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
TO BE COMPLETED BY THE POST OFFICE
Sl No.of
certificates
Issue Price
Rs.
Date of
encashment
Initials of the
Postmaster
Remarks like
transfer, issue of
duplicate etc with
initials
(1) (2) (3) (4) (5)
Total
Date Signature of Postmaster