Application For Opening of An Account Under Senior Citizen's Saving Scheme 2004 - PDF - Deposit Account - Affidavit

7/20/23, 12:26 PM Application For Opening of An Account Under Senior Citizen'S Saving Scheme 2004 | PDF | Deposit Account
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Application For Opening of An Account Under Senior Citizen'S Saving
Scheme 2004
Original Title: SCSS_forms
Uploaded by Hemlata Lodha
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7/20/23, 12:26 PM Application For Opening of An Account Under Senior Citizen'S Saving Scheme 2004 | PDF | Deposit Account | Affidavit

LNVI ‗ H
(Wee gahuse (m) nl ruae 6 hbm suf ruae (8) nl ruae 7) 
Werkha Bn…………
HTTAKGH]KNB LNV NTEBKBJ NL HB HGGNUB] UBMEV WEBKNV GK]K_EB‛W WH\KBJ WG@EIE 644=
]n
]è Frhbg` Ihbhjer
Tubohf & Wkbm Fhbc
^^^^^^^^^^^^^^^^^^^^^^^^^^
Bhie nl Hjebt (kb ghse nl tè hggnubt kbtrnmugem t`rnuj` hjebt ) ………………………………………………………………………….
Hjebgy Gnme Bn……………….. mhtem …………………… vhakm uptn …………………………………………
Wkr,
8. K. …………………………………Wnb / mhuj`ter / wkle nl ………………………………………………………… THB Bn. (nl

hppakghbt) …………………………………. h perihbebt reskmebt nl …………………………………………………………….hjem
……….. yehrs, èrefy hppay lnr npebkbj nl hb hggnubt ubmer tè Webknr Gktkzebs Whvkbjs Wgèie, 644=, (èrekbhlter relerrem tn hs tè
shkm sgèie), kb iy bhie/onkbtay kb iy bhie hbm iy spnuse^^^^^^^^^^^^^^^^^^^^^^(bhie hbm hmmress nl spnuse wkt` hje)* hbm
tebmer èrewkt` s^^^^^^^^^ (Vupees^^^^^^^^^^^^^^^^^^^^^^^^^^^^^) kb ghs`/gèque/meihbm mrhlt, tè phrtkguahrs nl w`kg` hre
lkaaem kb tè ebgansem ‐ phy-kb-sakp (Lnri-M), tnwhrms mepnskt kb tè hggnubt.
6. K/Ze* èrefy megahre t`ht,-

k. K/Ze* `hve gaehray ubmersthbm tè Webknr Gktkzebs Whvkbjs Wgèie Vuaes, 644= jnverbkbj tè hggnubtkbj ubmer tè shkm
sgèie, hs hiebmem lrni tkie tn tkie (èrekbhlter relerrem tn hs tè shkm ruaes)3
kk . K/Ze* s`haa hfkme fy tè shkm ruaes kb aetter hbm spkrkt 3
kkk. ]è methkas nl ntèr hggnubt npebem ehraker fy ie/us* ubmer tè shkm sgèie, hre hs ubmer ?
Bhie nl tè mepnsktnr(s) & type Bhie hbm hmmress nl tè Hggnubt Buifer wkt`
Wa Bn Hinubt nl mepnskt
nl hggnubt (kbmkvkmuha /onkbt) Mepnskt nllkge mhte nl npebkbj
8.
6.
7.
kv. K/Ze* s`haa hmère tn tè gekakbj nb mepnskts, `namkbj tè mepnskts kb haa tè hggnubts npebem fy ie/us* tnjetèr, hs spegklkem
kb ruae = hbm hiebmem lrni tkie tn tkie. Kb ghse, ht hby tkie, hby exgess mepnskt ks lnubm, sug` exgess mepnskt wkaa fe
relubmem tn ie/us* hlter regnvery nl exgess kbterest ubmer suf-ruae (0) nl ruae :.
7. K bnikbhte tè lnaanwkbj persnb/persnbs, iebtknbem feanw, tn w`ni, tn tè exgausknb nl haa ntèr persnbs, kb tè evebt nl iy meht` tè
hinubt sthbmkbj tn iy gremkt kb tè hggnubt wnuam fe phyhfae kb hggnrmhbge wkt` tè prnvksknbs gnbthkbem kb ruae <?
Bhie(s)nl tè bnikbee(s) Mhte(s) nl fkrt` nl

