaster

Page 27

As the nominee(s) at serial N0 (s) . Is/are minor(s), I appoint Shri
(Name and full address) as the person to receive the sum due on the Savings Bank Account in
the event of my death during the minority of the nominee(s).

Address Yours faithfully,
(In case of illiterate depositor Signature (Thumb impression if
Fathers name should be given) illiterate) of depositor.

Witness:
Name and address

Name and address

N.B. In the case of illiterate depositor, the witness shall be persons whose signature(s) are
known to the Post Office.

Date Stamp
Signature of Head/ Sub Postmaster.

______________________________________________________________________________

Sl. No. Name and address of nominee (s) Name and address of person
Appointed to receive payment in case
of minor nominee.

------------------------------------------------------------------------------------------------------------------------------------------

Page 28

DEPARTME NT OF POSTS
SB/CQE-4

APPLICATION FOR THE FACILITY OF MAKING WITHDRAWALS
BY CHEQUES FROM SAVINGS BANK ACCOUNTS
Dated-
To,
The Post Office Savings Bank ____________________ Post Office.
Please permit me/us to avail of the facility of making withdrawals by cheques and issue a
cheque book for my/our Savings Account No __________________ standing open at your office.
I/We hereby declare that I/We have read the conditions governing the issue of cheque books,
and withdrawals by cheques from Post Office Savings Bank Accounts, as laid down in Rule 28-a of the
Post Office Savings Bank Rule 1881, and that I/We accept all aforesaid conditions, and such
amendments thereto as may be issued from time to time, as binding upon me/us.
Names(s) of Depositor(s)_____________________________________________
(In Block Letters)
The cheque book should be delivered/sent by registered post to :-
Name ______________________________
Full address _________________________ ______________________________
___________________________________ Signature of Depositor(s)

______________________________________________________________________________
TO BEFILLED IN BY POST OFFICE
Account No ____________________ Cheque Book containing Cheques

Ledger No _____________________Nos. ___________ To____________ issued.
Noted in Ledger.

Initials with date of Group Initials with date of cheque Book
Head Clerk Head Clerk
CERTIFICATE OF IDENTIFICATION
I _______________________________________do hereby certify that
___________________________________________ the depositor of Post Office Savings Bank Account
No ________________ standing open at __________ Post Office is/are known to me and has/have
signed in my presence.
IDENTIFICATION ACCEPTED Signature of Identifier
Address:-

ACKNOWLEDGEMENT OF DEPOSITOR(S) FOR CHEQUE BOOK
I/We hereby acknowledge the receipt of the cheque book containing cheques No __________________
to ________________ which I/We have counted and found correct and in proper serial order.
Signature of Depositor(s)

Page 29

SB-83
Application for the purpose of availing the facility of automatic transfer from
SB Account to CTD/RD account
(To be filled in duplicate in case of Account stands at SO)
To,
The Postmaster,
----------. Post Office
Sir,
I/We .. the
holder/holders of SB account No requested that a sum of
Rs.. (Rupees ) may be debited
every month/every 6/12 months to the above mentioned account and the same be
credited to the under mentioned RD/CTD account/accounts standing in my/our
names. The name of my spouse/dependent child
Sl. No Name of Depositor Denomination Account No

This facility is not being availed of by me/us at present in respect of any
CTD A/c is in addition to the facility already granted to me/us in respect of CTD
Account No.
I/we hereby declare that the conditions subject to which facility and
automatic transfer is permissible have been read by/to me/us and I/we accept all
the said conditions and all such amendments thereto as may be issued from time to
time as binding upon me/us. The passbooks of the SB and CTD accounts
concerned are enclosed.

Yours faithfully,

Page 30

APPLICATION FOR DUPLICATE PASS BOOK.
1. Account No. & Type (TD/RD/CTD) Whether
Minor/public/Joint account etc. in respect
Of TD/CTD a/cs. state the category of the account. ~
2. Post Office at which account stands
(With the name of Head Office in brackets if the A/C is not at H.O.)
3. Name(s) of Depositor(s)
4. Name of father/husband or authority operating accounts.
i) Address of the Depositor(s) at the:
Time of opening of the Accounts.
ii) Present Address of the depositor(s):
5. Date of opening account & Office at
Which opened/if different from that Col.2
6. Date & particulars of the last transaction - :
in the account.
7. Balance at credit after the last transaction- :
8. Name of Post Office from which the account-:
was last transferred to the Office shown
at Col.2lwhere applicable.
9. Date& circumstances of loss of PBK &:
result of efforts made to trace it etc.
10. Whether loss was reported to Police &:
If so, with what result.
11. REMARKS.
The particulars given above are true to the best of my/our Knowledge & A
duplicate passbook may please be issued to me/us. I shall surrender the passbook;
if found.*Fee of 10/- has been paid by affixing postage stamps. .
*PLEASE SCORE OUT' IF EMPTION HAS BEEN GRANTED.
STATION:
Date
Signature(s) of Depositor(s)
Guardian/person of Authority
Operating A/C.
N.B.: If accurate information cannot be furnished in respect of Col.No.7 and .8
available particulars may be, given

PART- I
Page 31

FOR OFFICE USE
1. Has the account been traced in the
ledger/binder, index to ledger cards/
S.O.SB ledger and do the particulars furnished by the applicant tally with
the record.
2. Does the signature(s) of the applicant (s) tally with specimen(s)
on record? If not has he/she been satisfactorily identified.
3. Has the register of undeliverable Passbooks in safe custody
at the H.O. been consulted & is the PBK available in the H.O.
or SBCO or lying undelivered in the Sub office.
4. Do you consider further enquiries called for as laid down in Rule 68
PO SB Man. Vo1. I.
5. If answer to 4.is yes, result, of enquiries made.
6. Recommendation regarding Issue of Duplicate Pass-Book.

DATE:
Signature of APM/Dy. PM/HO/SBWith designation stamp.
(IN RESPECT OF APPLICATION RECEIVED FROM S.O.)
1. Have the Particulars of the A/C as given in the application verified
with H.O. record?
2. Has the register of undeliverable Passbook in safe custody at the H 0 been
consulted & is the PBK available in the H.O.?
3. Recommendation of APM/Dy. PM (SB) regarding Issue of the Duplicate
Passbook..
DATE:
Signature of APM/Dy. PM( SB)
H.O. with Designation stamps.
PART III ORDERS OF THE HEAD POSTMASTER
Duplicate Passbook may/may not be issued.

DATE: signature of the Postmaster With Designation stamps.
-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-
Receipt For Duplicate Passbook
Received Duplicate Passbook of Account No with
balance of Rs. Rupees
..)

DATE STAMP OF H.O. SIGNA'T'URE OF1I'HE DEPOSITOR (s}

Page 32

BINDER TOP SHEET

Sl. No of Binder-

Revised No. after re-groping on _________________

Ledger cards of Account Numbers in binder:-

From ____________________ to __________________________

From ____________________ to __________________________

From ____________________ to __________________________

From ____________________ to __________________________

From ____________________ to __________________________

From ____________________ to __________________________

Detail of Accounts closed or closed on transfer.

Sl. No Account Nos. Closed/Transferred
on
Signature of
P.A.
Signature of
SPM

Page 33

SB.71 RD LEDGER CARD

NAME OF DEPOSITOR---------------------------- A/C NO--------------------
FULL ADDRESS------------------------------------ TYPE--------------YEARS
--------------------------------------------------- INSTALMENT-----------
NAME OF NOMINEE -------------------------- DATE OFOPENING----------------
DATE OF BIRTH--------------------------------

MONTH

DATE OF
DEPOSIT

AMOUNT

BALANCE

INITIAL

MONTH

DATE OF
DEPOSIT

AMOUNT
BALANCE
INITIAL
L.A. P.M. L.A. P.M
JAN JAN

FEB FEB

MARCH MARCH

APRIL APRIL

MAY MAY

JUNE JUNE

JULY JULY

AUG AUG

SEPT SEPT

OCT OCT

NOV NOV

DEC DEC

TOTAL TOTAL

MONTH

DATE OF
DEPOSIT

AMOUNT

BALANCE

INITIAL

MONTH

DATE OF
DEPOSIT

AMOUNT
BALANCE
INITIAL
L.A. P.M.

L.A. P.M
JAN JAN

FEB FEB

MARCH MARCH

APRIL APRIL

MAY MAY

JUNE JUNE

JULY JULY

AUG AUG

SEPT SEPT

OCT OCT

NOV NOV

DEC DEC

TOTAL TOTAL

Page 34

MONTH

DATE OF
DEPOSIT

AMOUNT

BALANCE

INITIAL

MONTH

DATE OF
DEPOSIT

AMOUNT
BALANCE
INITIAL
L.A. P.M. L.A. P.M
JAN

FEB

MARCH

APRIL

MAY

JUNE

JULY

AUG

SEPT

OCT

NOV

DEC

TOTAL

MONTH

DATE OF
DEPOSIT

AMOUNT

BALANCE

INITIAL
PARTICULARSOF WITHDRAWAL AND REPAYMENT

PAYMENTS MADE ON MATURITY
L.A. P.M.

JAN

FEB

MARCH

APRIL

MAY

JUNE

JULY

AUG

SEPT
OCT
NOV
DEC
TOTAL
Page 35

M.I.S. INCENTIVE BIL OF . S. O.
FOR THE MONTH OF 2008

DATE

NO OF TRANSACTIONS

NAME
OF SPM

RATE
OF INC

AMOUNT
OF
INC.
OF SPM

NAME OF P,A.

RATE
OF
INC

AMT
OF
INC.
OF
P/A

TOTAL
AMOUNT
OF
INCENTIVE

CL
D
W
DL
NEW TOTA
L
- 50 - 1 -
- 50 - 1 -
- 50 - 1 -
- 50 - 1 -
- 50 - 1 -
- 50 - 1 -
- 50 - 1 -
- 50 - 1 -
- 50 - 1 -
- 50 - 1 -
50 - 1 -
- 50 - 1 -
- 50 - 1 -
- 50 - 1 -
- 50 - 1 -
- 50 - 1 -
- 50 - 1 -
- 50 1 -
- 50 - 1 -
- 50 - 1 -
- 50 - 1 -
- 50 1 -
- 50 1 -
- 50 1 -
- 50 1 -
- 50 1 -
- 50 1 -

-

Page 36

SUMMERY

CERTIFIED THAT:-
The official for whom incentive is claimed in the bill has actually earned it by
working or rendering working hours of 25% of the normal duty out put.
The incentive claimed in the bill has been checked with the initial record and
found correct.
The incentive is claimed at rate sanctioned by the competent authority.
The incentive has been taken into account in the calculating the income tax due
from the government servant noted in this bill.
The official for whom incentive are claimed have not been granted any
compensatory off in lieu thereof.
The incentive has been paid to the person to whom due and employment of
officials mentioned in this bill has been made only in avoidable exceptional and
emergent cases.
Each of the officials for whom incentive is claimed in this bill will not receive total
amount of such incentive exceeding Rs. 500/- in case of Postal Asstt and Rs 250/-
in the case of supervisor during the current month.
Ledger posting work of tractions noted in this bill has been completed.

Place: -
Date:-

SL
No
Name Of Official Designation No Of
Transaction
Rate Of
Incentive
Amount Of
Incentive
Remarks

Page 37

BALANCE REPORT FOR TRANSFER OF .. ACCOUNT
1. ACCOUNT NO:-
2. DATE OF OPENING:-
3. NAME OF DEPOSITOR: -
4. TYPE OF ACCOUNT:-
5. DENOMINATION:-
6. AMOUNT OF MONTHLY INTEREST:-
7. BALANCE:-
8. PAID UPTO:-
9. NO OF DEFAULTS:-
10. AMOUNT OF WITHDRAWAL:-
11. NOMINATION:-

Date Stamp Signature of Sub Postmaster.

No/ /20 -20 Dated at .. the .
To,
The Postmaster/Sub Postmaster,
..

Signature of Sub Postmaster.
Page 38

APPLICATION FOR TRANSFER OF MONTHLY INTEREST OF MIS ACCOUNT TO THE SAVINGS
BANK ACCOUNT
FROM,
.
.

