Annex I
Date:
To
The Chief General Manager
Public Debt Office
Reserve Bank of India
-------------------------

Dear Sir,

-------- Per cent West Bengal Government Stock 2019
In terms of para 3 (ii) of the Government of West Bengal Notification No ------------------------------------------- dated --------------------------2009, I/we -------------- hereby exercise the put option and offer for premature redemption of --------- per cent West Bengal Government Stock 2019 on my behalf (1)*/on behalf of my client (2)* to the Government of West Bengal for an aggregate face value of Rs. ------------ at par.
____________________________________________________________________________
(1)* The Stock is held by me/us in the following form:
(a)* SGL account No. ------------------------------------ at Public Debt Office ------------
(b)* Stock Certificate No. --------------------- (Duly discharged certificate/s enclosed).
(2)* The Stock is held in the following form:
* CSGL Account No. ------------------------- at Public Debt Office -----------------
____________________________________________________________________________
Accordingly, I/we request you to * debit my SGL/CSGL Account and credit my Current Account No. ** ---------------------- with Reserve Bank of India, -------------------- or pay me/us by way of cheque for the par value of the Stock tendered and half yearly interest payable on the Stock from the last coupon date.
Yours faithfully,
Signature:
Name:
Designation*:
Official Stamp/Seal:
* Strike out whichever is not applicable
** Applicable for persons having Current Account with Reserve Bank of India
Note: Separate Application for SGL and CSGL should be submitted.