Wa W`hre nl tè bnikbee(s) kb
hanbjwkt` reahtknbs`kp wkt` tè Terihbebt hmmress bnikbee(s) kb ghse nl h
Bn tè hinubt phyhfae.
mepnsktnr ikbnr/hje kb ntèr ghse(s).
8.
=. (h) Hs tè bnikbee(s) ht Werkha Bn.(s)^^^^^^^^^^^^^^^^^ hfnve ks/hre ikbnr(s), K hppnkbt W`rk/Wit/Cuihrk ^^^^^^^^^^^^^^^^^^^^
SBhie(s) wkt` perihbebt hmmress(es) nl tè persnb(s) kb respegt nl ehg` ikbnr bnikbeeY tn regekve tè sui mue ubmer tè shkm hggnubt
kb tè evebt nl iy meht` murkbj tè ikbnrkty nl tè bnikbee(s).
Zktbess (Wkjbhture ,bhie & hmmress) Wkjbhture/]ùif Kipressknb nl tè mepnsktnr
8. ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
6. ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ Mhte^^^^^^^^^^^^^^^ ht (Tahge)^^^^^^^^^^^^^^^^


Iy/nur* spegkieb skjbhture (]ùif kipressknb), hre hs feanw ?
k. Lkrst mepnsktnr ?
8. 6. 7.
kk. #Onkbt mepnsktnr ?
8. 6. 7.
(Gnubterskjbem kbg`hrje) (Gnubterskjbem kbg`hrje) (Gnubterskjbem kbg`hrje)
Mhte^^^^^^^^& nllkge seha) Mhte^^^^^^^^& nllkge seha) Mhte^^^^^^^^& nllkge seha)
5 K hasn megahre t`ht tè kblnrihtknb prnvkmem fy ie/us* kb tè hppakghtknb èrekb hfnve, ks true tn tè fest nl iy/nur cbnwaemje hbm
feakel hbm kb ghse, ht hby tkie, hby nl tè kblnrihtknb hbm/nr megahrhtknb, ks lnubm lhase, bn kbterest nb tè mepnskts s`haa fe phyhfae tn
ie/us*, tè mean nllkge s`haa ganse tè hggnubt(s) hbm relubm tè mean hlter regnvery nl tè kbterest, at hby, harehmy phkm nb tè
mepnskts.
[nurs lhkt`luaay,
(Wkjbhture nl tè hppakghbt)

LNVI F

(Wee suf-ruae(7) nl ruae =)
Werkha Bn…………………
HTTAKGH]KNB LNV EP]EBWKNB NL HB HGGNUB] UBMEV

WEBKNV GK]K_EB‛W WH\KBJW WG@EIE,644=
]n
]è Frhbg` Ihbhjer
Tubohf & Wkbm Fhbc
^^^^^^^^^^^^^^^^^^^^^^^^^^
Wuf ? Hppakghtknb lnr extebsknb nl hb hggnubt lnr t`ree yehrs

wkt` ellegt lrni……………… (mhte/inbt`/yehr)
K, ……………………………… ……. Wnb/mhuj`ter/wkle en …………… hmepnsktnr nl hggnubt

bn………………………….. (ère kbhlter relerrem tn hs tè ‐shkm hggnubt‛) èrefy hppay lnr gnbtkbuhtknb nl
tè hggnubt ubmer tè Webknr Gktkzeb's Whvkbjs Wgèie, 644=(èrekbhlter relerrem tn hs tè ‐tè shkm
sgèie‛), lnr h lurtèr perknm nl t`ree yehrs lrni tèmhte nl ihturkty nl iy hfnve shkm hnaked
K `hve ubmerstnnm tè teris hbm gnbmktknbs hppakghfae tn tè hggnubt murkbj tè perknm nl extebsknb ubmer
tè Webknr Gktkzeb's Whvkbjs Wgèie, 644= hs hiebmem lrni tkie tn tkie.
K s`haa ganse tè hggnubt kiiemkhteay nb gnipaetknb nl tè extebmem perknm hbm jet fhgc tè mepnskt sthbmkbj
ht iy gremkt kb tè hggnubt hlter hmoustiebt nl tè kbterest phkm kb exgess, kl hby, hbm hby ntèr g`hear
regnverhfae kb gnbbegtknb wkt` tè shkm hggnubt.
Mhte Wkjbhture nl tè Mepnsktnr
Tahge (Brother hbm hmmress)
-----------------------------------------------------------------------------------------------------------------------------------
LNV ]@E UWE NL METNWK] NLLKGE