To,
. Post office.
Subject: - Application for credit of M.I.S. monthly interest to Savings Bank Account.
Respected Sir,
I/We am/are the depositor(s) of the Monthly Income Scheme Accounts, details of which given
bellow; hereby request to your honour to draw the amount of monthly interest from my/our Monthly
Income Scheme Account(s)and credit the same to my/our Savings Bank Account No .
standing in the books of Post Office Savings Bank.
I/We hereby authorize to your honour to withdraw the amount from my/our account whichever
is credited excess (if any).Passbooks of both account (MIS an SB) are enclosed herewith for passing the
necessary remarks.
SL.
No
M.I.S.
Account No
Name of
Depositor(s)
Due Date Of
Interest
Amount of
monthly
interest
Savings
Bank
Account
No
Remarks

Yours Faithfully,
Page 39

BILL FOR CLAIM OF COMMISSION BY GDS SUB/BRANCH
POSTMASTERS FOR DEOSITS IN SAVINGS ACCOUNTS
Name of BO/EDSO .. Year
Month Deposit
in cash
Deposit
by
cheque
Total
Deposit
With-
drawal at
BO/EDSO
With-
drawal at
account
office
Total
with-
drawal
Net
Deposit
Remarks
April
May
June
July
August
September
October
November
December
January
February
March
Total
Net accretion during the year (In words and figures)
.
Total amount of commission claimed (In words and figures)
.
Date .. Signature of GDS BPM/SPM
Verified for payment of Rs
Date . Signature of PM/SPM
Passed for Rs
Received the amount specified above Rs.
Signature of GDS BPM/SPM
Page 40

BILL FOR CLAIM OF COMMISSION BY GDS SUB/BRANCH
POSTMASTERS FOR DEOSITS IN T.D. ACCOUNTS
Name of BO/EDSO .. MONTH
Time
Deposit
Account No
Category Amount of
Deposit
Rate of
commissio
n
Amount of
commission
claimed
Remarks

Total

Total amount of commission claimed (In words and figures)
.
Date .. Signature of GDS BPM/SPM
Verified total deposit for Rs

Passed for payment Rs .
Received the amount specified above Rs.
Signature of GDS BPM/SPM
Page 41

SB 13(a)
APPLICATION FOR THE TRANSFER OF POST OFFFICE TIME DEPOSIT ACCOUNT(S) AS SECURITY
Note 1:- Transfer of Time Deposit Accounts as security to an individual, association, institution,
private company, a body registered as a society under any law for the time being in force, a firm
registered under Indian Partnership Act 1932 (9 of 1932) is prohibited.
Note 2:- Time Deposit Account opened on behalf of minor can be transferred only if the
guardian certifies that the minor is alive and the transfer is for the benefit of the minor.
To
The POSTMASTER,

Sir,
I/We . (Name in Block Letters)
am/are required to deposit an amount of Rs .. as security to the President of India/
Governor of . State/Reserve Bank of India/ Scheduled bank/Co-Operative Bank/
Co- Operative Society/Corporation/Government Company/Local Authority.
I/We therefore request you to transfer the under mentioned Post Office T.D. account(s)
of which I am/We are the holder (s) as security to
President of India/Governor of State/Reserve Bank of India/ Scheduled bank/Co-Operative
Bank/ Co-Operative Society/Corporation/Government Company/Local Authority vide
declaration of the pledgee reverse this form.

I/We . hereby declare that
on the transfer of the under mentioned Post Office Time Deposit Account(s), the transferee,
(pledgee) shall, until it is/ these are re-transferred or released to me/us, be deemed to be the
holder of the Account(s). I/We also agree that the amount of the account(s) shall be withdrawn
by the pledgee when the security has been forfeited.
Particulars of Time Deposit Account(s)

Sl.
No.
Type of
Account
Account No. Date of opening Name of
office
where
account
stands
Balance Name of
Minor if
account stands
in the name of
minor

Address .. Yours faithfully,

Signature of Transferor(s)
Page 42

REVERSE
DECLARATION BY TRANSFEREE (PLEDGEE)
I .. (Official Designation of Government Officer)
hereby accept the savings certificates paricularised on the obverse of this form as security on
behalf of the President /Governor of State of
In his official capacity and hereby certify that I (Official
Designation of Government officer) am duly authorised under article 299 of the constitution
vide Notification No dated by the Government of India in the ..
Ministry of /State Government and to execute such instruments
or deeds on behalf of the President of India /Governor of State.
I . Official designation of officer of the
State/Reserve Bank of India/ Scheduled bank/Co-Operative Bank/ Co-Operative
Society/Corporation/Government Company/Local Authority . And
hereby certify that I am duly authorized to accept or release of to execute such instruments or
deeds on behalf of the State/Reserve Bank of India/ Scheduled bank/Co-Operative Bank/ Co-
Operative Society/Corporation/Government Company/Local Authority .

Date Signature of the transferee (Pledgee)

Official Designation of the Officer
accepting the pledge on behalf of
the pledge(Stamp and Seal)

Serial No of Head /Sub Office

To be filled in by the Postmaster of Head /Sub Post office

Sl.
No
.
Type of
Account
Account
No.
Name of
office
where
account
stands
Date of
pledging
letter of
authority
No and
Date of
releasing
the
pledge
Date of
Payment
Initials of the
Postmaster

DATE Signature of Sub/Head Postmaster

Oblong M.O. Stamp of Head/Sub Post Office
Page 43

L.I.35

Application for the issue of Duplicate Savings Certificates in lieu of the loss, theft, destruction,
mutilation of defacement of the Savings Certificates in the custody of the holder.

To
The Postmaster,
_________________
Sir,
I/we _______________________________________________________(Name in Block
Capitals) request you to issue Duplicate Certificates lieu of lost/destroyed/stolen
Savings Certificates details given bellow of which I am/we are the holder(s). I am/we are hereby
furnishing the following information which is true to the best of my knowledge and belief:-
i) PARTICULARS OF CERTIFICATES:
A) Name of issue of the certificates:
B) Serial numbers of certificates;
C) Date of issue;
D) Denominations:
E) Name of the office of issue:
F) Type (Single/Joint-A/Joint-B):
G) Registration No:
ii) How the above noted particulars of the certificates could be ascertained.

iii) Whether the identity slip was issued, if yes, the same is to be enclosed.

iv) Circumstances in which the theft/loss/destruction occurred.

v) Date of furnishing first report of the certificates to the Police Station / Post Office of registration.
vi) Result of police enquiries

Date________________ Signature of holder(s)
Name _______________________
Address______________________
___________________________

CERTIFICATE OF IDENTIFICATION
I _________________________________do hereby certify that Shri/Smt.________
________________________________________is/are known to me and has signed this application in
my presence.

Date______________ Signature of Identifier
Full Address

Holder(s) known to me /identification accepted.
Date_______________ Signature of Postmaste
Page 44

Report on application for duplicate in lieu of lost/destroyed certificates detailed
overleaf.

1. Name of investor in full.
(In Block Capital)
2. Serial no of P.O. Certificate(s).
(Including Index & Block Letters)

Denomination.
Office of Issue
Date of Issue
CERTIFIED
That the original application for purchase/transfer has been checked.
That the signature has been found to agree with that on record
That the particulars of the certificate are correct.
That remark regarding the loss/destruction of the savings certificate has been made in the
remarks column of the application for purchase or transfer of the certificates against the entry
of the certificate under the postmasters initials.
That the fee of Rs___________ for the issue of the duplicate certificate has been recovered and
credited under unclassified receipts on______________
That the certificate(s) stand(s) still undischarged as verified from the application for
purchase/transfer.
The identity slip was/was not issued; and it has been obtained from the holder and pasted to
the original application for purchase/it is also reported to have been lost.
That the holder is known to me/identified by ____________________________________
who is known to me.
That the indemnity bond referred to in rule 43 of P.O.S.B. Manual Volume II has been
obtained from the holder and kept on record.

That the certificate(s) is/are not attached by Court of Law.

Date___________________ Postmaster/Sub Postmaster

Orders of Head Postmaster

Date____________________ Head Postmaster

Page 45

No Co 61
Department of Posts, India
(Rule20 (14) of the revised Chapter 9 of the P. & T Manual Vol. VI)
BOND OF INDEMNITY
(To be executed by the holder of . Certificate(s) at the time of discharge of
original certificate(s) or issue of duplicate certificate(s) in lieu of lost, misplaced; spoilt,
destroyed, defaced or mutilated certificate(s) where original application for purchase is missing.)
Know all men by these, presents that I/We (A)
Holder/Holders of the. Certificate(s) am/are held and firmly bound up to the
President of India (hereinafter called the President) in the sum of Rs. . . . . . . .. . . . .
.Together with all costs, charges and damages as hereinafter mentioned- to be paid to the
president, his successors or assignees/for which payment well and truly to be made I/We bind
myself /ourselves, my/our heirs, executors and administrators and representatives jointly and
severally firmly by these presents Sealed with my/our seal dated this. . . . . . . . . . . . . . . . . . . . . . .
. day of in the year Two thousand .
Whereas on . . . . . . . . . . . . day of. . . . . . . . . . . . . . . . . . . . . . ..The said (A)
. purchased from. Post Office certificate(s)
numbered... . . . . . . . . . . , of the denomination(s) of Rs .. . . . . . . .. . ... . . . . ...
(Respectively) and obtained/ did not obtain identity slip(s) in respect of the above mentioned
certificate (s).
. And whereas the original application for purchase of the aforesaid certificate(s) is
missing from the records of the Post Office and whereas the said (A)
..has/have represented to the Postmaster
. P.O. that the aforesaid certificate(s) and the identity slip(s) has/have been lost
or misplaced or spoilt or -destroyed or defaced or mutilated while in the custody of the said (A)
. . .
..
And whereas the said (A) .. has/have further represented
to the Postmaster... . . .. . . . . . . . . . . . . . . . . . . . .. P.0. that the aforesaid certificate(s) and the
Identity slip(s) have not been .transferred, sold pledged or deposited or otherwise parted with by
way of security or otherwise and that the aforesaid certificate(s) has/have-not been attached by
any Court of Law.
2
And whereas the said (A) .... declares that, he/they/is/are
solely entitled to receive the money due on the above certificate(s) and has/have applied for the
discharge of original certificate(s) /issue of a duplicate certificate (s) in respect of the aforesaid
certificate (s) and whereas the Postmaster (Gazzetted) . /(Head of the
Postal Division) has on behalf of the President of India acceded to the said application on
condition of the said (A) . . . . . . .. . . . . . . . .. executing such bond as above written and whereas
the said (A) has agreed to execute the said bond with such condition as is hereunder written.
Now the condition (s) of the above-written bond is such that if the said
(A his/their heirs, executors, administrators and
representatives do and shall and when required so to do pay to the President, his successors or
assignees the sum of Rs . together with all costs as between attorney and, client and all
Page 46

charges losses damages and expenses that shall or may have been Incurred by or occasioned to
the President , his successors or assignees or any of the
servants of the Government by reasons of or consequent upon a duplicate certificate(s) in respect
of the aforesaid certificate(s) being issued, and further if the said
(A his I their heirs, executors. administrators and representatives,
shall and do from time to time and at all times hereafter well and sufficiently save , defend ,
keep, harmless and indemnified the President , his successors, and assigns and officers and
servants of the Government and each and every of them, from and against all and all manner of
action and actions suit and suits and other legal proceedings, costs, charges, damages and
expenses whatsoever which shall or may at any time or times, hereafter be bought, commenced
or sent by any person or body corporate or whomsoever or whatsoever against the President, his
successors or assignees or any of the officers or servants of the Government for or on account of
in respect of or by reason of a duplicate certificate(s) in respect. of the aforesaid certificate(s)
being issued THEN the above written bond shall be void and of no effect otherwise the same
shall be and remain in full force and virtue provided always and it is hereby expressly declared
and agreed by the said (A) and to the President, his successors and assignees
that in defense and prosecution of any action suit or other legal proceedings referred to in the
foregoing, clause for Indemnity or maintained in virtue thereof the President. his successors or
assignees shall not be responsible or accountable to the said
(A).. his or either of them their or either of their heirs
executors administrators and representatives for any act, omission, or mistake. in the defense or
prosecution of such action , suit or other leg, al proceedings and that in the defense or
prosecution of such action, suit or other .legal proceedings, the President his successors or
assignees and his and their officers and servants shall be required to do such acts and take such
steps only as shall in that behalf be approved, and advised by the Law Officers of the
Government of India.
This bond is being executed at the request and cost of the Government of India who has
agreed to pay and bear tile Stamp Duty.

Signed, sealed and delivered by the above' named (A) in the presence of
(Two witnesses to sign here)

1.

2 .
ACCEPTED

Station Signature .

Date *Designation .
For and on behalf of the President of India.

