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.
Sl. 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
Printed From Taxmann’s Income Tax Rules on CD Page 2 of 2
Signature of investor/ messenger/
authorised agent
Delete whichever is not applicable.
IDENTITY SLIP
Specimen signature
TO BE COMPLETED BY THE POST OFFICE
Sl. 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