FORM 3
[See rule 14(4)]
DEPARTMENT OF POSTS
Serial No. .
Form of application for cancellation or variation of nomination previously made in respect of savings certificates under section 6 of the Government Savings Certificates Act, 1959
(This form will be filled in by the holder(s) and submitted with the certificates to the Postmaster of the office where the certificates stands registered)
To
The Postmaster,
Space for postage stamps.
Under the provisions of section 6(1) of the Government Savings Certificates Act, 1959, I/we the holder(s) of savings certificates detailed below, hereby cancel the nomination previously made by me/us in respect of these certificates and registered in your office under No. dated .
In place of the cancelled nomination, I/we hereby nominate the person(s) mentioned below, who shall, on my/ our death, become entitled to the savings certificate(s) and to be paid the sum due thereon to the exclusion of all
other persons.
Sl. No. Name of nominee(s) Full Address Date of birth of nominee in case of minor
To be filled in case of variation only.
2. As the nominee(s) at serial number(s) above is/are minor(s), I/we
appoint Shri/ Smt./ Kumari (Name and full address) as the person to receive the sum due thereon in the event of my/our death during the minority of the
nominee(s).
3. The certificates detailed below are enclosed.
Sl. Nos. of certificates Denomination Date of issue Office of issue
Address : Yours faithfully,
Signature (or thumb impression,
if illiterate), of holder(s)
(In case of illiterate holder father's name should be given) :
Witnesses :
Name :
Address (1) :
Name :
Address (2) :
Note: In the case of illiterate holders, the witnesses shall be persons whose signatures are known to the post
office.
Order of the Postmaster accepting the nomination.
Date stamp of post office.
Signature of Head/ Sub-
Postmaster