*by a Gazzetted Officer of the India Post and Telegraphs Department, subject to such conditions
as may be laid down by the Posts and Telegraphs Board vide item 4 (i) of part XXIII of the
Government of India in the Ministry of Law Notification No. G S R. 585 Dated 1st February,
1966.
Page 47

Form No. NC 54 (A)
DEPARTMENT OF POST
BOND OF INDEMNITY
[To be executed by the holder of certificate (s) with one surety at the time of
the issue of a duplicate certificate (s) in lieu of lost, misplaced, spoilt or
mutilated certificate (s)]
Know all men by these present that I/We (A)
(holder/holders) of the and (B)
Surety are held and firmly bound unto the President of India (hereinafter called the
President) in the sum of Rs together with all costs, charges and
damages as hereinafter mentioned, to be paid to the President, his certain attorneys,
successors or assigns for which payment well and truly to be made we bind
ourselves, our heirs, executors and administrators and representatives jointly * (and
every three of us bind ourselves, our heirs, executors and administrators and
representatives jointly and every two of us bind ourselves, our heirs, executors,
administrators and representatives) and each of us binds himself, his heirs,
executors, administrators and representatives severally firmly by these presents
sealed with our respective seals dated the . day of .. In the
year two thousand and ..
* To be altered as required
Whereas on day of the said (A) .
purchased from Post Office, a .............
Certificates (s) numbered of the denomination of
Rs (Respectively) and obtained/did not obtain identity slip (s)
in respect of the above mentioned certificates.
And whereas the said (A).
has/have represented to the Postmaster . Head Post Office
that the aforesaid certificates and the identity slip (s) have been lost or misplaced
or spoilt or mutilated while in the custody of the said (A) ..
And whereas the said (A)
has/ have further represented to the Postmaster Head
Post Office that the aforesaid certificates(s) and the identity slip have not been
transferred, sold, pledged or deposited or otherwise parted with by way of security
or otherwise and
Whereas the said (A) declares
that he/they is/are solely entitled to receive the money due on the above certificates
and has/have applied for the issue of a Duplicate Certificates (s) in respect of the
aforesaid certificate (s); and
Page 48

Whereas Postmaster Head Post Office has on
behalf of the President acceded to the said application on condition of the said (A)
and one sufficient surety executing such bond as above
written and the said (B) .. has accordingly as such
surety agreed to execute the said bond with such condition as is hereunder written.
Now the condition of the above written bond is such that if the said (A)
. his/their heirs, executors, administrators and
representatives do and shall when required so to do pay to the President, his
successors or assigns the sum of Rs. .. Together with all costs as
between attorney and client and all charges, losses, damages and expenses that
shall or may have been incurred by or occasioned to the President, his successors
or assigns or any of the servants of the Government by reasons of consequent upon
a Duplicate Certificate (s) In respect of the aforesaid certificates being issued and
further if the said (A) .and (B)
.. their heirs, executors, administrators, representatives, shall
and do from time to time and at all times hereafter well and sufficiently save,
defend, keep harmless and indemnified the President, his successors and assigns
and officers and servants of the Government and each and every of them from and
against all and all manner of action and actions, suit and suits and other legal
proceedings, costs charges, damages and expenses whatsoever which shall or may
at any time or times thereafter be brought, commenced or sued by any person or
body corporate whomsoever or whatsoever against or happen or be occasioned to
the President, his successors or assigns or any of the officers or servants of the
Government for or on account of in respect of the aforesaid certificate (s) being
issued. THEN the above written bond shall be void and of no effect otherwise the
same shall be and remain in full force and virtue PROVIDED ALWAYS and it is
hereby expressly declared and agreed by the said (A)
and (B) .. with and to the President, his
successors and assigns that in defence and prosecution of any action, suit or other
legal proceedings referred to in the foregoing clause for indemnity or maintained in
virtue thereof the President, his successor or assigns shall not be responsible or
accountable to the said (A) and (B)
or any or either of them, their or either of their
heirs, executors, administrators and representatives for any act, omission or
mistake in the defence or prosecution of such action, suit or other legal
proceedings and that in the defence or prosecution of such action, suit or other
legal proceedings the President, his successors, or assigns and his and their officers
and servants shall be required to do such acts and take such steps only, as shall in
Page 49

that behalf be approved and advised by the Law Officers of the Government of
India.
PROVIDED FURTHER that the liability of the surety hereunder shall not be
impaired or discharged by reason of time being granted or any forbearance act or
omission of the President or any person authorized by him (whether with or
without the consent or knowledge of the surety) nor shall it be necessary for the
President to sue Shri before suing the surety
for amounts due hereunder.

Signed, sealed and delivered by the above name

seal
(A) ..
In the presence of (two witnesses to sign here)

1)
Seal

2)

Signed, sealed and delivered by the above-name (B)
in the presence of (two witnesses to sign here)

1)

2)
ACCEPTED

Station Signature

Date *Designation
For and on behalf of the President of India

* Under clause (i) of item 4 of Part XXIII of the Government of India in the
Ministry of Law Notification No. GSR 585 dated 1.2.1966, Postmaster
(Gazzetted)/Senior Supdt. Of Post Offices/ Supdt. Of Post Offices is competent to
sign this bond for and on behalf of the President of Ind
Page 50

Form No. NC 54 (B)
DEPARTMENT OF POSTS
BOND OF INDEMNITY
[To be executed by the holder of a certificate with a Bank's Guarantee at the time
of the issue of a duplicate certificate (s) in lieu of lost, misplaced, spoiled or
mutilated certificates]
KNOW all men by these present that I/We (A)
(holder/holders) of the . certificate (s) am/are held and firmly bound up
to the President of India (hereinafter called the President) in the sum of Rs
together with all costs, charges and damages as hereinafter mentioned to be paid to
the President, his certain attorneys, successors or assigns for which payment well
and truly to be made I/ We bind myself/ourselves, my/our heirs, executors and
administrators, and representatives, jointly *(and every three of us bind ourselves,
our heirs, executors, administrators and representatives jointly and every two of us
bind ourselves, our heirs, executors, administrators, and each of us binds himself,
his heirs, executors, administrators and representatives severally firmly by these
presents sealed with my/our seal dated this day.. Of ..
in the year two thousand and
* To be altered as required.
WHERE AS on day of . the said
(A).. Purchased from
Post Office, a certificate (s) numbered of the
denomination (s) of Rs (Respectively) and obtained/did not obtain
identity slip (s) in respect of the above-mentioned certificates.
AND whereas the said (A) has/have
represented to the Postmaster Head Post Office that the
aforesaid certificates and the identity slip(s) has/have been lost or misplaced or
spoilt or mutilated while in the custody of the said (A)
AND whereas the said (A) has/have
further represented to the Postmaster . Head Post Office that
the aforesaid certificate (s) and the identity slip (s) have not been transferred, sold,
pledged or deposited or otherwise parted with by way of security or otherwise and
WHEREAS the said (A) ..
declares that he/they is/are solely entitled to receive the money due on the above
certificates and has /have applied for the issue of a duplicate certificate (s) in
respect of the aforesaid certificate (s); and
WHEREAS Postmaster Head Post Office has on behalf of
the President acceded to the said application on condition of the said (A)
Page 51

..executing such bond as above written and
furnishing a Bank's Guarantee as endorsed on this Bond and whereas the said (A)
has agreed to execute said bond with such
condition as is hereunder written.
NOW the condition of the above written bond is such that if the said (A)
. his/their heirs, executors, administrators and
representatives do and shall when required so to do pay to the President, his
successors or assigns the sum of Rstogether with all costs as
between attorney and client and all charges, losses, damages, and expenses that
or assigns or any of the servants of the Government by reasons of or consequent
upon a duplicate certificate (s) in respect of the aforesaid certificates being issued,
and further if the said (A) .. his/their
heirs, executors, administrators and representatives, shall and do from time to time
and at all times hereafter well and sufficiently save, defend, keep harmless and
indemnified the President, his successors and assigns and officers and servants of
the Government and each and every of them from and against all and all manner of
action and actions, suit and suits and other legal proceedings, costs, charges,
damages and expenses whatsoever which shall or may it any time or times
hereafter be brought, commenced or sued by any person or body corporate
whomsoever or whatsoever against or happen or be occasioned to the President, his
successors or assigns of any of the officers or servants of the Government for or on
account of in respect of or by reason of a duplicate certificate (s) in respect of the
aforesaid ce11ificate(s) being issued THEN the above written bond shall be void
and of no effect otherwise the same shall be and remain in full force and virtue
PROVIDED ALWAYS and it is hereby expressly declared and agreed by the said
(A) . with and to the President, his
successors and assigns that in defence and prosecution of any action, suit or other
legal proceedings referred to in the foregoing clause for indemnity or maintained in
virtue thereof the President, his successors or assigns shall not be responsible or
accountable to the said (A) his/or either of them, their or either of their heirs,
executors, administrators and representatives for any act, omission or mistake in
the defence or prosecution of such action, suit or other legal proceedings and that
in the defence or prosecution of such action suit or other legal proceedings the
President, his successors or assigns and his and their officers and servants shall be
required to do such acts and take such steps only, as shall in that behalf be
approved and advised by the Law Officers of the Government of India.

Page 52

Signed, sealed and delivered by the above-named
(A) . in the presence of

(Two witnesses to sign here)

1)

2)
BANK'S GUARANTEE
In consideration of the President issuing a duplicate certificate in respect of the
aforesaid certificate to the said (A) as stated in the
above Bond we (name of the Bank) hereby guarantee to the President, his
successors or assign the payment of the sum of Rs. together with all costs as
between attorney and client and all charges, losses and damages and expenses that
or assigns or any of the servants of government by reasons of or consequent upon a
duplicate certificate in respect of the aforesaid certificates being issued as referred
to in the above Bond. Provided that the liability of the bank hereunder shall not be
impaired or discharged by reason of time being granted or any forbearance, act or
omission of the President or any person authorized by him (whether with or
without the consent or knowledge of the Bank) or any other matter or thing
whatsoever under the law relating to sureties shall, but for this provision, have the
effect of so releasing the Bank from its such liability nor shall it be necessary for
the President to sue Shri before suing the bank for
amounts due hereunder.
Dated this: day of .. 200
(To be executed by the Bank in the manner provided by its Articles of
Association)
ACCEPTED
Station .
Date .
Signature
*Designation
* Under clause (i) of item 4 of Part XXIII of the Government of India in the
Ministry of Law Notification No. GSR 585 dated 1.2.1966, Postmaster
(Gazzetted)/ Senior Supdt. Of Post Offices/ Supdt. Of Post Offices is competent to
sign this bond for and on behalf of the President of India.

seal

Page 53

CERTIFICATE OF HOLDING OF NSC
Certified that the following Savings Certificates hold by Shri / Shrimati
__________________________ are registered in this office.
Sl No No and
Type of
Certificate
Date of
issue
Denomination Registration
No
Remarks

Date Stamp Signature of PM/SPM

CERTIFICATE OF DISCHARGE OF NSC
Certified that Shri / Shrimati _____________________________
Has discharged following National Savings certificates at this office.
Sl. no Sl. Nos. of
Certificates
Denomination Maturity
value of
certificate
Registration
No
Remarks

Date Stamp Signature of PM/ SPM
Page 54

APPLICATION FOR DISCHARGE OF SAVINGS CERTIFICATE AT THE OFFICE OTHER
THE OFFICE OF REGISTRATION
To,
______________ , District :- Raigad
Subject: - Application for discharge of Savings certificates at the office other than
the office off registration.
Respected Sir,
I have purchased following KVPs/NSCs at _______________ post
office.
I wish to discharge those KVPs/NSCs at your office; details of KVPs/NSCs are given
bellow.

Sl
N
o
Sl No of
KVPs/NSCs
Denominati
on
Date of
Purchase
Registrati
on No
Remarks
1
2
3
4

Thanking You,
Yours faithfully,

(Name and Address of Purchaser)

To,
The Superintendent of Post Offices,
Raigad Division, Alibag, 402 201.
No- / /20 - Dated at the- / /20
Submitted for onward transmission to the office of registration.

Page 55

N.C.-10
Advice of payment of certificate registered at____________ Head_ post office
Sub
under ___________________H.O.* and paid at______________ Head_ post office under
Sub
___________________ H.O. on the 20
No of
certificate
Denomination Date of issue Date of last
transfer
Name of
holder
Remarks

Date stamp of office
of payment No. date

Forwarded to the Postmaster
Sub/Head Postmaster
-------------------------------------------------------------------------------------------------------------------------
N.C.-10
Advice of payment of certificate registered at____________ Head_ post office
Sub
under ___________________H.O.* and paid at______________ Head_ post office under
Sub
___________________ H.O. on the 20
No of
certificate
Denomination Date of issue Date of last
transfer
Name of
holder
Remarks

Date stamp of office
Of payment No. date

Forwarded to the Postmaster
Page 56

NC-41
APPLICATION FOR THE TRANSFER OF POST OFFICE SAVINGS
CERTIFICATES AS SECURITY
Registration No .. Serial No and Date of original
Application for purchase Of Certificates.
To
The POSTMASTER,

Sir,
I/We . (Name in Block Letters)
am/are required to deposit an amount of Rs .. as security to the President of
India/Governor of . State/Reserve Bank of India/ Scheduled bank/Co-Operative
Bank/ Co-Operative Society/Corporation/Government Company/Local Authority.
I/We therefore request you to transfer the under mentioned Post Office Savings
Certificates/Duplicate Certificates of which I am/We are the holder (s) as security to
.. President of India/Governor of
Society/Corporation/Government Company/Local Authority vide declaration of the pledgee
reverse this form.

I/We . hereby declare that
on the transfer of the under mentioned Post Office Savings Certificates/Duplicate certificates,
the transferee, (pledgee) shall, until it is/ these are re-transferred or released to me/us, be
deemed to be the holder of the certificate(s). I/We also agree that the certificate(s) shall be
encashable by the pledgee when the security has been forfeited.
Particulars of Certificates/Duplicate Certificates

No and Date of
letter from the
pledge calling for
security
Sl No of
Certificates
Date of Issue
of
certificates
Name of
office of
issue
Registration
No of
certificates
Denomination
of certificates

Total No of Certificates .
Address .. Yours faithfully,

Signature of Transferor(s)
(Holders of Certificate(s)

Page 57

REVERSE
DECLARATION BY TRANSFEREE (PLEDGEE)
I .. (Official Designation of Govern- ment Officer)
hereby accept the savings certificates paricularised on the obverse of this form as security on
behalf of the President /Governor of State of
In his official capacity and hereby certify that I (Official
Designation of Government officer) am duly authorised under article 299 of the constitution
vide Notification No dated by the Govern-
ment of India in the .. Ministry of /State Government
and to execute such instruments or deeds on behalf of the President of India /Governor of
State.
I . Official designation of officer of the
Society/Corporation/Government Company/Local Authority . And
hereby certify that I am duly authorized to accept or release of to execute such instruments or
deeds on behalf of the State/Reserve Bank of India/ Scheduled bank/Co-Operative Bank/ Co-
Operative Society/Corporation/Government Company/Local Authority .

