FORM F
[See sub-paragraph (3) of paragraph 11]

[Name of the Deposit Office]
Serial No

Application for cancellation or change of nomination previously made in respect of account under the Capital Gains Accounts Scheme, 1988

To
The Manager
[Name and address of the Deposit Office]
I, son of residing at [Address of the depositor] hereby cancel the nomination made by me in respect of my Account/Accounts mentioned under column 2 here under:
2 Details of Account/Accounts
(1) Account-A No
Nomination made on
in favour of
(2) Account-B No
Nomination made on
in favour of
3 In the place of the cancelled nomination referred to under column 2 here in above, 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 account/accounts mentioned under column 2 here in above would be payable
Sl No Name(s) of the
nominee(s)
Relationship Full address(es) Date of birth of nominee in case of minor
As the nominee(s) at Serial No (s) stated above is/are minor(s), I appoint Shri /Smt /Kumari
[Name and full address] as the person to receive the sum due under the said account(s) in the event of my death during the minority of the nominee(s)
Signature of witness : Signature/Thumb impression of the
depositor
Name and Address : PAN & Distt /Ward/Circle/Range
where assessed
Date
Place
FOR THE USE OF DEPOSIT OFFICE
The nomination referred to under column 2 here in above has been cancelled and fresh nomination as per column 3 here in above has been registered on and accordingly entry has been made in the Pass book for account-A No Deposit Receipt No for account-B No referred to under the column 2 here in above
Date
Officer-in-charge

Note :
Delete whatever is not applicable If space provided under the columns here in above is not sufficient to furnish the requisite details, the same may be done by way of using separate enclosure and referring to the same under the respective columns