FORM A
FORM OF APPLICATION FOR PURCHASE OF KISAN VIKAS PATRA
Serial No. ..............................
The Postmaster
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Post Office
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FORM A |
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FORM OF APPLICATION FOR PURCHASE OF KISAN VIKAS PATRA |
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Serial No. .............................. |
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| To The Postmaster
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Post Office |
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| 1. | I/We hereby tender Rs............................... (Rupees .................................................... .................................... only) in cash/ by cheque No……………........... for the purchase of Kisan Vikas Patra of the type Single/Joint "A" Joint "B" |
(a) |
in the name(s) of……………………………..............and…………………………….................... |
| (b) | in case of minor, his date of
birth…………….encashable by the minor’s parents/guardian Shri/Smt…………………........................................ |
| (c) | in the name
of……………………….(Members etc.)
through……..(Society or Company etc.)
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| 2. | I/We nominate the person(s) named below who shall on my death, receive payment: |
| Sl.No. | Name of Nominee | Full Address | Date of Birth of Minor Nominee |
| 1. | |||
| 2. | |||
| 3. |
| 3. | I/We hereby agree to abide by the Kisan Vikas
Patra Rules, 1988. |
| 4. | The Certificate(s) and Identity slip may be made over to my/our agent Authority No……………........ or messenger who presents this application. |
Signature (s)thumb impression of Investor(s) |
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| Signature and Address of witness to nomination |
Date .......................................... |
| …………………………….................... ........................................................ ........................................................ …………………………………….......... …………………………….................... …………………………….................... |
Address …………………………….................... ........................................................ ........................................................ ……………………………………........... |
| Received the certificate(s) and identity slip |
Signature of investor/messenger/authorised agent |
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Date ........................................ |
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| Delete whichever is not applicable | |
TO BE COMPLETED BY THE POST OFFICE |
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| Serial 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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TOTAL |
Date: ..................................... |
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Identity slip |
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