Date Signature of the transferee (Pledgee)

Official Designation of the Officer
accepting the pledge on behalf of
the pledge(Stamp and Seal)

Serial No of Head /Sub Office

To be filled in by the Postmaster of Head /Sub Post office

Sl no of
certificates
with Date
of issue
Deno-
mination
Office of
issue
Date of
Pledging of
Certificates
No and
date of
letter of
authority
the
releasing
the pledge
Date of
Discharge
Initials of
the Post-
Master/
Sub
Postmaster

DATE Signature of Sub/Head Postmaster

Oblong M.O. Stamp of Head/Sub Post Office
Page 58

NC-34
DEPARTMENT OF POSTS
APPLICATION OF TRANSFER OF SAVINGS CERTIFICATES
FROM ONE PERSON TO ANOTHER (EXCEPT AS PLEDGE)
[A separate application is required for each series of certificate]
To
Postmaster,
.......................................
Sir,
I/We ............................................................... ..(Name in block capital of
person/institution, etc.) Request you to transfer the under mentioned Savings
Certificate(s)*/Duplicate Certificate(s)* held in my/ our*name(s) in the name of
the minor (*) Shri/Kumari..................................................... to ....
. under the Rules governing the Certificates
* Delete whichever is not applicable.
* I/We certify that the minor is alive and the transfer is in his/her interest.
* Strike out if the Certificate is not in the name of the minor.
* Circumstances in which transfer is sought..............................................................

* Only if applied within one year from the date of issue.
2. Particulars of Savings Certificates/Duplicate Certificates
Series and Sl. No.
of Certificates

Denomination
Date of Issue

3. Fee of Rs . is paid herewith.
Date ...............................
Address .....................
Yours faithfully,

............

Signature of transferor(s)
For certificate(s) held by a minor
to be signed by the parent/guardian.
Page 59

DECLARATION BY TRANSFEREE(S)
1. I/We hereby
agree to the transfer of above mentioned certificate( s) in my/our name( s) and to
abide by the Rules governing these certificates as amended from time to time.

Signature or thumb impression (If illiterate)
of transferee of certificate( s)
Date ...................
----------------------------------------------------------------------------------------------------
FOR USE IN THE POST OFFICE
Registration No,

Sl.No. & date of original Oblong M.O. H.O. /S.O.
Application for purchase stamp

Sub Office Postmaster Head Office Postmaster

PARTICULARS OF CERTIFICATES ISSUED TO TRANSFEREE

Series and Sl.
No. of
Certifi-
cate(s)
Denomin
ation
Date of payment
of interest and
initials of Post
Master
Date of
discharge and
initials of
Postmaster

Remarks
Every change
affecting the certificate such as
transfer, issue of duplicate
certificate should be noted here
under the signature of
postmaster

Total number of certificates.................. signature of Postmaster of office
Of Registration
Date ,......

Page 60

DAILY TOTALS OF KISAN VIKAS PATRAS/6N.S.C.(VIII) ISSUED
AT ______________SO DURING .2006

DATE

RS 100

RS500 RS1000 RS5000 RS10000 TOTAL
NO AMOUNT NO AMOUNT NO AMOUNT NO AMOUNT NO AMOUNT NO AMOUNT

TOTAL
PREVIOUS
GR.
TOTAL

SUB POSTMASTER,

Page 61

DAILY TOTALS OF KISAN VIKAS PATRAS /6NSC (VIII) DISCHARGED AT ______________S.O.
DURING THE I/II PERIOD OF 200

SUB POSTMASTE

DATE

RS100

RS500

RS1000

RS500

RS10000

TOTAL

N
O

AMT

INT

N
O

AMT

INT

N
O

AMT

INT

N
O

AMT

INT

N
O

AMT

INT

N
O

AMT

INT

Page 62

N.C. 51
Serial No
Form of application for Nomination under section 6 of the Government Savings Certificates
Act, 1959.
(The form will be filled up by the holder(s) and submitted with savings Certificates to the
Postmaster of the office where the savings certificates registered)
To,
The Postmaster,
.
Under provision of section 6(1) of the Government Savings Certificate Act, 1959, I/We
. the holder(s) of Savings Certificate(s) detailed on the
reverse, hereby nominate the person(s) mentioned bellow, who shall, on my/our death,
become entitled to the Savings Certificate(s) and to be paid the sum due thereon to the
exclusion of all other persons. I/We hereby declare that I/We have not so far made any
nomination in respect of these certificates.
The Certificates are enclosed.
Sl. No Name of Nominee Full Address of
Nominee
Date of birth of
nominee in case of
minor

As the nominee(s) at serial No(s) . above is/are minor(s) I/We appoint
Shri/Smt./Kumari . (Name and Full address) as the
person to recover the sum thereon in the event of my/our death during the minority of the
nominee(s)
______________________________________________________________________________
ACKNOWLEDGEMENT
To,
---------------------------------------------
.
Your application dated
Nomination in respect of the certificates detailed in Colum 1 of reverse in favour of
person mentioned in Colum 2 has been registered in this office under No Dated
..

Date Stamp of Post Office Signature of the Postmaster

Page 63

Serial Nos. of
Certificates
Denomination Date of issue Office of isssue

Address: - Yours Faithfully,

In case of illiterate holder Signature of holder(s)
(Fathers name should be given) (Thumb impression if illiterate)

Witness:-

1) Name and address ..

.
.
N.B. In case of illiterate holders the witnesses shall be the persons whose signatures are known
to the post office.
ORDERS OF THE POSTMASTER ACCEPTING THE NOMINATION

Date Stamp
Signature of the head/Sub Postmaster
______________________________________________________________________________

Particulars of Certificates Name and address of nominee/person
to receive payment on behalf of minor
nominee
Sl. No of Savings
certificates
Denomination

Page 64

N.C. 53
Serial No
Application for Cancellation or variation of Nomination previously made in respect of Postal
Savings Certificates under section 6 of the Government Savings Certificates Act, 1959.
(The form will be filled up by the holder(s) and submitted with savings Certificates to the
Postmaster of the office where the savings certificates registered)
To,
The Postmaster,
.
Under provision of section 6(1) of the Government Savings Certificate Act, 1959, I/We
. the holder(s) of Savings Certificate(s) detailed on the
reverse, hereby cancel the nomination previously made by me in respect of these Certificate(s)
and registered in your office under No .. Dated .
* in place of the cancelled nomination, I hereby Nominate the person(s) mentioned
bellow who shall on my death, become entitled to the Savings Certificate(s) and to be paid the
sum due thereon to the exclusion of all persons.
Sl. No Name of Nominee Full Address of Nominee Date of birth of nominee in case of
minor

As the nominee(s) at serial No(s) . above is/are minor(s) I/We appoint
Shri/Smt./Kumari . (Name and Full address) as the
person to recover the sum thereon in the event of my/our death during the minority of the
nominee(s)
*To be filled in case of variation only.
The Certificates are enclosed.
____________________________________________________________________________
ACKNOWLEDGEMENT
To,
---------------------------------------------
.
Your application dated
Nomination in respect of the certificates detailed in Colum 1 of reverse in favour of
person mentioned in Colum 2 has been registered in this office under No Dated
..

Date Stamp of Post Office Signature of the Postmaster

Space for
postage
stamp
Page 65

Serial Nos. of
Certificates
Denomination Date of issue Office of isssue

Address: - Yours Faithfully,

In case of illiterate holder Signature of holder(s)
(Fathers name should be given) (Thumb impression if illiterate)

Witness:-

.
.

.
.
N.B. In case of illiterate holders the witnesses shall be the persons whose signatures are known
to the post office.
ORDERS OF THE POSTMASTER ACCEPTING THE NOMINATION

Signature of the head/Sub Postmaster

______________________________________________________________________

Particulars of Certificates Name and address of nominee/person
to receive payment on behalf of minor
nominee
Sl. No of Savings
certificates
Denomination

Date Stamp
Page 66

NC-32
APPLICATION FOR TRANSFEROF SAVINGS CERTIFICATE(S) FROM ONE POST OFFICE TO
ANOGTHER
To
The Postmaster,
..
I/We .. Request that
following Certificate(s)/ Duplicates Certificates held by me/us/Shri/Shrimati/ kum.*
.. (Minor) which stands registered at your office be transferred to ..
Post office.
*Delete which ever is not applicable.

Full Name of series,
serial no and type
Deno-
mination
Date of
issue
Sl. no of
identity
slip
If purchased on behalf of minor
Date of birth of
minor
Name o
guardian
authorised
to encash

Signature (not thumb impression) Signature of (or thumb impression*) applicant
of authorised guardian

Address .

*Should be attested by a witness known to the Post office

For use of applicant
Page 67

FOR THE USE OF TRANSFERING POST OFFICE

INTIMATION OF TRANSFER OF CERTIFICATE(S)
Serial No and
date of issue

To,
1. Certificate(s)/ Duplicate certificates particularised above is/are transferred to your
office after verification of the applicants signature and other particulars furnished by him.
2. Nomination under Section 6(1) of the Government Savings Certificates Act, 1959 as
extracted bellow stands registered at this office in respect of them:-
Name of the
nominee(s)
Full address If nominee is
minor Date of
Birth
Name of person with full address of
authorised to receive the amount due in the
event of death of the holder during the
minority period

Yours faithfully,
Postmaster

For use of transferee Post Office

Oblong
MO
stamp

Serial
Number of
Transferring
office

Certificates issued Payments Remarks like transfer, issue of
duplicate certificate etc. with
initials of postmaster
Serial no of
certificate(s)
Issue Price Date payment
of interest with
initials of PM
Date of
encashment
with initials of
PM

Signature of Postmaster

Page 68

CERTIFICATE OF HOLDING OF 6 NSC (VIII)
This is to certify that following Savings Certificates are held by
are registered in this
office.

Sl. No. Sl. No. and
type of
certificate
Date of issue Denomination Remarks

Date stamp Postmaster/Sub postmaster

Certificate of accrual of annual interest on 6 NSC (VIII)
From, To,
..
.
No- / 20 - 20 Dated at .. The ..
This is to certify that an amount of Rs. (Rupees ...
.. ) has accrue as interest for the year .. on
certificates, Particularized bellow standing in your name at
this office.
Sl. No. Sl. No. of certificate Denomination(Rs.) Value(Rs.) Interest(Rs.)

Date Stamp Postmaster/Sub Postmaster

Form A
Page 69

(See clause (D) of rule 2 and sub rule 3)
APPLICATION FOR OPENING OF AN ACCOUNT UNDER
SENIOR CITIZENS SAVINGS SCHEME
To
The Postmaster /Incharge,

.

*Name of Agent (in case of the account introduced through agent)
Agency Code No Dated . Valid up to.

PAN NO of applicant
Sir,
1. I, son/daughter/wife of 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 under stood the Senior Citizens Savings Scheme,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
No
Name and of depositor and type
of account(joint or individual
Name and address
of deposit office
Account No with
date of opening
Amount of
deposit

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.

Page 70

3. I/we nominate the following person/ persons, mentioned bellow, to whom, to the
exclusion of all others persons, in the event of my death the amount standing to my credit in
the account should be payable in accordance with the provisions contained in rule 6.
Sl.
No
Name(s) of Nominee(s)
along with relationship
with depositor
Permanent
address of
nominee(s)
Date(s) of birth of
nominee(s) in case of
minor/ age in other case(s)
Share of the
nominee(s) in the
amount payable

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 persons 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 Place ..........
My/ our* specimen signatures (thumb impression), are as under
i) First depositor:-
1 2 3

ii)*Joint depositor:-
1 2 3

#Witness # Witness # Witness .......
(Countersigned of Postmaster) (Countersigned of Postmaster) (Countersigned of Postmaster)
Date & office seal Date & office seal Date & office seal
Page 71

4. I also declare that the information provided by me/ us* in the application hereinabove,
is true to the best of my 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 deposit after recovery of the interest, if
any, already paid on the deposits.
Yours faithfully,
(Signature of the depositor)
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 along with amount of deposit.
4. Certificate from employer as specified in sub-clause (ii) of clause (d) of rule 2.
* Score out which is not applicable.
# In case of thumb impression.

(1) The applicant (s) who are not assessed to income tax, may furnish 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 Income Tax Authorities, attested Photo copy of the receipted application
from for allotment of PAN should be attached to the application form.

