FORM OF APPLICATION FOR PURCHASE OF NATIONAL SAVINGS CERTIFICATES (IX ISSUE)

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..... To The Postmaster Sir, I/We hereby tender Rs. . . . . . . . . . . . . . . . . . . . . . . . .(Rupees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .only) in cash/by cheque No . . . . . . . . . . . . . . . . . . . . . . . . . . . for purchase of National Savings Certificates IX Issue of the type Single/Joint A/Joint B. (a) .....

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..... 3. I/We hereby agree to abide by National Savings Certificates (IX Issue) Rules, 2011. 4. The Certificates may be made over to my/our agent Shri/Smt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Authority No. . . . . . . . . . . . . . . or messenger who presents the application. Signature/Thum .....

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..... . . . . . . . . . . . . . . . . . . . . . . . . . .. TO BE COMPLETED BY THE POST OFFICE S.No. of Certificates Issue Price (Rs.) Date of encashment Initials of the Postmaster Remarks like transfer, issue of duplicate, etc. with initials .....

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