FORM E
[See sub-paragraph (1) of paragraph 11]
(To be submitted only in case of individual depositor)

[Name of the Deposit Office]
Serial No.

Form of nomination under the Capital Gains Accounts Scheme, 1988
To
The Manager
[Name and address of the Deposit Office]
I, [Name of the Depositor] son of residing at
[Address] 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 account-A No. Pass Book No. /account-B No. Deposit Receipt No.
under the Capital Gains Accounts Scheme, 1988, 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) specified 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 .
Signature of witness
Name and Address
Date .
FOR THE USE OF DEPOSIT OFFICE
The above nomination has been registered on and entry has been made in the Pass book
No for account-A No. Deposit Receipt No
for account -B No.
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.