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Form C For SCSS

This document is an application form for nomination, change, or cancellation of nomination under the Senior Citizens Savings Scheme. It allows an applicant to [1] nominate one or more individuals to receive the funds in their savings account in the event of their death, [2] appoint a guardian to receive funds if the nominee is a minor, and [3] cancel an existing nomination. The form requires information such as the applicant's name and account number, nominee details including name, date of birth, relationship, and share of funds, signatures of nominee(s) and witnesses, and a request to change or cancel an existing nomination.

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9K views2 pages

Form C For SCSS

This document is an application form for nomination, change, or cancellation of nomination under the Senior Citizens Savings Scheme. It allows an applicant to [1] nominate one or more individuals to receive the funds in their savings account in the event of their death, [2] appoint a guardian to receive funds if the nominee is a minor, and [3] cancel an existing nomination. The form requires information such as the applicant's name and account number, nominee details including name, date of birth, relationship, and share of funds, signatures of nominee(s) and witnesses, and a request to change or cancel an existing nomination.

Uploaded by

murugeshlp
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

FORM-C

(See rule 6)
Serial No…………………..

APPLICATION FOR NOMINATION/CHANGE/CANCELLATION OF NOMINATION UNDER SENIOR CITIZENS


SAVINGS SCHEME, 2004

TO
The Postmaster/Incharge,
……………………………………………………(name of the Deposit office)
…………………………………………………….
…………………………………………………….

Subject: Application for Nomination or Change/Cancellation of Nomination.


Sir,

1.* I,………………………………………………hereby nominate the following person / persons, mentioned


below, to whom, to the exclusion of all other persons, in the event of my death the amount standing to my
credit in the account No………………………would be payable in accordance with the provisions contained in
rule 6 of Senior Citizens Savings Scheme Rules, 2004.

TABLE

Sl. Name(s)of the nominee(s) Date(s) of birth of Share of the


No. alongwith relationship with Permanent Address nominee(s) in case nominee(s) in the
the depositor of a minor/ age in amount payable.
other case(s)
(1) (2) (3) (4) (5)

Photograph(s) of the nominee(s) Signature/thumb impression of the nominee(s)


(6) (7)”.

2.* As the nominee(s) at Serial No.(s)……………………………above is/are minor(s), I appoint


Shri/Smt./Kumari………………………………………………………………………………………………………[name(s) in full with complete
address(es) of the person(s) 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).

3.* This is in supercession of the nomination(s), made by me earlier at the time of opening of account/vide my
application dated……………………………… .

4.* I…………………………………………………, hereby request to cancel the nomination made by me earlier vide my
application dated…………………………..

Witnesses(Signature, name and address):

1………………………………………………………………………… Signature of the depositor


(Name and address)
2………………………………………………………………………….
Date……………………………At (Place)………………………….
*Score out whichever is not applicable.
FOR THE USE OF DEPOSIT OFFICE

The above nomination has been registered on…………………………………….. AND/OR the earlier
nomination dated………………………………………has been changed/cancelled.
Necessary entries have been made in the Pass Book (No…………………………) and relevant Ledger folio
No………………………… accordingly.

Date…………………………………….. Signature of the Incharge of Deposit Office


(alongwith name and designation stamp)

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