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 registrar
of Births and Deaths; Voter Identity Card issued by the Election of India; PAN card; Passport;
Ration Card; Date of birth certificate from the school last attended by the applicant or any
other recognized educational institution or Driving License issued by the local licensing
authority. (2) Originals of the documents attached, should also be produced simultaneously for
verification and return immediately.
_____________________________________________________________________________
FOR OFFICE USE ONLY
The account has been opened on with Rs.. (Rupees
) under Senior Citizens Savings Scheme, 2004.
Account No .. Ledger Folio No ..
Agents name and 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).
Passbook No has been issued.
Date

Signature of the Incharge of Deposit Office
With designation stamp
Page 72

DECLARATION
I/We Shri/Smt. ___________________________________ hereby declare that
my/our income from all sources ( including the interest income from the account
to be opened vide this application ) does not cross the exemption limit and I/We
is not required to obtain PAN under Income Tax Act, 1961 as amended from time
to time.

Place-
Date- Signature of Depositor.

(Declaration to be obtained from Depositor of S.C.S.S. Account when PAN card is
not produced with application for opening the S.C.S.S. Account)

DECLARATION

I/We Shri/Smt. ___________________________________ hereby declare that
my/our income from all sources ( including the interest income from the account
to be opened vide this application ) does not cross the exemption limit and I/We
is not required to obtain PAN under Income Tax Act, 1961 as amended from time
to time.

Place-
Date- Signature of Depositor.

(Declaration to be obtained from Depositor of S.C.S.S. Account when PAN card is
not produced with application for opening the S.C.S.S. Account)

Page 73

FORM B
(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 , depositor
of account No . .." (Here in after 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 In charge of Deposit Office
(Along with name and designation stamp)
Page 74

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/ In Charge
. (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.. (Here in after
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

______________________________________________________________________________

FOR USE BY THE DEPOSIT OFFICE
ACCOUNT NO. DATE OF DEPOSIT AMOUNT OF DEPOST
Rs.....................................
Withdrawal on account of Interest Rs and deposit Rs
totaling 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 totaling to RS......
(Rupees ..............................) has been adjusted.
NETAMOUNT PAID Rs............... (Rupees ..)

Signature of In charge of Deposit office
______________________________________________________________________________
RECEIPT
Received a sum of Rs (Rupees .) From
(Name of Deposit office) as per details furnished above.

Signature/ Thumb impression of the depositor
*: Score out whichever is not applicable.

Page 75

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 (JOINTHOLDER) / 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 claim
Page 76

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 where of we have here unto 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

Page 77

ANNEXURE-II TO FORM -F
(Affidavit)
TO
(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 1/ We alone represent the estate of Shri/ Smt. ...................................................
(2) That the deceased did not leave any will and therefore 1/ 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.
ATTESTED

DEPONENTS

OATH COMMISSIONER

Page 78

ANNNEXTURE-III TO FORM - F
(Letter of disclaimer on Affidavit)
TO
. (Name of the deposit office)
1I/ 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 our selves 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 realization 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 Commissio
Page 79

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)..............
specimen signature/thumb impressions, as available In the record of transferer deposit office, are as
below:-
(I)1
ST
Depositor:-
1

2

3
*Witness .*Witness .. *Witness
(i) Joint Depositor:-

1

2

3
Countersigned Countersigned Countersigned
(Postmaster/Incharge (Postmaster/Incharge (Postmaster/Incharge
of Transferer office) of Transferer office) of Transferer office)
Date& office Seal Date & ...office Seal Date & office Seal
.
Forwarded to. (Transferee Deposit 0ffiIce) and necessary entries
passed in the office record
Date Signature & office seal (Transferer Deposit office)
----------------------------------------------------------------------------------------------------------------------------
FOR USE BY THE TRANSFEREE DEPO.S.I.T OFFICE
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

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,
Passbook received in original Signature of Postmaster/Incharge
(With office seal) transferee office
Signature/ Thumb impression of Depositor Date ..

Page 80

FORM NO 15(G)
[See rule 29C]

Declaration under Sub Section (1) and (1A) of section 197A of the Income Tax Act 1961 to be made by an
individual or a person ( not being a company or a firm) claiming certain receipts without deduction of
tax.
I/We* .. *son/daughter /wife of
.. Resident of @ do hereby declare:
1. That the securities or sums, particulars of which are given in Schedule III bellow, stand in
*my/our name and beneficially belong to*me/us, and the *interest in respect of such securities is not
includible in the income of any other person under section 60 to 64 of the Income Tax act, 1961;
2. That *my/our present occupation is .. ;
3. That the tax on the estimated total income computed in accordance with the provisions of
Income the Income Tax Act,1961, for the financial year ending on will be nil;
4. The aggregate amount of interest credited or paid or likely to be credited or paid during
financial year is not more than the maximum amount which is not chargeable to tax (Rs 1,00,000/- for
male and Rs 1,25,000/- for female tax payers) ;
5. That *I/We have not been assessed to income-tax at any time in the past but I fall within the
jurisdiction of the Chief Commissioner or Commissioner of Income Tax . ;
OR
That *I/We *was/were last assessed to income tax for the assessment year . by the
Assessing Officer .. Circle/Ward/District and the permanent account
number allotted to me is .. ;
6. That I *am /am not resident in India within the meaning of Section 6 of the Income Tax Act,
1961;
7. Particulars of securities in respect of w2hich the declaration is being made. Are as under:-
SCHEDULE III

Name and address
of the person to
whom the sums
are given in
interest
Amount of such
sums
Date on which
sums were given
on interest
Period for which
such sums were
given on interest
Rate of Interest

**Signature of the declarant.

Page 81

VERIFICATION

*I/We .. Do hereby declare that
to the best of *my/our knowledge and belief what is stated above is correct, complete and truly stated.
Verified today, the .. Day of ..
Place:
** Signature of the declarant
Notes:-
1. @ Give complete Postal address.
2. The Declaration should be furnished in duplicate.
3. * Delete whichever is not applicable
4. **Before signing the verification, the declarant should satisfy himself that the information
Furnished in the declaration is true, correct and complete in all respects. Any person making a false
statement in the declaration shall liable to prosecution under section 277 of the Income Tax Act. 1961,
and on conviction be punishable:-
(i) In a case where tax sought to be evaded exceeds one lakh rupees with rigorous
imprisonment which shall not be less than six months but which may be extended to seven
years and with fine.
(ii) In any other case, with rigorous imprisonment which shall not be less than three months but
which may extend to three years and with fine.
PART II
(For use by the person to whom the declaration is furnished)
1. Name and address of the person responsible for paying the income, mentioned in paragraph 1
of the declaration.
2. Date on which the declaration was furnished by the declarant.
3. Date of payment of interest from account number .. Under Senior
Citizen Savings Scheme.
4. Period in respect of which interest is being credited or paid
5. Amount of interest received from Senior Citizen Savings Scheme.
6. Rate at which interest credited/paid.
Forwarded to the Chief Commissioner or Commissioner of Income Tax ..

Place ..
Date

Signature of the person responsible for paying
the income referred to in paragraph 1

Page 82

FORM NO 15(H)
[See rule 29C (1A)]
Declaration under Sub Section (1C) of section 197A of the Income Tax Act 1961 to be made by an
individual who is of age of sixty-five years or more claiming certain receipts without deduction of tax.
I/We* .. *son/daughter /wife of
.. Resident of @ do hereby declare:
1. That particulars of my account under the Senior Citizen Savings Scheme and the amount of quarterly
interest are as per the schedule bellow :-
SCHEDULE

Description and
details of
investment
Amount of
investments
Date of sums were
investment /
opening account
Estimated Income Rate of Interest

2. That *my/our present occupation is .. ;
3. That I am of the age of . Years;

3. That the tax on my estimated total income, including income/incomes computed in
accordance with the provisions of Income the Income Tax Act,1961, for the previous year ending on
relevant to the assessment year .will be nil;
5. That *I/We have not been assessed to income-tax at any time in the past but I fall within the
jurisdiction of the Chief Commissioner or Commissioner of Income Tax .
OR
That *I/We *was/were last assessed to income tax for the assessment year . by the
Assessing Officer .. Circle/Ward/District and the permanent account
number allotted to me is .. ;
6. That I *am /am not resident in India within the meaning of Section 6 of the Income Tax Act,
1961;

**Signature of the declarant.

VERIFICATION

*I/We .. Do hereby declare that
to the best of *my/our knowledge and belief what is stated above is correct, complete and truly stated.
Verified today, the .. Day of ..
Place:
** Signature of the declarant

Page 83

Notes:-
5. @ Give complete Postal address.
6. The Declaration should be furnished in duplicate.
7. * Delete whichever is not applicable
8. **Before signing the verification, the declarant should satisfy himself that the information
Furnished in the declaration is true, correct and complete in all respects. Any person making a false
statement in the declaration shall liable to prosecution under section 277 of the Income Tax Act. 1961,
and on conviction be punishable:-
(iii) In a case where tax sought to be evaded exceeds one lakh rupees with rigorous
imprisonment which shall not be less than six months but which may be extended to seven
years and with fine.
(iv) In any other case, with rigorous imprisonment which shall not be less than three months but
which may extend to three years and with fine.
PART II
(For use by the person to whom the declaration is furnished)
7. Name and address of the person responsible for paying the income, mentioned in paragraph 1
of the declaration.
8. Date on which the declaration was furnished by the declarant.
9. Date of payment of interest from account number .. Under Senior
Citizen Savings Scheme.
10. Period in respect of which interest is being credited or paid
11. Amount of interest received from Senior Citizen Savings Scheme.
12. Rate at which interest credited/paid.
Forwarded to the Chief Commissioner or Commissioner of Income Tax ..

Place ..
Date

Signature of the person responsible for paying
the income referred to in paragraph 1

Page 84

APPLICATION FOR CONTINUE/DISCONTINUE BY JOINT HOLDER OF THE SENIOR
CITIZEN SAVINGS ACCOUNT

FROM:-
_______________________
________________________
_______________________
To:-
The Postmaster/ Sub Postmaster,

__________________________

Subject:-Application for Continue/Discontinue the Senior Citizen Savings Account
by joint holder of SCSS Account No________________ Standing at
__________________ Post Office.
Respected Sir,
I am the joint holder of the Senior Citizen Savings Account No___________
Standing at your office in the name of Late Shri/Smt.
____________________________
Who has died on _________________( death certificate is enclosed herewith). I
wish to continue/Discontinue the said account till maturity.
I hereby declare that my total deposit in the Senior Citizen Savings Account
after continuing this account shall not exceed the prescribed limit of Rs 15, 00,000
/- Rs Fifteen Lakh only.

So please permit me to continue the above mentioned account.
Thanking You,
Yours faithfully,

Page 85

APPLICATION FOR CLAIM UNDER THE SCHEME OF PROTECTED SAVINGS
To
The Postmaster,
________________________
Respected Sir,
In connection with the settlement of the claim in respect of the 5-year Post Office
Recurring Deposit Account particularized bellow, I/We the undersigned
_______________________________________________________ hereby claim the full
maturity value under the Scheme of Protected Savings.
Particulars of the Account:-
1. Name of Depositor in full _______________________________________
(In BLOCK letters)
2. Name of father/husband of Depositor:- _____________________________
3. Last address of Depositor :- _______________________________________
________________________________________

4. Date of Death of Depositor:- ______________________________________
5. Place of death of Depositor :- _____________________________________
6. Declared Date of birth of Depositor ________________________________
At the time of opening the account.
7. Date of opening of Account :- _____________________________________
8. R.D. Account No :- ______________________________________________
9. Denomination Rs _______________________________________________
10. Name of Post Office Where account stands :- ________________________
11. Head Post Office:- ______________________________________________
12. Date of Claim :- _______________________________________________
13. Particulars of claimant :-

Sl No Name and Address of Claimant Relationship with
Depositor

14. Particulars of Near Relatives of Depositor

Sl No Name and address Age Relationship with
Depositor

Page 86

To my/our knowledge, the deceased has the following other Recurring Deposit Accounts in the
Post Office on which I/we shall not claim the benefit under the Scheme of Protected Savings
but shall claim only proportionate amount payable under the R.D. RULES:-
SL
NO
ACCOUNT
NO
HEAD
POST
OFFICE
DATE OF
OPENING
DENOMINATION NAME OF
NOMINEE

In support of the claim I/We submit the Death Certificate in respect of the
Depositor issued by ________________________________________
I/we are the nominee of the deceased depositor as per nomination registered in
your records.
I/We certify that I/We have not made any claim in respect of any other R.D.
Account standing in the name of the deceased depositor under the Scheme of protected
Savings nor shall we do so in future.
Address of Claimant(s) Yours Faithfully
i) __________________________ Signature ______________________
__________________________ Name _________________________

ii) _________________________ Signature ______________________
__________________________ Name _________________________

CERTIFICATER BY TWO WITNESSS
We hereby certify that claimant(s) who has/have signed above are known to
us the particulars furnished above by him/them are correct.

Dated 1. Signature______________________________
Name __________________________________
Address _________________________________
Dated 1. Signature______________________________
Name __________________________________
Address _________________________________

ORDERS BY THE POSTMASTER
Page 87

VERIFICTION OF CLAIM UNDER THE SCHEME OF PROTECTED SAVINGS

From To
The Postmaster, Postmaster General
..
No . dated at the ..
Subject: - REGISTRATION OF CLAIM UNDER THE PROTECTED SAVINGS SCHEME .

