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NATIONAL SAVING CERTIFICATE PURCHASE APPLICATION FORM

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NC - 71
                                       Department of Posts India

                 APPLICATION FOR PURCHASE OF NATIONAL SAVINGS CERTIFICATES (VIII ISSUE)

To

The Postmaster                                                        Serial No………………….
……………………… Post Office

1       I/We hereby tender Rs………………….. (Rupees …………………………………… only)
in cash/by cheque No……………………….. for purchase of National Savings Certificates (VIII
Issue) 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 parent/guardian Sri/Smt …………………………………..

2         I/We nominate the person(s) named below who shall, on my/our death receive payment

     Sl No    Name of Nominee        Full Address                Date of birth of minor
                                                                 nominee

       (1)             (2)                       (3)                          (4)




3         I/We hereby agree to abide by National Savings Certificates (VIII Issue) Rules, 1989

4      The Certificates may be made over to my/our agent Shri/Smt ………………………………
Authority No………………………………. or messenger who present the application.

                                                             Signature/Thumb impression of Investor

                                                              Date                          ………………………...

                                                              Address        ………………………...
                                                                             ………………………...
                                                                             ………………………...
Signature and Address of Witness to nomination

……………………………………………………                                          Received the Certificate(s)

……………………………………………………                                          Signature of investor/messenger/
Delete whichever is not applicable                            Authorised agent

                                                              Date
                                                                                      2




                 TO BE COMPLETED BY THE POST OFFICE



Sl No.of       Issue Price   Date of      Initials of the     Remarks like
certificates   Rs.           encashment   Postmaster          transfer, issue of
                                                              duplicate etc with
                                                              initials

        (1)        (2)           (3)            (4)                   (5)




       Total




Date                                                        Signature of Postmaster

				
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