]è hggnubt bn………………………. w`kg` whs npebem nb …………….. wkt` Vs………………….
(Vupees………………………………………………..) ubmer tè Webknr Gktkzeb's Whvkbjs Here, 644=hbm
ihturem nb ……………………, `hs minute extebmem lnr h perknm nl t`ree yehrs wkt` ellegt lr ni ……………
tn ………………… Vhte nl kbterest ht ………………… pergebt per hbbui hs hppakghfae ubmer tèHere
tn lres` mepnskts npebem nr tn fe npebem nb tè mhte nl ihturkty, s`haa fe hppakghfae murkbj tè extebmem
perknm nl tè mepnskt.
Begesshry ebtrkes `hve feeb ihme kb tè Thssfnnc Bn……………………… hbm reaevhbt Aemjer lnakn
Bn……………….. hggnrmkbjay.
Mhte Wkjbhture nl tè kbg`hrje nl Mepnskt Nllkge
(hanbj wkt` bhie hbm meskjbhtknb sthip)

LNVI G
Werkha Bn……………………
HTTAKGH]KNB LNV BNIKBH]KNB/G@HBJE/GHBGEAAH]KNB NL BNIKBH]KNB

UBMEV WEBKNV GK]K_EBW WH\KBJW WG@EIE, 644=
]n
]è Frhbg` Ihbhjer
Tubohf & Wkbm Fhbc
^^^^^^^^^^^^^^^^^^^^^^^^^^
What? Hppakghtknb lnrBnikbhtknb nr g`hbje/ghbgeaahtknb nl Bnikbhtknb

wkr
8* K, ………………………………… èrefy bnikbhte tè lnaanwkbj persnb/persnbs iebtknbem feanw, tn w`ni,

tn tè exgausknb nl haa ntèr persnbs, kb tè evebt nl iy meht` tè hinubt sthbmkbj tn iy gremkt kb hggnubt bn.
……………. wnuam fe phyhfae kb hggnrmhbge wkt` tè prnvksknbs gnbthkbem kb ruae < nl Webknr Gktkzeb's Whvkbjs
Here, 644=.
Of Bhie(s) nl tè bnikbee(s) Terihbebt Hmmress Mhte(s) nl fkrt` nl W`hre nl

hanbjwkt` reahtknbs`kp wkt` bnikbee(s) kb ghse nl bnikbee(s) kb
tè mepnsktnr(s) h ikbnr/hje kb ntèr hinubt phyhfae
ghse(s)
6* Hs tè bnikbee(s) ht Werkha Bn.(s) ……………………………… hfnve ks/hre ikbnr(s), K hppnkbt

Wrk/Wit/Cuihrk ………………………………………………. Sbhie(s) kb luaa wkt` gnipaete hmmress(es) nl tè
persnb(s) kb respegt nl ehg` ikbnr bnikbeeY tn regekve tè sui mue ubmer tè shkm hggnubt kb tè evebt nl iy meht`
murkbj tè ikbnrkty nl tè bnikbee(s).
7* ]`ks ks kb supergessknb nl tè bnikbhtknb(s) ihme fy ie ehraker ht tè tkie nl npebkbj nl hggnubt/vkme iy
hppakghtknb mhtem ………………………
=* K……………………………………. èrefy request tn ghbgea tè bnikbhtknb ihme fy ie ehraker vkme

hppakghtknb mhtem ………………………..
Zktbesses SWkjbhture, bhie hbm hmmressY

8 Wkjbhture nl tè Mepnsktnr
(Bhie hbm Hmmress)
6
Mhte ………………… ht pahge ………………
* Wgnre nut w`kgèver ks bnt hppakghfae
------------------------------------------------------------------------------------------------------------------------------
LNV ]@E UWE NL METNWK] NLLKGE
]è hfnve bnikbhtknb `hs feeb rejksterem nb ……………………….. HBM/NV tè ehraker bnikbhtknb mhtem
………………………. `hs feeb g`hbjem/ghbgeaaem. Begesshry ebtrkes `hve feeb ihme kb tè Thssfnnc
(Bn……………...……….) hbm reaevhbt Aemjer lnakn Bn…………… hggnrmkbjay.
Mhte Wkjbhture nl kbg`hrje nl Mepnskt Nllkge