Sir,
We have received a claim for the payment of the full maturity value of the
Recurring Deposit Account standing open in the books of this office, as
particularised bellow:-

i) Name of Depositor in full
(In block letters)
ii) Name of Depositors father/husband
iii) Last address of Depositor .
iv)Date of death of Depositor
v) Place of death of Depositor .
vi) Declared age/ date of birth of .
Depositor at the time of opening of account.
vii) Date of opening of Account
viii) R.D. Account No
ix) Denomination Rs
x) Post Office .
xi) Head Post Office .
xii) Date of Claim
xiii) Particulars of claimant(s)

Sl no Name and address of claimant Relationship with depositor

Page 88

It is certified that, I have verified the particulars given above from the postal
record and the admissible documents submitted by the claimant(s).
The account had not become a discontinued account at the time of death
of the Depositor.
The first twenty four monthly deposits have been made without default,
and no withdrawal has been made from account during the first twenty four
months.
I have satisfied myself about the death of the Depositor and about the right
of the claimant(s) to the full maturity value of Account.
This intimation is sent in duplicate for verification if any claim under the
Scheme of Protected Saving has already been registered in the name of the above
mentioned deceased.
Yours faithfully,

Postmaster
Office of the Postmaster General
No dated at the .
Certified that no claim has been previously registered in this office in
respect of the deceased shri/smt./kum.
holder of Recurring Deposit Account particularised on the previous page, who
died on at
The claim may be admitted if otherwise in order.
Registration Number dated

OR
Certified that a claim has been previously registered in this office in respect
of CTD/RD Account standing in the name of the deceased shri/smt./kum
. vide particulars furnished bellow.
CTD/RD NO Denomination .. Opened at post
office . on .. Name of claimant(s)
.. Registration No
(Delete whichever certificate is not applicable)

Seal of circle office
Signature and Name of the
Officer of the circle office
Page 89

DEPARTMENT OF POSTS
Claim application for settlement of savings certificates of the deceased holder who died on
___________________ where nomination has been registered.

To,
The Postmaster,
______________________
Sir,
In connection with settlement of Post Office Savings Certificate(s) standing in the name
of deceased ____________________________________ in the books of _______________
(Name of Post Office), I hereby claim the payment of the value of Post Office Savings
Certificate(s) as details given bellow. The payment may be made by cash/cheque or money
order (after deducting commission). In support of the claim, I hereby submit, (i) death
certificate of the deceased, (ii) death certificate of nominee(s), if any.
The nomination was registered at ______________ Post Office under No _________
Dated _______________

Details of Savings Certificates

Sl No Sl No of certificates Denomination Date of issue Registration
No
Remarks

Yours Faithfully

Signature of claimant

Name and address of claimant
____________________________________
____________________________________

This is to certify that claimant Shri/Smt. is known to me and he/she has signed in my presence.

Signature of Identifier,
Name and address of identifier__________________________________
____________________________________
____________________________________
Page 90

DEPARTMENT OF POSTS
Claim application for settlement of the claim to a Savings Bank account of the deceased
Depositor who died on___________________ where nomination has been registered.

To,
The Postmaster,
______________________
Sir,
I/We hereby claim the payment of the balance at credit at of savings Account No
............standing in the name of the deceased in the
books of (Name of the Post Office). In support of the claim, I / we hereby
submit :-
1) Passbook of Account No .
2) A certificate of death of the depositor.
3) A certificate of death of other nominee, if any.
The nomination was registered at .. Post office under the No
. dated

Yours Faithfully

Signature of claimant

Name and address of claimant
____________________________________
____________________________________

This is to certify that claimant Shri/Smt. is known to me and he/she has signed in my presence.

Signature of Identifier,
Name and address of identifier__________________________________
____________________________________
____________________________________

Page 91

DEPARTMENT OF POSTS
Claim application form for settlement of savings bank account of the deceased
depositor
(Where the claim is preferred by legal evidence of heir ship.)
To,
The Postmaster,
.
Sir,
In connection with the settlement of savings account standing in the name of
(deceased) in the book of
(Name of post office). I a ,.. (State the full relationship) of the deceased
who died on hereby claim the payment of the balance at credit of the savings
account No. in support of the claim, I hereby
submit the original/certificate/attested copy of the following documents:
a) A succession certificate granted by ... under No. ...
dated .
b) Probate of will granted by. dated
c) Letters of administration of estate of the deceased granted by .
No. dated .. Under No. ..
Under .
Address:
Dated (Signature of claimant)
Certificate by two witnesses
We hereby certify that the person who has applied and put his signature to the
application for the payment is the real claimant and same person in whose favour
the succession certificate/probate of will/letters of administration has been granted
by the court.
Date:
Signature, name and address

Date:
TO BE FILLED IN BY POST OFFICE.
Certified that I am satisfied that the legal evidence of heir ship produced by the
claimant is Genuine and that certificate/probate of will/letter of administration.

Date stamp Signature of postmaster

Page 92

DEPAARTMENT OF POSTS
Claim application form for settlement of savings Certificates of the deceased
holder (Where the claim is preferred by legal evidence of heir ship.)
To,
The Postmaster,
.
Sir,
In connection with the settlement of Post Office Savings Certificates standing in
the name of (deceased) in the book of
(Name of post office). I a,.
(State the full relationship) of the deceased who died on hereby claim the payment
of the value of the Post Office Savings Certificates details of which given bellow.
Details of Savings Certificates

Sl No Sl No of certificates Denomination Date of issue Registration
No
Remarks

In support of the claim, I hereby submit the
original/certificate/attested copy of the following documents:
a) A succession certificate granted by ... under No. ...
dated .
b) Probate of will granted by. dated
c) Letters of administration of estate of the deceased granted by .
No. dated .. Under No. ..
Under .
Address:
Dated (Signature of claimant)

Page 93

Certificate by two witnesses
We hereby certify that the person who has applied and put his signature to the
application for the payment is the real claimant and same person in whose favour
the succession certificate/probate of will/letters of administration has been granted
by the court.
Date:

Date:

TO BE FILLED IN BY POST OFFICE.
Certified that I am satisfied that the legal evidence of heir ship produced by the
claimant is Genuine and that certificate/probate of will/letter of administration.

Date stamp Signature of postmaster

Page 94

SB-84
ANNEXURE-5
[See Para 56 (4) (i)]
DEPARTMENT OF POSTS
Post Office Savings Bank/Savings Certificate claim application where no
nomination exists or legal evidence is not produced
Instructions for filling up the form
(1). The form must be filled in by the person who is entitled under the Hindu
Succession Act or Indian Succession Act or any act under the Mohammadan Law.
(2) The consent/dissent statements of all near relatives should be attached to the
claim. (3) Payment will be made only at the office where the account/certificate
stands. (4) Amount can be remitted by crossed cheque on the request of the
claimant.
1. I, . (name of the claimant)
hereby claim the proceeds of P.O. Savings / MIS /RD/TD//NSS Account
No....................P.O. Savings Certificate Type No(s) amounting to Rs.
Rupees . standing/registered
at P.O. . under HPO in the name(s)
of......................................................................
(Deceased holder(s) who died on at place.
1. The particulars of the near relatives (including claimant) left behind by the
deceased depositor/holder are given below:-
2.
SI.
No.

Name Age Relationship to
the deceased
depositor/holder
Address

The minor(s) at item No.(s) above are living with
and maintained by ........................................

Page 95

3. The documents listed below are attached in support of my claim.
(i) Pass Book/Savings Certificates or receipt for the Pass Book/Savings
Certificates.
(ii) Death Certificate of the depositor/holder from a Municipal/Local Authority
/Hospital/Police Station. When death occurs at a place where none of these
institutions or authorities exist, a certificate from a Gazzetted Officer, MP/MLA or
Panchayat Officer or Mukhiya, Village Police Patel or certificate from a last
employer or the doctor or Hakim who last attended the deceased depositor, in case
where the balance does not exceed Rs 250/-
(iii) Statements of consent from the near relatives left behind by the depositor as
mentioned against item NO.2 above. (iv) A guardianship certificate OR behalf of
the minor relatives of the deceased depositor (if the claimant is not a guardian
under the law applicable to him).
4. To the best of "my information, the deceased did not operate/hold any other
account certificate (if he had one, give details).
5. In case of Account/Certificate pledged as Security Deposit, I am enclosing
Release Authority NO ., dated of the pledgee.

Date Signature of claimant

Name (in Block Letters) .......................................
Address
DECLARATIION
I, the above said do here by declare on oath/solemn affirmation that each and all
the particulars stated above are true and correct to the best of my knowledge and
belief and that nothing has been concealed therein.

Date Signature of claimant .
Name (in capital letters).............................
Above said Shri/Smt. .. . is personally known to
me/identified before me by Shri/Smt. .. and has made
before me the above declaration on oath/solemn affirmation this day of
20........
Signature .............................................
Name (in block letters).......................
Designation stamp ""''''''''''''''''''
Page 96

Note 1:- The above declaration may be made before (a) Postmaster/Departmental
Sub Postmaster/Superintendent of Post Offices/Regional Director Postal
Services/Head of the Circle.
Note 2:- The claimants statement should also be signed in the presence of the
authority before whom the declaration is made. If the above declaration is not
made, the statement of the claimant should be attested by one of the authorities
mentioned in Note-3 below in the following form and also the certificates and
statements accompanying should be attested by that authority.
Certified that the claimant is known to me and the above statement made by
him is, to the best of my knowledge and belief Correct.

Date .. Signature .................................................
Name (in block letters)............................
Designation stamp...................................
Address ..................................................

Note 3:- The above certificate may be signed by a Gazzetted Officer,
President (of the Local Municipal Board, Gram Panchayat, Block Development
Officer, Sarpanch, Chief Executive Officer of the Municipality, Corporation,
Justice of Peace, Member of Parliament, member of Legislative Assembly or a
Postal officer not below the rank of an Inspector of Postal Offices.
Certified the signature of the attesting authority Shri..............................................

Signature
Name (in block letters)..............................
Designation stamp.....................................
Of the Postal Officer
Date...........................................................

Note 4:- In case the claimant makes a declaration on oath/solemn affirmation
before the sanctioning authority or a Judge, Magistrate or other authority
empowered under the law to administer oath or take evidence. The statement need
not be certified by any of the above persons. The certificate is necessary only in
cases the claimant is unable to make a declaration on oath/solemn affirmation. The
documents mentioned in item-3 of the application form should also be attested by
the certifying authority.

Page 97

CONSENT/DISSENT STATEMENT
I .. (Name of the deponent) son
of Shri (Here state the full relationship)
.. to Shri (name of the deceased holder) depositor of
P.O. Savings Bank Account No......................... Postal Certificates No. (s)
.. ...... ......................................... issued from (Post
Office) of the total value of Rs .. hereby consent/dissent* to the
payment of the amount being made to (name of the claimant).
My age is .. Years.
The above statement has been made in presence of two under noted witnesses.
* State the nature of objections prescribed below.

Date . Signature
Of the Deponent
Name (in block letters) .................................
Address .........................................................
The above statement was made by (name ..
(Name of the Deponent ) who is personally known to us.

Witnesses :-

1. Signature 2. Signature .

Name (in block letters)................ Name (in block letters) .................................

Address ............. Address. ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Date........................................ Date ..

Page 98

REPORT ON THE SAVINGS CERTIFICATE (S) BELONGS TO DECEASED HOLDER

1) Name of Post Office where certificate(s) stands:-

2) No of certificate(s):-

3) Registration No and date of issue:-

4) Full name and address of deceased holder:-

5) Current balance of the savings certificate(s)

6) Whether certificate(s) pledged as security:-

7) Whether certificates attached by court of law:-

8) Whether savings certificate(s) stands undischarged:-

9) Whether savings certificate(s) lying with claimants:-

10) Whether any nomination is in force in respect of the savings certificate(s):-

Date: - Signature of the Sub Postmaster

Page 99

Form No. SB 25
DEPARTMENT OF POSTS
BOND OF INDEMNITY
[To be executed by heirs of deceased Savings Bank Depositors and deceased
Holders of Post Office Savings Certificates]
Know all men by these presents that we (a)*
*(a) Principal
and (b) .. *(b) Surety and (c)
**... Surety and held and firmly bound unto the President of
India in the sum of rupees . of
lawful money of the Indian Union to be paid to the said President of India, his
certain attorneys, successors, or assigns for which payment well and truly to be
made we bind ourselves, our heirs, executors, administrators and representatives
jointly and every two of us bind ourselves, our heirs, executors, administrators and
representatives jointly and each of us bind himself, his heirs, executors,
administrators and representatives severally firmly by these presents sealed with
our respective seals dated this. day of in
the Christian year two thousand and
Whereas the above bounden (a)
hath caused to be represented to the said President of India that he is*
to . of
deceased who died on the . day
of 20.. , leaving an amount of Post
Office Savings Bank Account No. Rs in
Post Office Savings Certificate (s) No. (s) at
Post Office and whereas the said (a)- has applied to
the Postmaster General/Director of Postal Services for the payment to him as such
as aforesaid of the amount so standing to the credit of the said
deceased in Post Office Savings Bank Account No . . . .
standing at "..,Post Office Savings certificate (s) No. (s)
.. Post Office as
aforesaid the President of India has on the aforesaid representation of the (a)
acceded to the said application on
condition of the said (a).
and two sufficient sureties executing such bond as above written and the said (b)
. and (c)
have accordingly as such sureties agreed to execute the said bond with such
condition as hereunder written.
Page 100

