FORM 3
[See para 5(c)]

Application for withdrawal under the Deposit Scheme for Retiring Employees of Public Sector Companies, 1991

The Manager,
(Name of the Bank)
(Address)
I wish to withdraw from the Deposit Scheme for Retiring Employees of Public Sector Companies, 1991, Account No sum of Rs. (Rupees ). A period of years have expired from the date of deposit.
2. The Pass Book No. is enclosed.
.
Date . Signature or Thumb
Place . impression of depositor
TO BE USED BY THE ACCOUNTS OFFICE
Date of initial deposit .
Amount available in the Account Rs .
Date on which last withdrawal was allowed .
Amount available for withdrawal in accordance with para of the scheme.
Withdrawal of a sum of Rs sanctioned.

Signature of Official
RECEIPT
Received a sum of Rs (Rupees ) by way of
withdrawal from Deposit Scheme for Retiring Employees of Public Sector Companies, 1991.

Date . Signature or Thumb
Place . impression of depositor