FORM 1
[See rules 6, 10 and 18]
Form of application for purchase of National Savings Certificates
(VI Issue)
Serial No……….

To
            The Postmaster ………..Post Office………………
I/We, hereby tender Rs…........………(Rupees…...............………….only) in cash/ by cheque No ………........………..for the purchase of National Savings Certificates (VI 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 Shri/ Smt ……………………
 (c) in the name of…………….(members, etc.)…………… through……………(society or company, etc.).
2. I/We nominate the person(s) named below who shall, on my/ our death, receive payment.

SI. No.	Name of nominee	Full Address	Date of birth of minor nominee

 3. I/We, hereby agree to abide by the National Savings Certificates (VI Issue) Rules, 1981.
4. The certificate/ identity slip may be made over to my/ our agent Authority No. or messenger who presents this application.
Signature/thumb impression of investor (s)
Date    
Address          
Signature and address of witness to nomination
Date                                                                  Received the certificate(s) and identity slip
                                   
                                                    Signature of investor/ messenger/ authorised agent
 Delete whichever is not applicable.
IDENTITY SLIP
Specimen signature
TO BE COMPLETED BY THE POST OFFICE
 

SI. Nos. of certificates	Issue price Rs.	Date of encashment	Initials of the postmaster	Remarks like transfer issue of duplicates, etc., with initials
Total

Date : ………….        
            Signature of Postmaster