FORM 1A
[See rules 6 and 18(1)]
INDIAN POSTS AND TELEGRAPHS DEPARTMENT
Form of application for purchase of National Savings Certificates (VI Issue) by non-resident or person who is not resident in India

Serial No. .
1. I/We hereby apply for the purchase of National Savings Certificates (VI Issue) as detailed below:
PARTICULARS OF CERTIFICATES REQUIRED *
Denomination (Rs.) Number of certificates Total face value Rs. Type of joint
certificates required
('A' or 'B' type)
5,000
1,000
500
100
50
Total
To be filled only for joint -holding.
Joint 'A' type certificate is payable to both holders jointly or to the survivor; joint 'B' type is payable to
either or survivor.
(a) in my/our name(s) $ .
(b) on behalf of minor $ .
Date of birth of minor .
Certificate to be made encashable by father/ mother/ either parent/ lega l guardian of the minor.
(c) ( ** )in the name of $ through [Name and
address of bank branch]
†Strike out (a)/ (b)/ (c) if not applicable.
$Give in block capital name(s) with aliases, if any, address and country of residence.
Strike out any or all of the alternatives, if not required.
For a scheduled bank on behalf of client having Non-resident (External)/ Foreign Currency (Non resident) Account with the bank.
2. I/We tender herewith towards the purchase price of the certificates applied for:
(a) Cheque No. dated in favour of the Postmaster [Name of
post office] for Rs. (Rupees ) drawn on my/ our Non-resident
(External) Account No. with [Name and
address of bank branch in India]
(b) Demand draft/pay order No. dated in favour of the
postmaster [Name of post office] for
Rs. (Rupees ) issued by [Name
and address of bank branch in India] by debit to non-resident (External) Account No. or by withdrawal of equivalent funds from foreign currency (Non-resident) Account No. of [Name(s) and address of applicant(s)] together with a certificate from the said bank confirming that the draft/ pay order has been issued by debit to or withdrawal from the account referred to above.
(c) Demand draft No. dated in favour of the
postmaster [Name of post office] for drawn
by [Name and address of bank in a country
outside India] on [Name(s) and address of
its branch or correspondent bank in India]
(d) A sum of Rs. (Rupees ) in cash
together with foreign inward remittance certificate/ bank certificate indicating conversion of foreign exchange in rupees/bank certificate indicating that the funds have emanated from my/ our Non-resident (External) Foreign Currency (Non-resident) Account No. Issued in my/our favour by [Name and address of the bank concerned]
Fill up (a)/(b)/(c)/(d), as the case may be and delete the rest.
For applicant(s) or for a scheduled bank or on behalf of client applicant(s).
Amount in Indian or foreign currency, as the case may be, in words and figures.
3. I/We agree that -
(a) in cases where the Post Office requires a bank certificate showing the source of funds out of which the
certificates are to be purchased, the certificates will be issued to me/us only on receipt of such bank certificate
by the Post office;
(b) in cases the proceeds of the cheque/demand draft are less than the face value of certificate(s) applied for, certificate(s) may be issued for the maximum possible total face value within such proceeds;
$ (c) in case such proceeds one more than the face value of certificate(s) applied for, certificate(s) may be
issued as applied for; and
$ in either case, any balance amount of the proceeds may be refunded to
[Name and address of person] who is hereby authorised by me/us to receive the same, or
(d) credited to my savings account No. in post office savings bank [Name of Post Office]
Applicable where the required bank certificate is not submitted with the application.
Applicable only for cheque/draft expressed in foreign currency.
$ Delete (c) or (d), as the case may be.
4. I/We declare that I am/we are citizen(s) of India/person(s) of Indian origin.
Note: A person shall be deemed to be of Indian origin if he, or either of his parents or any of
his grand-parents, was born in undivided India.
5. I/We agree to abide by the National Savings Certificates (VI Issue) Rules, 1981.
6. I/We do/do not require identity slip.
Note: No identity slip shall be issued to a person other than the one authorised, vide
paragraph 1(b) above in case of purchase on behalf of a minor.
Signature Signature [or thumb impression
(not thumb impression) of the person(s) authorised, (if illiterate) of applicant(s)]
if any, as per paragraph 1(b) above
Date Date
Address Address
Strike out portions not applicable.
If the applicant is illiterate, his father's name may also be given.
The certificate(s) and the identity slip may be made over to Shri/Smt Agent
(Authority No. ) or messenger who presents this application.
Signature [or thumb impression
(if illiterate) or investor(s)]
Date
To be signed or thumb impression affixed only when the investor does not take delivery of certificates
personally.
7.Received the certificate(s) detailed above $ and identity slip.
$$Marks of identification of applicant(s) Signature or thumb impression of purchaser
or his agent/messenger (in case of authorised
agent his Authority No. should be given)
$$ Specimen signature(s) of applicant(s)
$Cross out, if the identity slip is not required.
$$To be furnished if identity slip is required under paragraph 6 and if the application is submitted through an agent, messenger of scheduled bank.
$ 8.Under provisions of section 6(1) of the Government Savings Certificates Act, 1959, I/we ,the holder(s) of Savings Certificates(s) mentioned in this application, hereby nominate the person(s) mentioned below who shall, on my/our death, become entitled to the Savings Certificate(s) and the amount due thereon to the exclusion of all other persons:-
Sl.No. Name(s)of the Nominee(s) Full address Date of
birth of
nominee, if
minor
$Strike out portions not applicable.
As the nominee(s) at Serial No.(s) above is/are minor(s),
I/we, appoint Shri/Smt./Kumari [Name and full
address] as the person to recieve the amount due thereon in event of my/ our death during the minority of the nominee(s).
Signature and full address of witness Signature [or thumb impression(if illiterate) of holder(s)]
TO BE COMPLETED BY THE POST OFFICE
Sl.No. of
certificate
Issue price Rs. Date of encashment
of certificate
Initials of
postmaster
Remarks like transfer
issue of duplicates, etc.,
and initials of
postmaster
Tot al
Printed From Taxmann’s Income Tax Rules on CD Page 4 of 4
TOTAL NUMBER OF NATIONAL SAVINGS CERTIFICATES (VI ISSUE)
* Amount realised Rs.
Certificate(s) issued for Rs.
Amount refunded as per paragraph 3(b) Rs.
Date
Signature of postmaster
*In case of investment by cheque/ demand draft in foreign currency.