APPLICATION FOR OPENING A SUKANYA SAMRIDDHI ACCOUNT UNDER THE

SUKANYA SAMRIDDHI YOJANA

TO,

THE BRANCH MANAGER

SUBHASH ROAD, DEHRADUN

PAN NO: CDYPS7262R

GBM HOLDER REF NO: GBMSSH007837

GBM SSA REF NO: GBMSSA008093

DATE: 2/16/22 10:20 PM

I GURVINDER SINGH

hereby apply for opening an account under the Sukanya Samriddhi Yojana, in my name/in the name of
. SUKHPREET
. . . . . . . . . .KAUR
. . . . . . . . . . . . . . . . . . . . . . . , of whom I am the guardian and tender herewith Rs. 500 (Rupees. Five
Hundred Only) in cash/cheque as the initial subscription.

Permanent address of subscriber/guardian: 215 OLD DALAN WALA

KARANPUR GURUDWARA ROAD

I agree to abide by the provisions of the Sukanya Samriddhi Yojana, and amendments issued thereto from time to time.

ACCOUNT IN THE NAME OF MINOR(S)

Date of birth of minor 24/04/2017

Applicant's relationship with minor, if any . . . . Father

...............

(i) I hereby declare that I am not maintaining any other Sukanya Samriddhi Account, except an account on behalf of a
minor

(ii) I hereby declare that the details of other Sukanya Samriddhi Accounts opened earlier by me as guardian are as
under:-

S.NO Description Name and Address of the Bank

01 In the name of Minor(s) of whom I

am the guardian

(iv) I also declare that I shall adhere to the ceiling on deposits as provided for by Central Government from time to time,
which is Rs.1,50,000/ in a financial year . In case, at any time the said declaration is found untrue / false, no interest
shall be payable to me/ the subscriber on the amount of deposits found in excess of the prescribed limit. I shall be
investing directly and not through any agent

Additional Specimen Signatures: Signature/Thumb Impression of

Guardian

1)

2)

Date:
 FOR THE USE OF ACCOUNTS OFFICE

The account has been opened on . . . . . . . . . . . . . . . with Rs . . . . . . . . . . . under SSY A/C NO. . . . . . . . . . . . . . . .
PassBook No . . . . . . . . . . has been Issued.

Date . . . . . . . . . . . . . .

Accounts Officer*