nr. nr. E\$.

\$m_© B©
PPF FORM-E
bmoH$ ^{dî` {Z{Y 1968 Ho$ AÝVJ©V Zm_m§H$Z ànÌ
FORM OF NOMINATION UNDER THE PUBLIC PROVIDENT FUND SCHEME 1968
^maVr` ñQ>oQ> ~¢H$/State Bank of India
emIm/Branch ...........................................................................................
à{V/To
emIm à~ÝYH$/The Branch Manager,
^maVr` ñQ>oQ> ~¢H$/State Bank of India ............................................................................................................................
_¢/I .......................................................................................................................................................................
BgHo$ Ûmam AnZr _¥Ë`w H$s Xem _| bmoH$ ^{dî` {Z{Y ImVm g§. ............................................................... _| O_m am{e Ho$, _oar _¥Ë`w na,
^wJVmZ hoVw AÝ` g^r ì`pŠV`m| H$mo N>mo‹SH$a {ZåZm§{H$V ì`pŠV(`m|) H$mo Zm_m§{H$V H$aVm h±y&
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.

AZwH«$_m§H$ Zm{_Vr (`m|) H$m/Ho$ Zm_ nyam nVm/nyao nVo Zm~m{bJ H$s Xem _| Zm{_Vr H$s OÝ_ {V{W
Sl. No. Name(s) of the nominee(s) Full Address(s) Date of Birth of nominee in case of minor

My§H$s D$na Cpëb{IV H«$_m§H$( m|)................................................... na A§{H$V Zm{_Vr Zm~m{bJ h¡/h¢, _¢ CgH$s Zm~m{bJr Ho
Xm¡amZ AnZr _¥Ë`w H$s Xem _| lr/lr_Vr/Hw$_mar .....................................................................................................................
nVm.....................................................................................................................................................................................
H$mo CnamoŠV ImVo Ho$ AÝVJ©V Xo` aH$_ àmßV H$aZo Ho$ {bE {Z`wŠV H$aVm/H$aVr hÿ±&
As the nominee(s) at Serial No.(s) ................................................................................. specified above is/are
minor(s), I appoint Shri/Shrimati/Kumari ..........................................................................................................................
Address ..............................................................................................................................................................................
.............................................................................................................................................................................................
to receive the sum due under the said account in the event of my death during the minority of the nominee(s).

Jdmh Ho$ hñVmja/Signature of witness:

Zm_ d nVm/Name and address:
{XZm§H$/Date:
Jdmh Ho$ hñVmja/Signature of witness:
Zm_ d nVm/Name and address:
{XZm§H$/Date: A{^XmZ H$Vm© Ho$ hñVmja/A§JyR>m {ZemZr
Signature or Thumb Impression of Subscriber

boIm H$m`m©b` Ho$ à`moJ Ho$ {bE

FOR THE USE OF ACCOUNTS OFFICE
Cn`w©ŠV Zm_m§H$Z .......................................................................................... H$mo a{OñQ>S>© {H$`m J`m Ed§ nmg ~wH$ _| à{d{ï> H$s JB©&
The above nomination has been registered on ........................................................... and entry made in the Pass Book

{XZm§H$/Date
* Omo bmJy Z hm| CÝh| H$mQ> Xo&
Delete if not applicable
boIm A{YH$mar Ho$ hñVmja
Signature of Accounts Officer
100101041