Now the condition of the above written bond is such that if the above
bounden (a) . his heirs, executors, administrators
and representatives do and shall when required so to do repay to the said President
of Indian, his successors or assigns the amount so paid to the said (a) together with
all cots as between Attorney and Client and all charges, losses damages and
expenses that shall or may have been incurred by or occasioned to the said
President of India, his successors or assigns or any of the servants of the
Government by reason of or consequent upon the payment to the said
(a) of the amount so standing to the credit of the said deceased in the above
mentioned Savings Bank Account .. Post Office Savings
Certificate (s). and further if the said (a)
and (b) .. and (c)
their heirs, executors, administrators and representatives, shall and do from time to
time and at all times hereafter well and sufficiently save, defend, keep harmless
and indemnified and said President of India, his successors and assigns and the
officers and servants of the government and each and every of them or from and
against all and all manner of action or actions, suit and suits and other legal
proceedings, costs, charges, damages and expenses whatsoever which shall or may
at any time or times hereafter be brought, commenced or sued by any person or
body corporate whomsoever or whatsoever against or happen or be occasioned to
the said President of India his successors or assigns or any of the officers or
servants of the Government for or on account or in respect of or by reason of the
amount so standing to the credit of the said
deceased in the above mentioned. Saving bank Account/Post Office Savings
Certificates (s) been paid to the said (a) then the above written bond shall be void
and of no effect otherwise the same shall be and remain in full force and virtue
provided always and it is hereby expressly declared and agreed by the said
(a) and (b)
and (c) with and to the said President of
India, his successors and assigns that in the defence and prosecution of any, action,
suit or other legal proceedings referred to in the foregoing clause for indemnity or
maintained in virtue thereof the President of India, his successors or assigns shall
not be responsible or accountable to the said (a)
and (b) and (c) or
any or either of them, their or any or either of their heirs, executors, administrators
and representatives for any act, omission or mistake in the defence or prosecution
of such action, or other legal proceedings and that in the defence or prosecution of
such action, suit or other legal proceedings the said President of India, his
successors or assigns and his and their officers and servants shall be required to do
Page 101

such acts and take such steps only, as shall in that behalf be approved and advised
by the Law Officers of the Government.

Signed, sealed and delivered by the Seal
Above named (a)
in the presence of (To witnesses to sign here)

Above named (b) in the presence of(Two witnesses to sign here)

Above mentioned (c) in the presence of (Two witnesses to sign here)

ACCEPTED
Station
Date Signature
* Designation

* The Postmaster (Gazzetted)/Senior Supdt. of Post Offices/Supdt. of Post Offices
is competent to sign this Bond for and on behalf of the President of India.[D.G. P
& T letter No. 35-30/84-SB dated 24.7.1984]
Note 1: Indemnity Bond will be for the total amount payable on the date of
discharge or on the date of maturity or at the end of extended period of maturity
permissible under rules as the case may be. The checks prescribed in Note (1)
below Rule 43 (2) shall apply mutates mutandis.
[D.G. P & T letter No. 93-5/81-SB dated 4-3-1983]
Note 2: The surety should be adequately solvent. The Postmaster may require
production of solvency certificate where he is not personally satisfied. Solvency of
a surety if he is an employee of the Central or State Government or of a local body,
Government aided educational institution, the Reserve Rank of India, a public
sector undertaking or any other body controlled by the government, to the extend
of his salary for 12 months excluding allowances, as certified by the employer is
acceptable. In other cases, the solvency certificate should be from the revenue
authority having jurisdiction over the estate of the surety.
[D.G. P & T letter No. 93-5/81-SB dated 9.11.1982
Page 102

DEPARTMENT OF POSTS
Sanction Memo
To, _____________________ From, _____________________
_______________________ _______________________
NO: SB/ /DD/ 20 - Dated at .. The / / 200
Sir/Madam, Date: ________________
Sanction of the undersigned is hereby accorded to the payment to you of Rs -------
(Rupees________________________________________________________) Only being the balance
inclusive of interest at credit of the post office Savings Account No ______________standing at ..
Post Office in the name of late ___________________________________ who is reported to have died
on ______________________.
2) The amount mentioned together with interest which has since accrued thereon on the
account (up to the close of the last month) will be paid to you on your making application direct to
Postmaster concerned through . post office on surrendering the original sanction order.
3) Interest will also be allowed on the account of the deceased depositor from the beginning of
the month in which the sanction is issued up to, the close of the month preceding the one in which
payment is actually effected only if the balance in the account of the deceased or the share thereof to
which you are entitled together with balances, if any in other savings accounts held in your name or
balances of your share in joint accounts held by you does not exceed Rs. 1,00,000/-and you should
furnish a declaration to the post office that the amount payable out of the balances in the account of
the deceased together with the balances of your account or share in joint accounts held by you does not
exceed Rs. 1,00,000/- The passbook of Savings bank account no ----------- is enclosed herewith.
4) The pass book is returned herewith. This is valid for one year from the date of issue.
Yours faithfully,
(Sanctioning Authority)
Copy forwarded to:
1) The Postmaster____________________ for information and necessary action. This has a
reference to his letter No ___________________________dated _____________The date of
payment should be reported.2) The Sub Postmaster ______________________ for necessary
and reporting the date of payment. 3) The I/C S.B. Control organization _______________ Head
Post Office. No other accounts in the name of the deceased depositor failing under the
Government Savings Banks Act, 1873 have come to notice.
Sanctioning Authority

Page 103

NC-35
DEPARTMENT OF POSTS
Sanction Memo (KVP/NSC)
To, From,
_____________________ _____________________
_____________________ _____________________
NO:
Sir/Madam, Date: ________________
Sanction of the undersigned is hereby accorded to the payment to you the amount due on the
postal savings certificate(s) detailed below standing in the name of
___________________________________ who is reported to have died on ______________________.
The amount due will be paid to you on your presenting the savings certificate(s) duly receipted
for payment at the _________________ post office on surrendering the original sanction order.
You are however, at liberty not be accepted payment of amount due on savings certificate(s)
before the date of maturity entered therein in which case the savings certificates(s) in question shall be
transferred to your name subject to the conditions laid down in the rules governing the savings
certificate(s) in question.
The sanction is valid for accepting payment or for getting the certificate(s) transferred in your
name for a period of one year only from the date of its issue.
Sr.
No.
Sr. Nos. of postal
savings certificates
Denomination Date of issue Registration
No. (s)
Office of
registration

Yours faithfully,
Copy forwarded to:
i) The Postmaster/SPM ____________________________ Post Office. The date payment may
be communicated as soon as the payment is effected.
ii) The director/Dy. Director of Postal Accounts ______________. The current value of PO
certificate(s) does not exceed Rs. ________________ (Limit of sanctioning authority) as per
claimants statement.
Page 104

DEPARTMENT OF POSTS
Sanction Memo (MIS)
To, From,
_____________________ _____________________
_____________________ _____________________
NO: SB/ /DD/ 20 - Dated at the / / 200
Sir/Madam, Date: ________________
inclusive of interest at credit of the post office MIS Account No ______________standing at
.. Post Office in the name of late ___________________________________ who is reported
to have died on ______________________.
The amount mentioned together with interest which has since accrued thereon on the account
(up to the close of the last month) will be paid to you on your making application direct to Postmaster
concerned through DASGAON post office on surrendering the original sanction order.
You are entitled to the interest up to the month proceeding the MIS month the account will be closed
on receipt of this sanction. MIS rules do not have the provision to continue the account by the
nominee/Legal heir. Bonus on maturity is also admissible irrespective of the fact that the account holder
is/was alive or not on the date of maturity. Post maturity interest is applicable at savings account rate
for a maximum period of two years from the date of maturity. The passbook of MIS account no -----------
is enclosed herewith.

This sanction is valid for a period of one year from the date of issue.
Yours faithfully,
Copy forwarded to:
1)The Postmaster____________________ for information and necessary action. This has a reference to
his letter No ____________________________dated _____________The date of payment should be
reported.
2) The Sub Postmaster ______________________ for necessary and reporting the date of payment.
3)The I/C S.B. Control organization _______________Head Post Office. No other accounts in the name
of the deceased depositor failing under the Government Savings Banks Act, 1873 have come to notice.

Page 105

DEPARTMENT OF POSTS
Sanction Memo (TD)
To, From,
_____________________ _____________________
_____________________ _____________________
NO: SB/ /DD/ 20 - Dated at . the / / 200
Sir/Madam, Date: ________________
inclusive of interest at credit of the post office Time Deposit Account No ______________standing at
.. Post Office in the name of late ___________________________________ who is
reported to have died on ______________________.
The amount mentioned together with interest which has since accrued thereon on the account
(up to the close of the last month) will be paid to you on your making application direct to Postmaster
concerned through DASGAON post office on surrendering the original sanction order.
You are entitled for the interest applicable to the time deposit account for the period for which the
deposit has remained with the Post Office. Interest is also admissible up to 24 months beyond the
maturity date at the rate applicable to saving account. The passbook of TD account no ----------- is
enclosed herewith.
The sanction is valid for a period of one year from the date of issue.

Yours faithfully,
Copy forwarded to:
reported.
of the deceased depositor failing under the Government Savings Banks Act, 1873 have come to
notice.Sanctioning Authority

Page 106

DEPARTMENT OF POSTS
Sanction Memo (RD)
To, From,
_____________________ _____________________
_____________________ _____________________
NO: SB/ /DD/ 20 - Dated at the / / 200
Sir/Madam, Date: ________________
inclusive of interest at credit of the post office Recurring Deposit Account No ______________standing
at Post Office in the name of late ___________________________________ who is
reported to have died on ______________________.
You will be entitled to receive interest as per provision of Rule 12 of Recurring Deposit Rules 1981.You
may also continue the account if desired on furnishing an application in form SB-3with specimen
signature slips. The passbook of RD account no ----------- is enclosed herewith.

This sanction is valid for a period of one year from the date of issue.
Yours faithfully,

Copy forwarded to:
reported.
of the deceased depositor failing under the Government Savings Banks Act, 1873 have come to notice.

Page 107

REPORT FOR SUB OFFICE SAVINGS BANK DEATH CLAIM CASES

1. Name of Post office where the account stands:-
2. Account No:-
3. Is it an ordinary account?
4. Is it a minor account?
5. Is it a Security Deposit account?
6. Is it interest bearing account?
7. Full Name and Address of the deceased Depositor
8. Balance (including Interest of credit of the
account on date of death of the depositors
i.e. ..
9. Is the balance of credit attached with Court of Law?
10. What is the present balance up to the end of
the month of submitting the claim to
sanctioning authority?
11. What is the date of last tranction?
12. Whether the account is treated as silent and if so from when?
13. Full particulars of Govt. Security (if any) held by the deceased depositor.

14. If any nomination in force in respect of the account, if so
full particulars there should be furnished.

Date
Date stamp Signature of Postmaster.

-------------------------------------------------------------------------------------------------------------

No- /20 -20 /dated at .. the
Forwarded to the
.
.

Signature of Postmaster.
Page 108

Daily T.D.S. Deduction statement
Dated Name of Agent: Agency No: ....
Valid up to: .. Name of PO where amount deposited .

Particulars of
deposit
Amount of
deposit
Amount of
commission paid
Amount of
TDS credited
Signature of SPM
N.SC.
K.V.P.
MIS
T.D
S.C.S.S
R.D.
TOTAL
Certified that the amount of TDS shown above has been recovered from above agent and
credited to Government account on (date)
Dated:
Place: Signature of Sub Postmaster

Daily T.D.S. Deduction statement
Dated Name of Agent: Agency No
Valid up to: .. Name of PO where amount deposited:

Certified that the amount of TDS shown above has been recovered from above agent and
credited to Government account on (date)

Dated:
Place: Signature of Sub Postmaster

Particulars of
deposit
Amount of
deposit
Amount of
commission paid
Amount of
TDS credited
Signature of SPM
N.SC.
K.V.P.
MIS
T.D
S.C.S.S
R.D.
TOTAL
Page 109

Est.-95
Signature of Applicant___________________________

Medical Certificate for non-gazzetted officers recommended for leave or
extension or commutation of leave

I ____________________________ after careful examination of the case hereby certify
that Shri/Smt. ___________________________________ whose signature is given above is
suffering from ______________ and I consider that a period of absence from duty of
_________ days with effect from -------------- is absolutely necessary for the restoration kof his
health.

Date_________________ Govt. Medical Attendant
Or
Registered Medical Practioner (No ---------)

Signature of Applicant _____________________

Medical Certificate of fitness to return to duty

I __________________________ civil surgeon of/ registered Medical Practioner of do
hereby certify that I have carefully examined Shri/Smt. _________________________________
of department of Posts, India whose signature is given above and find that he has recovered
from his illness and is now3 fit to resume his duties in Government Service. I also certify that
before arriving at this decision I have examined the original Medical Certificates and statements
of the case ( or certificated thereof ) on which leave was granted or extended and have taken
these into consideration is arriving at my decision.

