FORM 20





[See sub-paragraph (1) paragraph 12]



NOMINATION UNDER THE PUBLLI PROVIDENT FUND SCHEME,1968.



To

The Agent/Manager,

State Bank of …… ………………….

I………………….hereby nominate the person (s) 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 Public Provident Fund Account No……….. at the time of my death would be payable.

Serial No.

Name(s) of the nominee(s)

Full address(es)

Date of birth of nominee(s) in case of minor

Proportionate amount for each nominee

As the nominee(s) at serial No. (s)…………………specified above is/are minor(s), I appoint Shri/Smt./Kumari…………………….address………………to receive the sum due under the said account in the event of my death during the minority of the nominee(s).

Signature of witness:

Signature/Thumb impression of subscriber

Name and address:

Date :

FOR THE USE OF ACCOUNTS OFFICE

The above nomination has been registered on………..and an entry made in the pass book.

Date…………..

Signature of Accounts Officer

* Delete if not applicable