FORM 1
[See rules 6, 10 and 18(1)]
Form of application for purchase of National Savings Certificates (VII 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 (VII 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 (VII Issue) Rules, 1981.
4. The certificate/ identity slip may be made over to my/ our agent Authority No. or messenger who presents this application.
5. Depositor's instruction :- Please credit the interest to my/our Savings Account No .
Signature/thumb impression of investor(s)
Date .
Address
.
Signature and address of witness
to nomination
Received the certificate(s) and identity slip
Date .
Signature of investor/ messenger/ authorised
agent
Delete whichever is not applicable.
IDENTITY SLIP
Specimen Signature
Printed From Taxmann’s Income Tax Rules on CD Page 2 of 2
TO BE COMPLETED BY THE POST OFFICE
Serial Nos. of
certificate
Issue price
Rs.
Date of payment
of interest
Date of
encashment
Initials of the
postmaster
Remarks like transfer,
issue of duplicates, etc.,
with initials
Total
Date . Signature of postmaster