FORM E
[See sub-paragraph (1) of paragraph 12]
STATE BANK OF .
Nomination under the Public Provident Fund Scheme,1968

To
The Agent/Manager,
State Bank of .
I, 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 the Public Provident Fund Account No. at the time of my death would be payable :-
Sl. No. Name(s) of the
nominee(s)
Full address(es) Date of birth of
nominee(s) in
case of minor
Proportionate amount
for each nominee
As the nominee(s) at Serial No.(s) specified above is/are minors, I appoint
Shri/Smt./Kumari Address to receive the sum due under the said account in the event of my death during the minority of the nominee(s).

Signature of witness Signature/ thumb impression of subscriber
Name and Address:
Date:
FOR THE USE OF ACCOUNTS OFFICE
The above nomination has been registered on and an entry made in the Pass
book.
Date
Signature of Accounts Officer
Delete if not applicable.