(hanbjwkt` bhie hbm meskjbhtknb sthip)

LNVI E

SWee suf ruae(8) nl ruae 0 hbm ruae ;Y
Werkha Bn……………………
HTTAKGH]KNB LNV GANWUVE NL HB HGGNUB] UBMEV WEBKNV GK]K_EB‛W WH\KBJW WG@EIE 644=
]n
]è Frhbg` Ihbhjer
Tubohf & Wkbm Fhbc
^^^^^^^^^^^^^^^^^^^^^^^^^^
Wuf ? Hppakghtknb lnr wkt`mrhwha/gansure nl hggnubt

Wkr
8 K, ……………………………………….. snb/mhuj`ter/wkle nl ………………………………………

reskmebt nl …………………………………………………………………………………………………
hbm mepnsktnr nl hggnubt bn…………………… (èrekbhlter relerrem tn hs tè ‑shkm hggnubt’) ère fy hppay
lnr gansure nl tè shkm hggnubt wkt` kiiemkhte ellegt. ]è kbterest nl Vs……………….. hbm mepnskt nl
Vs………… ……………… ]N]HA (KB]EVEW] + METNWK]) Vs……………………………….
(Vupees ………………………………………………………………………) *hlter hmoustiebt nl nverphkm
kbterest hbm/nr memugtknb equha tn ……………. pergebt nl tè mepnskt, hinubtkbj tn Vs…………………….
(Vupees ………………………………………………………………………………) hbm hby ntèr g`hrjes,
regnverhfae lrni ie kb respegt nl tè hggnubt kb questknb, ihy ckbmay fe relubmem tn ie kiiemkhteay.
6 ]è phssfnnc ks ebgansem.
Wkjbhture nr tùif kipressknb nl tè Mepnskt

-----------------------------------------------------------------------------------------------------------------------------------
LNV UWE F[ ]@E METNWK] NLLKGE
HGGNUB] Bn……………………… MH]E NL METNWK] ……………. HINUB] NL METNWK]

Vs……………………………….
Zkt`mrhwha nb hggnubt nl Kbterest Vs……………….. hbm mepnskt Vs………………………… tnthaakbj tn
Vs……………………………. (Vupees ………………………………………………………………………)
ks
shbgtknbem kb lhvnur nl tè mepnsktnr.
*Vegnvery nl nverphkm kbterest Vs…………………. memugtknb nl Vs…………………………… hbm ntèr
g`hrjes (tn fe spegklkem) Vs…………………. tnthaakbj tn Vs……………………….. (Vupees
………………..……………………………………………………………………………..) `hs feeb
hmoustem.
BE] HINUB] THKM Vs………….. (Vupees ………………………………………………………………..)
VEGEKT]
Vegekvem h sui nl Vs…………………. (Vupees ……………………………………………………………)
lrni …………………………….. (Bhie nl Mepnskt Nllkge) hs per methkas lurbksèm hfnve.
Wkjbhture/]ùif kipressknb nl tè mepnsktnr

* Wgnre nut w`kgèver ks bnt hppakghfae

LNVI L
(Wee suf-ruaes (7) hbm (=) nl Vuae 0)
Werkha Bn……………………..
HTTAKGH]KNB LNV GANWUVE NL HGGNUB] UBMEV WEBKNV GK]K_EBW WH\KBJW WG@EIE, 644= F[ WTNUWE
(ONKB] @NAMEV)/BNIKBEE(W)/AEJHA @EKVW
]n
]è Frhbg` Ihbhjer
Tubohf & Wkbm Fhbc
^^^^^^^^^^^^^^^^^^^^^^^^^^
Wuf ? Hppakghtknb lnr wkt`mrhwha/gansure nl hggnubt
Wkr
K/Ze * ………………………………………………. tè spnuse (Onkbt `namer/bnikbee(s)/aejha èkrs

nl ahte ………………………………….., tè mepnsktnr tn tè Webknr Gktkzeb's Whvkbjs Wgèie, 644= hggnubt
Bn………………………………. wks` tn wkt`mrhw tè ebtkre hinubt sthbmkbj tn tè gremkt nl tè megehsem
kb tè shkm hggnubt.
Taehse lkbm ebgansem ?-

