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Form ASLASS-I(B)

Application Form for an Individual for Appointment as an Authorised Agent (MPKBY)

To

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                                  (Appointing Authority)

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                        Sub: Application for appointment as an Authorised Agent.

Sir,

1. I request that I may be appointed as an Authorised Agent under the Mahila Pradhan Kshetriya Bachat Yojna for canvassing and securring deposits in 10-Year Post Office Cumulative Time/5-Year Recurring Deposit Accounts on a commission (at such rate as may be notified by the Govt. of India from time to time) in the  ........................ area (Municipal House No. /Plot No. ........................ to ........................ which consists of .......................... families).

2. I agree to abide by all the rules and regulations regarding the appointment of Authorised Agent present in force and as may be amended from time to time under the above said Agency Scheme.

3. I shall provide a security of Rs. 100 (Rs. one hundred only) in shape of 7-Year National Savings Certificate duly pledged to President of India.

4. The Agreement (Form ASLASS-3) will be executed by me immediately on hearing from you about the approval of my appointment as an Authorised Agent.

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

Yours faithfully




Place:

Name and full address of the applicant

Date:

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FOR USE BY DISTRICT SAVINGS OFFICER

Memo. No......................................                                      Dated:.........................................
Forwarded to  .................................................................................................

(Appointing Authority)

Recommended that the applicant may be/may not be appointed as authorised agent on account of the following reasons:

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Signature .........................

(District Saving Officer)

                                                                                         
                                                                    ............................................
                                                                     Place


FOR USE OF APPOINTING AUTHORITY

Appointment as recommended by the District Savings Officer, National Savings ........................... approved/ not approved.

Place:

Signature: .......................

Date:

(Designation of the Appointing Authority)