Date ___________________ Govt. Medical Attendant
Or
Registered Medical Practioner (No _______

Page 110

CHARGE REPORT
This is to certify that charge of the office of
Was made over by (name)
To (name) at (place) on the (date)
Fore/ after noon in accordance with
No. Dated from
Certified that the balance of this date of the several books (including stock
book and registers) and accounts of the office have been checked and found
correct.
Certified that the balances as detailed bellow were handed over to me by
the relieved officer and I accept responsibility for the same.
A) Cash Rs.
B) Stamp imprest

Relieved Officer Relieving Officer

No- / /20 -20 /dated at the ..

Forwarded to
1)
2)
3)
4)

Page 111

FORM NO 16A
[See rule 31(1) (B)]
Certificate of deduction of tax at source under section 203 of the Income Tax Act, 1961.
For interest on securities; dividends; interest other than interest of securities; winnings fro
lottery or crossword puzzle; winning from horse race; payments to contractors; and sub contractors;
insurance commission; payments to non resident sportsman/sports associations; payment in respect of
deposits under National Savings Scheme; payments on account of repurchase of units by Mutual fund or
Unit Trust of India; commission, remuneration or prize on sale of lottery tickets; rent; fees for
professional or technical services; income in respect of units; other sums under section 195;income of
foreign companies referred to in section 196 a(2); income from units referred to section 196B; income
from foreign currency bonds or shares of an Indian company referred to in section 196C; income from
foreign institution Investors from securities referred to in section196D.
Name and address of the
person deducting tax
TDS circle where Annual Return
under section 206 is to be delivered
Name and address of the person to
whom payment made or in whose
account it is credited

TAX DEDUCTION A/C NO OF
THE DEDUCTOR

NATURE OF PAYMENT PAN/GIR OF PAYEE
PAN/GIR NO OF DEDUCTOR FOR THE PERIOD
TO

DETAILS OF PAYMENT, TAX DEDUCTION AND DEPOSIT OF TAX INTO CENTRAL GOVERNMENT ACCOUNT

Date of
Payment
/credit
Amount paid /
Credited
Rs.
Amount of
Income Tax
deducted (Rs.)
Rate at which
deducted
Date and
challan no of
deposit of tax
into Central
Government
Account
Name of Bank
and branch
where tax
deposited

Certified that a sum of Rs. (Rupees .)
has been deducted at source and paid to the credit of the Central Government as per details given
above.

Signature of person responsible for deduction of tax
Place Full Name .
Date . Designation
Page 112

M.O. 10(A)
Month Stamp

Oblong MO Stamp A.O. Stamp

MEMO OF ADMISSION OF PAYMENT
1. Office of Issue......................................................................
2. No. and Date of lost Money Order ..
3. Amount of Order .
______________________________________________________________________________
4. Name of Remitter (If Known)
5. Name of Payee
6. Office of Payment
7. Date of Payment of original Order ..
Counter Signed
Postmaster of .. (Office Payment)
I admit that I have received the amount of the money order noted on the reverse.

* Signature of Witness Signature of Payee
*When payee is illiterate, not known to the post office or postman or lives in village outside the
post-town.
Date Stamp of
office of issue
Date Stamp of
office of Payment
Oblong MO stamp on payment

Page 113

MO 10 (B) DEPARTMENT OF POSTS, INDIA.

To,
Shri/Smt. ..
.
(Name and address of Remitter of MO)
Name Stamp of office of Dispatching
Office

______________________________________________________________________________
CERTIFICATE OF PAYMENT

Your letter No.. Dated the
I hereby certify that Money Order NO . dated the
for Rs. issued by Post office was paid on
.

Date Stamp of office of Payment Signature of Postmaster.

Page 114

MO 35
From,
The .
..
To,
The Director /Dy. Director, Audit and Accounts,
Posts and Telegraphs
No dated .. the ..
sir,
I am to request you kindly to forward the paid Money Order described bellow of this
office.
Name and office of issue(When
the office of issue is a S.O., its
B.O. should be added in
brackets after it)
No and Date of
Money Order
Amount Office of
Payment
Date of
Payment
(if known)
Rs. Ps.

Yours faithfully,

Page 115

MO 12

______________________________________________________________________________
MO 11 NOTICE TO PAYEE

A money order for Rs issued by the Post office
in your favour has been received by the office. Please call personally or send an agent
authorised in writing to sign the money order, to receive payment of the above amount. the
acknowledgement for the money order ( to be returned to the remitter) is sent herewith, and
should be presented at the Post Office along with this notice by yourself or by your agent when
Appling for payment of the order.
Should you preferred to return this notice duly endorsed with a receipt of payment,
together with the acknowledgement duly signed through an ordinary messenger, the amount
of the money order will be paid to the person who presents these documents on your behalf.
Payment of the money order will be made only after Postmaster is satisfied about the
identity of the payee.
Yours faithfully,

Money Order Stamp Postmaster
Round MO stamp of
Redirecting office
MO 12 DEPARTMENT OF POSTS, INDIA
Redirected Money Order
To
The Postmaster,
-------------------------------------------------------------
Round MO stamp of
office of Payment.
Page 116

MO 66
H.O. Journal of Indian Postal Orders paid during the month of .. 20
Date Denomination Sl. No. Value of
order
Value of Postage
stamps affixed to
make up broken
amount
Number of Indian
Postal Order
Total Value
(Total of
columns 4 and
5)
1 2 3 4 5 6 7

Page 117

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-||||`|| t||-||-|,
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||`-||||-|||t vs~~s.
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-|r|:|,
-||;|| ||||| -------------- t||||-|| =||-| .|-|||
--------------- -| |-|-| =||-| ||r. -|| =||-||-|| -|||`|-| |`-|| |||`|| |||-|| |||-||r| ||r| |
| -||-|= | : -|t-| ||r.-|| |-|-| =||-||-|| -|| -|-| ||r| -||-| |= ;-a| -| ||r. -|| |-||| -|-||
|: =||-| -|| -||-| |=| |`-|=|| r| |`||-||.

||-|-||/||-|-|| |`||||

Page 118

STATEMENT OF D.A. ARREARS PAID TO SWEEPER AND WATERWOMAN AT..
FOR PERIOD FROM .TO .

Name of
Sweeper/Water
woman

Basic
Allowance

Amount
of D.A.
Paid

Amount of
D.A. Due

Difference
between
amount
paid and
due to pay

Amount
of
arrears
paid

Total
arrears paid

1 2 3 4 5 6 7 8 9 10

TOTAL

Page 119

-| |||| ||-| | | -|-||
-----------------------------
-------------------------------
---------------------------------------
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----------------t|||.
|` |||--||| || t /|`|c -|~| -||| ||-||| | |` -|-|| -| |` ||||-|.
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||-||| -|||`:|

To:-
The Manager,
Computerized Customer Care Centre,
Alibag-Raigad ,402 201.
No/ / / Dated / /20
Forwarded for necessary action please.
Sending particulars :-
2) Number of Money Order/Register Letter:-
3) Date of booking :_
4) Name of Office of booking:-
5) Amount of Money Order:-
6) Name and address of Remitter / Sender :-

7) Name and address of Payee / Addressee :-

Page 120

From:-

To: - The Sub Postmaster/Postmaster,
_________________________
__________________________
________________________________________________________________________
No- / / Dated at _____________the
________________________________________________________________________
Subject: - Issue of duplicate money order.
Reference: -The Superintendent of Post offices Raigad Division, Alibag, Dist, Raigad, No-
Respected Sir,
Please find herewith a duplicate money order no dated
For Rs ______/-(Rs___________________________________________ ) in favor of Payee/Remitter
Shri/Smt._________________________________________________
_____________________________________________________________________
At your risk. Please read rule no 74 of Post Office Manual VI Volume II and act the needful.
PLEASE AVOID DOUBLE PAYMENT and intimate the date of payment to The
Superintendent of Post offices Raigad Division, Alibag, Dist, Raigad 402 201. and also to this office.
Thanking you,
Yours faithfully,

Copy to: -
1) The Superintendent of Post offices Raigad Division, Alibag, Dist, Raigad, 402201.for
information with reference to his above mentioned letter.
2) The Superintendent /Senior Superintendent of Post Offices,
_______________________________________________________________
3) Office copy.

Page 121

UNSOLD STOCK STATEMENT OF 6 NSC (VIII) AT S.O.
FOR THE MONTH OF __________200

PLACE-DASGAON
DATE-- SUBPOSTMASTER, ..
------------------------------------------------------------------------------------------------------------
UNSOLD STOCK STATEMENT KISAN VIKAS PATRAS AT S.O.
FOR THE MONTH OF __________200

PLACE-DASGAON
DATE-- SUBPOSTMASTER,.

DENOMINATION SL NOS OF CERTOFICATES TOATL IN STOCK
RS 100
RS 500
RS1000

RS 5000
RS 10000
TOTAL
DENOMINATION SL NOS OF CERTOFICATES TOATL IN STOCK
RS 100
RS 500
RS1000
RS 5000
RS 10000
TOTAL
Page 122

UNSOLD STOCK STATEMENT OF INDIAN POSTAL ORDERS
AT ..S.O. FOR THE MONTH OF_________200
DENOMINATION SL NOS OF IPOS TOTAL
00.50
1.00
2.00
5.00
7.00
10.00
50.00
100.00

PLACE-
DATE-- SUBPOSTMASTER,.
------------------------------------------------------------------------------------------------------------
UNSOLD STOCK STATEMENT OF INDIAN POSTAL ORDERS
AT S.O. FOR THE MONTH OF_________200
DENOMINATION SL NOS OF IPOS TOTAL
00.50
1.00
2.00
5.00
7.00
10.00
50.00
100.00

PLACE-
DATE-- SUBPOSTMASTER,

Page 123

FORMA
APPLICATION FOR CHANGE OF NOMINATION
(To be copied on the back of the policy document)
I (Full Name) ___________________________________________________________
The assured under within written policy hereby nominate in terms of Section 39 of the
Insurance Act. Mr/Mrs (Full Name)
__________________________________________________ Relationship
_______________________________________________________ aged _______________
years residing at ________________________ to be the person to whom money secured by the
within policy shall be paid in the event of my death lieu of (Name within policy)
_____________________________
(Full Name) Named in the endorsement of the policy No ______________________________
dated at (Place) ________________ the ____________ day of ______________________ 200

Witness Signature:-
Full Name :- _______________________________ Signature of Policy holder
Occupation :- ______________________________ Signature of the New Nominee.
Address __________________________________
___________________________________

Page 124

OFFICE OF THE Sub Post Master,
., Dist. - Raigad
To,
The Branch Manager,
STATE BANK OF INDIA,
.. BRANCH.
No- / / dated at the
Subject: - Intimation for drawing of crossed Cheque.
Respected Sir,
Following crossed cheques have been drawn as per details given bellow today.

Sl.
No
Sl. No of Cheque Date of
issue
Name of Payee Amount of Cheque Remarks

Yours faithfully

Copy to The Postmaster, Alibag

OFFICE OF THE Sub Post Master,
., Dist. - Raigad
To,
The Branch Manager,
STATE BANK OF INDIA,
.. BRANCH.
No- / / dated at the
Subject: - Intimation for drawing of crossed Cheque.
Respected Sir,
Following crossed cheques have been drawn as per details given bellow today.

Sl.
No
Sl. No of Cheque Date of
issue
Name of Payee Amount of Cheque Remarks

Yours faithfully

Copy to The Postmaster, Alibag
Page 125

FORM FOR APPLICATION FOR LEAVE
(See supplementary rule 216)
Note:- Items 1 to 11 must be filled in by the applicant whether gazetted or non-gazetted
1. Name of applicant:-
2. :eave rules applicable:-
3. Post held:-
4. Department, Office, and section:-
5. Pay:-
6. House rent allowance, conveyance allowances, or compensatory
7. Nature and period of leave applied for and date from which required:-
8. Sundays and holidays, if any proposed to be prefixed/suffixed to leave
9. Ground on which leave is applied for:-
10. Date of return from last leave, period of that leave:-
11. I propose/do not propose to avail myself of leave travel concession in the block years ----
---- during the ensuring leave.
1. I undertake to refund the difference between the leave salary drawn
during leave on average pay/commuted leave and that admissible
during leave on half average pay/half pay leave, which would not
has been admissible had the provision F.R. 81(b)(ii) of the revised
Leave Rules, 1933, not been appl9ed in the event of my
retiarement from service at the end or during the currency of the
leave.
2. I undertake to refund the leave salary drawn during leae not due
which would not hae been admissible had A.R 81(c)/rule 11(d) of
the Revised Leave Rules, 1933 noty been applied, in the event of
volantary retirement of resignation from, at any time until I eatrn
half pay leave not less that the amount of leave not due availed of
by me. Date ..........................
Signature of applicant
Remarks and or recommendation of the controlling officer.
Date ................................ Signature..................................................
Designation ................................................
CERTIFICATE REGARDING ADMISSIBILIGTY OF LEAVE
certified that ................. (Nature of leave for ......................... To
.................... is admissible under rule ................. of the ................................... rules.
Date ................................ Signature..................................................
Designation................................................
Orders of the sanctioning authority:-
Date ................................ Signature.......................................
Designation ...
Page 126

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