(k) H gertklkghte kb rejhrm tn tè meht` nl tè Mepnsktnr
(kk)* H gertklkghte kb rejhrm tn tè meht` nl Wrk/Wit …………………………………… Wrk/Wit
………………………………………… hasn tè bnikbee(s) hppnkbtem fy tè Mepnsktnr
(kkk)** Wuggessknb Gertklkghte/Aetter nl Hmikbkstrhtknb wkt` httestem gnpy nl prnfhtem wkaa nl tè megehsem
mepnsktnr kssuem ubmer tè prnvksknbs nl tè Kbmkhb Wuggessknb Hgt, 8;65.
(kv) Thss Fnnc nl tè Mepnsktnr
(v) # Aetter nl Kbmeibkty
(vk) # Hllkmhvkt
(vkk) # Aetter nl mksgahkier nb hllkmhvkt
Wkjbhture nr tùif kipressknb nl gahkihbt(s)
Zktbess ……………………………. (Wkjbhture, bhie hbm hmmress)

Mhte ………………………………
Tahge ………………………………
------------------------------------------------------------------------------------------------------------------------------
LNV UWE F[ ]@E METNWK] NLLKGE
Zkt`mrhwha nl Vs………….. (Vupees ………………………...……………………………) ks shbgtknbem

Hmoustiebts ihme (tn fe spegklkem) Vs……………., (Vupees…………………………………………)
Bet hinubt phyhfae Vs…………………. (Vupees ……………………………………………………..)


VEGEKT] ]N FE WKJBEM F[ ]@E GAHKIHB](W)
Vegekvem h sui nl Vs……………… (Vupees …………………………………………………....) lrni

…………………………………………… (bhie nl mepnskt nllkge) hs per methkas hfnve kb luaa settaeiebt nl
nur gahki
Wkjbhture nr tùif kipressknb nl gahkihbt(s)
* Meaete w`kgèver ks bnt hppakghfae

* Wtrkce nll kl tère ks h vhakm bnikbhtknb
** ]n fe prnmugem fy aejha èkrs, kb tè hfsebge nl bnikbhtknb(s) lnr gahkis uptn Vs.8 ahc`


HBBEPUVE K ]N LNVI L
(Aetter nl kbmeibkty)
]n
]è Frhbg` Ihbhjer
Tubohf & Wkbm Fhbc
^^^^^^^^^^^^^^^^^^^^^^^^^^
Kb gnbskmerhtknb nl ynur phyiebt nr hjreekbj tn phy ie/us ……………………………………..

………………………………………………………………………………………………………………
(Bhie(s) nl Aejha èkr(s) tè sui nl Vs………….. (Vupees …………………………………………….)
sthbmkbj kb tè hggnubt bn…………………….. ubmer WEBKNV GK]K_EBW WH\KBJW WG@EIE, 644=
wkt` ynur nllkge kb tè bhie nl …………………………………………………………………. wkt`nut
prnmugtknb nl aetters nl hmikbkstrhtknb nr h suggessknb gertklkghte tn tè esthte nl tè megehsem …………...
………………………………… (bhie nl tè mepnsktnr), K/Ze ……………………………..
…………………………………………hbm we ………………………………………..…….. (suretkes) mn
èrefy lnr nurseaves hbm nur èkrs, aejha represebthtkves, exegutnrs hbm hmikbkstrhtnrs onkbtay hbm severhaay
ubmerthce hbm hjree tn kbmeibkly ynu hbm ynur suggessnrs hbm hsskjbs hjhkbst haa gahkis, meihbms,
prngeemkbjs, ansses, mhihjes, g`hrjes hbm expebses w`kg` ihy fe rhksem hjhkbst nr kbgurrem fy ynu fy
rehsnb nr kb gnbsequebge nl `hvkbj hjreem tn phy/nr phykbj ie/us tè sui hs hlnreshkm.
Kb wktbess wèrenl we `hve èreubtn set iy/nur `hbms ht t`ks ………………… mhy nl ……………
………… ………. kb tè presebge nl wktbesses,
Wkjbem hbm meakverem fy tè hfnve bhiem

