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Form AAS-1

Standardised Agency System
Annexure -1
(See Para 4)

Application form for appointment as Authorised Agent
(To be used by individuals only)

To

 

 

Sir,

I desire to act as an Authorised Agent for the sale of Kisan Vikas Patras, 1,2,3, & 5 -Year Time Deposits, 6-Year National Savings Certificates (VIII issue), N.S.S. 1992, M.I.S. Accounts and other small savings securities which may be notified by the Government of India from time to time as securities which authorised Agent may canvass.

2
  1. My full name is ..........................................................
  2. My father's name is ...................................................
  3. My occupation is ......................................................
  4. My business/office address is ....................................
  5. My residential address is ...........................................
  6. My age is .....................................

 

3. I declare that (i) I am not a close relative (i.e. wife, husband, legitimate child or step child, father/step father, mother/step mother, sister/step sister, brother/step brother, father-in-law, mother-in-law, brother-in-law, sister-in-law, son-in-law or daughter-in-law) of employee of Department of Posts working anywhere in India in a gazetted capacity or in-non-gazetted capacity in the State where the agency falls. (ii) I am not a close relative of an employee of the National Savings Organisation and (iii) I am not employed under the Central or State/Union Territory Government.

3.(A).  I declare that none of my near relatives (i.e. my wife/husband, legitimate child or step child, my father/step father, mother/step mother, brother/step brother, sister/step sister, father-in-law, mother-in-law, brother-in-law, sister-in-law or daughter-in-law) is employed under the Central or State/Union Territory Government.

OR

I give below the particulars of my near relatives (i.e. my wife/husband, legitimate child or step child, my father/step father, mother/step mother, brother/step brother,  sister/step sister, father-in-law, mother-in-law, brother-in-law, sister-in-law, son-in-law or daughter-in-law) who are employed under the Central or State/Union Territory Government:-

Name of relative Relationship with the applicant Name and address of office where employed.
 

 

   
 

 

   
 

 

   
I attach the communication(s) in original from the Head(s) of Office/Department where the above mentioned person(s) is/are employed to the effect that there is no objection to my being appointed as agent under the Standardised Agency System.

4(a) I request that for the sale of certificates issued through post offices, I may be attached to the
       undernoted Post Offices:

(i)---------------- G.P.O./H.P.O/S.P.O./B.P.O.
(ii)---------------- G.P.O./H.P.O/S.P.O./B.P.O.
(iii)---------------- G.P.O./H.P.O/S.P.O./B.P.O.

  (b) In respect of certificates issued through other agencies, I may be attached to following
       office(s):-
  1. ................................................................
  2. ................................................................
  3. ...............................................................

5. *In the event of my appointment being approved, I shall -
  1. put  up two acceptable sureties each guaranteeing to extent of Rs. .................

OR

  1. furnish security in cash or in the shape of Government securities totalling to the issue price of Rs. ..........

OR

  1. furnish one surety of bank for Rs. ............

OR

  1. furnish a Fidelity Guarantee Policy of the value of Rs. .............

6. I agree to abide by all the rules, regulations, instructions, etc. regarding the appointment of
    authorised agents at present in force and as may be amended from time to time

7. I previously worked as Authorised Agent at ....................during  the years(s) .............................

OR

     I have not so far worked as Authorised Agent.

8. I may be allowed to obtain Receipt Books from (Name and address of Issuing Authority) ..........
    .................................................................................

9. Give names and addresses of two* responsible persons known to you:-





* A Gazetted Officer/Member of Parliament/Metropolitan/Municipal Council/ Headmaster of a recognised school/ Registered Medical Practitioner/ Practising Advocate/ Chartered Accountant/ Bank Manager/ Village Pradhan/ Sarpanch/ Chairman, Block  Panchayat Samities.

10. I enclose herewith in triplicate, my specimen signature.


Yours faithfully,

Place:


Date:

Signature of Applicant

*Does not apply to government servants appointed as Internal Agents.
 

 

[To be filled up only if the application is recommended by some body]

I recommend this application:-

Name .............................................

Signature:
Full address:

Designation:
Date:
 

[To be filled in the office of the Appointing Authority]

  1. Application scrutinised by

Signature: .......................... Designation: ..........................

  1. Applicant's appointment as Authorised Agent approved on ................ (Date) after verifying the solvency of the sureties, in cases where sureties are put up.

  1. Agreement completed on ................ (Date)

  1. Certificate(s) of Authority bearing number(s) issued on ................ (Date)

  1. Signature of Appointing Authority ....................................

  2. Designation of Appointing Authority ...........................

Date: ...................
 

AFFIDAVIT

[To be furnished by the SAS Agent along with the application]

I .................. S/o, W/o, D/o, Shri ........................  solemnly affirm that:-
  1. I am not an employee of the State or Central Government and undertake to report to the appointing authority and to give up the agency whenever I enter such employment.

  2. None of my near relatives is employed in the National Saving Organisation anywhere in India.

  3. None of my rear relatives is employed in the Postal wing anywhere in India in gazetted capacity and in non-gazetted capacity anywhere in the State where the Agency falls.

  4. I declare that none of my near relative is employed under the State or Central Government.

OR

I give below the particulars of my near relative(s) who is/are an employee under the Central/State Government

Name of the close relative

Relationship

Particular of office where employed

     
     
     
  1. I attach No Objection Certificate(s) from the Head(s) or Office/Department where the above  mentioned persons is/are employed to the effect that there is no objection to my taking up agency under the above said agency system.

A person will be regarded as near relative if the official is the person wife/ husband / father/ step father/ mother/step mother/ legitimate child/step child/ brother/step brother/sister/step sister/sister in law/ brother in law/ son in law/daughter in law/ father in law/ mother in law.

 

Date:
Place:

DEPONENT

Signed in my presence:

(1) Name and Address     Signature (2) Name and address      Signature
 

   

CONDUCT CERTIFICATE

Certified that Shri/Ms. ________________________________ S/o, W/o, D/o, __________ _____ r/o ________________________ is personally known to me for the last ____ years (Not less than 2 years) and to the best of my knowledge and belief she is a person of integrity and good conduct.  She is not related to me.

Signature:

Name and Address:




Date: Seal: