NC - 71 Department of Posts India APPLICATION FOR PURCHASE OF NATIONAL SAVINGS CERTIFICATES (VIII ISSUE) To The Postmaster Serial No........ ......... Post Office 1 I/We hereby tender Rs......... (Rupees .............. only) in cash/by cheque No........... for purchase of National Savings Certificates (VIII Issue) of the type Single/Joint A/Joint B. a In the name(s) of .......... and ............ b In case of minor, his date of birth ............... encashable by the minor's parent/guardian Sri/Smt ............... 2 I/We nominate the person(s) named below who shall, on my/our death receive payment Sl No Name of Nominee Full Address Date of birth of minor nominee (1) (2) (3) (4) 3 I/We hereby agree to abide by National Savings Certificates (VIII Issue) Rules, 1989 4 The Certificates may be made over to my/our agent Shri/Smt ............ Authority No............. or messenger who present the application. Signature/Thumb impression of Investor Date ............ Address ............ ............ ............ Signature and Address of Witness to nomination .................... Received the Certificate(s) .................... Signature of investor/messenger/ Delete whichever is not applicable Authorised agent Date TO BE COMPLETED BY THE POST OFFICE Sl No.of certificates Issue Price Rs. Date of encashment Initials of the Postmaster Remarks like transfer, issue of duplicate etc with initials (1) (2) (3) (4) (5) Total Date Signature of Postmaster