èkr/èkrs nl tè megehsem
Wkjbem hbm meakverem fy tè

hfnve bhiem suretkes (Wkjbhture, bhies hbm hmmress)
Wkjbhture, bhies hbm hmmress nl wktbesses
6
H]]EW]EM
BN]HV[ TUFAKG


HBBEPUVE KK ]N LNVI L
(Hllkmhvkt)
]n
]è Frhbg` Ihbhjer
Tubohf & Wkbm Fhbc
^^^^^^^^^^^^^^^^^^^^^^^^^^
K/Ze …………………………… ùsfhbm nl/wkle nl ahte ………………………………………. hjem

………………….. hjem ………………… hjem ………………… snbs/mhuj`ters nl tè shkm ahte
………………………………………… reskmebt nl ……………………………………. mn èrefy megahre
hbm snaeibay hllkri hs ubmer?-
8 ]`ht K/we hi/hre tè nbay èkr(s) nl tè megehsem ………………………………… w`n mkem ht
…………..……………………… nb ………………………….. K/Ze hanbe represebt tè esthte nl Wrk/Wit
………………………………………………..
6 ]`ht tè megehsem ……………………………. mkm bnt aehve hby wkaa hbm tèrel nre K/we hre tè nbay
suggessnr(s) tn tè esthte nl tè shkm megehsem.
METNBEB]W
\EVKLKGH]KNB ? K/Ze tè hfnve bhiem mepnbebts mn èrefy verkly nb snaeib hllkrihtknb kb ……
……… ………… ………… (bhie nl pahge) t`ht tè gnbtebts nl t`ks hllkmhvkt hre true tn tè fest nl iy/nur
cbnwaemje hbm bnt`kbj ihterkha `hs feeb gnbgehaem.
Mhtem ……………………
7
H]]EW]EM METNBEB]W
NH]@ GNIIKWWKNBEV

HBBEPUVE KKK ]N LNVI L

(Aetter nl mksgahkier nb Hllkmhvkt)
]n
]è Frhbg` Ihbhjer
Tubohf & Wkbm Fhbc
^^^^^^^^^^^^^^^^^^^^^^^^^^
K/Ze (k) …………………………………………….. @usfhbm nl/wkle nl ………………………...

Veskmebt nl …………………………………………………………………………………………………(kk)
…….…………………….. snb/mhuj`ter nl …………………………………… (kkk) ………………
………………………………….. snb/mhuj`ter nl …………………………………… mn èrefy megahre hbm
snaeibay hllkri hs lnaanws ?-
(8) ]`ht Wrk/Wit ……………………………………………. mkem kbtesthte nb ………………….. aehvkbj

fe`kbm us ………………………………………………….………… `ks/èr nbay èkrs.
(6) ]`ht we ……………………………………………………. @ekrs nl nur ahte lhtèr/intèr nurseaves

hbm nb fe`hal nl nur èkrs, exegutnrs, represebthtkves hbm hsskjbs tn èrefy reakbquks` nur gahkis tn tè
fhahbge nl Vs……………………………. w`kg` ihy fe gremktem tn tè hggnubt snuj`t fy nur intèr/lhtèr
tn fe npebem kb tè mepnskt nllkge kb tè bhie nl tè esthte nl tè shkm ……………….. ……………
……………………………………… megehsem lhtèr/intèr hlter tè rehakzhtknb nl Mrhlt Bn…………
…………………… nb …………… ………………. kssuem fy ………………………………… …… (bhie
nl tè mepnskt nllkge) hbm `hve bn nfoegtknb w`htsnever kb tè fhahbge kb tè hfnve relerrem hggnubt
bn…………………… tnjetèr wkt` kbterest kl hby, hggruem tèrenb fekbj phkm fy tè Mepnskt nllkge tn nur
intèr/lhtèr Irs/Ir ………………………………..
7
METNBEB]W
\EVKLKGH]KNB ? K/Ze tè hfnve bhiem mepnbebts mn èrefy verkly nb snaeib hllkrihtknb t`ht tè
gnbtebts nl t`ks hllkmhvkt hre true tn tè fest nl iy/nur cbnwaemje hbm bnt`kbj ihterkha `hs feeb gnbgehaem.
Mhtem ……………………
7
METNBEB]W
K kmebtkly tè mepnbebt(s) w`n ks/hre persnbhaay cbnwb tn ie hbm w`n `hs/`hve skjbem kb iy presebge
Mhtem …………………………
NH]@ GNIIKWWKNBEV


LNVI J
(Wee ruae 88)
Werkha Bn…………..
]n
]è Frhbg` Ihbhjer
Tubohf & Wkbm Fhbc
^^^^^^^^^^^^^^^^^^^^^^^^^^
Wkr,
Wuf ? Hppakghtknb lnr ]rhbsler nl hggnubt tn hbntèr Mepnskt nllkge

K ………………………………………………… snb/mhuj`ter/wkle nl …………………………
reskmebt nl …………………………………………………………………………………………………..
mepnsktnr nl hggnubt bn………………………………. èrefy hppay lnr ]VHBWLEV NL I[ HGGNUB]
Bn……………. wkt` mepnskt nl Vs…………… (Vupees ………………………………………………
………………………………………………..) ubmer tè Webknr Gktkzeb's Whvkbjs Wgèie, 644= tn
……………………………………………………………………………………………………..
………………………………………………… (bhie hbm luaa hmmress nl tè trhbsleree mepnskt nllkge)
]è Thssfnnc ks ebgansem
Wkjbhture nr tùif kipressknb nl tè Mepnsktnr

Zktbess …………………………………. *
(Wkjbhture, bhie hbm hmmress)………………….
Iy spegkieb skjbhture/tùif kipressknbs, hs hvhkahfae kb tè regnrm nl trhbslerer mepnskt nllkge hre hs
feanw ?-
8 8st Mepnsktnr
8 6 7
* Zktbess …………………….. * Zktbess …………………….. * Zktbess ……………………..
6 Onkbt Mepnsktnr
8 6 7
Gnubterskjbem Tnstihster/ Gnubterskjbem Tnstihster/ Gnubter Tnstihster/

Kbg`hrje nl ]rhbslerer Nllkge Kbg`hrje nl ]rhbslerer Nllkge Kbg`hrje nl ]rhbslerer Nllkge
Mhte …….. & nllkge seha Mhte …….. & nllkge seha Mhte …….. & nllkge seha
Lnrwhrmem tn ……………………………… (]rhbsleree Mepnskt Nllkge) hbm begesshry ebtrkes phssem
kb tè nllkge regnrms.
Wkjbhture & Nllkge Weha (]rhbslerer Mepnskt Nllkge)

Mhte …………………..

LNV UWE F[ ]@E ]VHBWLEVEE METNWK] NLLKGE
H Vegekvem hppakghtknb lnr trhbsler nl hggnubt bn…………………. npebem nb …………….. ubmer

WEBKNV GK]K_EBW WH\KBJW WG@EIE, 644= kb tè bhie nl ……………………………………..
hbm …………………………………………. (onkbt `namer, kl hby) sthbmkbj nb tè fnncs nl tè
………………………………………………..………………………………………… (bhie
hbm hmmress nl tè trhbslerer mepnskt nllkge) s`nwkbj mepnskt nl Vs………… (Vupees …………
………………………………………………) mue tn ihture nb …………………….
F ]è ebtrkes kb tè phssfnnc `hve feeb gègcem, begesshry ebtrkes kbmkghtkbj trhbsler, `hve feeb ihme
hbm phssfnnc `hs feeb returbem tn tè mepnsktnr.
Thssfnnc regekvem kb nrkjkbha Wkjbhture nl Kbg`hrje

(wkt` nllkge seha)
]rhbsleree Mepnskt
…………………………………………
# (Wkjbhture/tùif kipressknb nl tè mepnsktnr)
Mhte ………………………
Mhte ………………….
* Kb ghse nl tùif kipressknb
# tn fe skjbem nb regekpt nl tè phssfnnc ht tè trhbsleree mepnskt nllkge
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Application For Opening of An Account Under Senior Citizen's Saving Scheme 2004 - PDF - Deposit Account - Affidavit

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8. K. …………………………………Wnb / mhuj`ter / wkle nl ………………………………………………………… THB Bn. (nl

6. K/Ze* `erefy megahre t`ht,-

Bhie(s)nl t`e bnikbee(s) Mhte(s) nl fkrt` nl

Zktbess (Wkjbhture ,bhie & hmmress) Wkjbhture/]`uif Kipressknb nl t`e mepnsktnr

6. ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ Mhte^^^^^^^^^^^^^^^ ht (Tahge)^^^^^^^^^^^^^^^^

kk. #Onkbt mepnsktnr ?

(Gnubterskjbem kbg`hrje) (Gnubterskjbem kbg`hrje) (Gnubterskjbem kbg`hrje)

Mhte^^^^^^^^& nllkge seha) Mhte^^^^^^^^& nllkge seha) Mhte^^^^^^^^& nllkge seha)

(Wkjbhture nl t`e hppakghbt)

HTTAKGH]KNB LNV EP]EBWKNB NL HB HGGNUB] UBMEV

Wuf ? Hppakghtknb lnr extebsknb nl hb hggnubt lnr t`ree yehrs

K, ……………………………… ……. Wnb/mhuj`ter/wkle en …………… hmepnsktnr nl hggnubt

Mhte Wkjbhture nl t`e Mepnsktnr

Tahge (Brother hbm hmmress)

LNV ]@E UWE NL METNWK] NLLKGE

Mhte Wkjbhture nl t`e kbg`hrje nl Mepnskt Nllkge

(hanbj wkt` bhie hbm meskjbhtknb sthip)

HTTAKGH]KNB LNV BNIKBH]KNB/G@HBJE/GHBGEAAH]KNB NL BNIKBH]KNB

What? Hppakghtknb lnrBnikbhtknb nr g`hbje/ghbgeaahtknb nl Bnikbhtknb

8* K, ………………………………… `erefy bnikbhte t`e lnaanwkbj persnb/persnbs iebtknbem feanw, tn w`ni,

Of Bhie(s) nl t`e bnikbee(s) Terihbebt Hmmress Mhte(s) nl fkrt` nl W`hre nl

6* Hs t`e bnikbee(s) ht Werkha Bn.(s) ……………………………… hfnve ks/hre ikbnr(s), K hppnkbt

=* K……………………………………. `erefy request tn ghbgea t`e bnikbhtknb ihme fy ie ehraker vkme

Zktbesses SWkjbhture, bhie hbm hmmressY

Mhte Wkjbhture nl kbg`hrje nl Mepnskt Nllkge

Wuf ? Hppakghtknb lnr wkt`mrhwha/gansure nl hggnubt

8 K, ……………………………………….. snb/mhuj`ter/wkle nl ………………………………………

6 ]`e phssfnnc ks ebgansem.

Wkjbhture nr t`uif kipressknb nl t`e Mepnskt

LNV UWE F[ ]@E METNWK] NLLKGE

HGGNUB] Bn……………………… MH]E NL METNWK] ……………. HINUB] NL METNWK]

BE] HINUB] THKM Vs………….. (Vupees ………………………………………………………………..)

Wkjbhture/]`uif kipressknb nl t`e mepnsktnr

Wuf ? Hppakghtknb lnr wkt`mrhwha/gansure nl hggnubt

K/Ze * ………………………………………………. t`e spnuse (Onkbt `namer/bnikbee(s)/aejha `ekrs

Taehse lkbm ebgansem ?-

Wkjbhture nr t`uif kipressknb nl gahkihbt(s)

Zktbess ……………………………. (Wkjbhture, bhie hbm hmmress)

Zkt`mrhwha nl Vs………….. (Vupees ………………………...……………………………) ks shbgtknbem

Vegekvem h sui nl Vs……………… (Vupees …………………………………………………....) lrni

Wkjbhture nr t`uif kipressknb nl gahkihbt(s)

* Meaete w`kg`ever ks bnt hppakghfae

Kb gnbskmerhtknb nl ynur phyiebt nr hjreekbj tn phy ie/us ……………………………………..

Wkjbem hbm meakverem fy t`e hfnve bhiem

Wkjbem hbm meakverem fy t`e

Wkjbhture, bhies hbm hmmress nl wktbesses

K/Ze …………………………… `usfhbm nl/wkle nl ahte ………………………………………. hjem

HBBEPUVE KKK ]N LNVI L

K/Ze (k) …………………………………………….. @usfhbm nl/wkle nl ………………………...

(8) ]`ht Wrk/Wit ……………………………………………. mkem kbtesthte nb ………………….. aehvkbj

(6) ]`ht we ……………………………………………………. @ekrs nl nur ahte lht`er/int`er nurseaves

Wuf ? Hppakghtknb lnr ]rhbsler nl hggnubt tn hbnt`er Mepnskt nllkge