(Annexure – 1)
FORM -1
Application for opening an account
To
The Postmaster/Manager
…………………………………………………
Paste photograph of
…………………………………………………
applicant/s
Sir,
I ………………………..(Applicant/guardian) hereby apply for opening of an account
under______________________________________(Name of the scheme in your Post
Office/Bank.
I tender herewith Rs……………………../-
(Rs…………………………………………………………………………….) in cash/Cheque/DD.
No………………… date………. as initial deposit. My particulars are as under:-
1. Name of the Depositor
……………………………………………………………
Date of Birth ……… ..……… ………………
(DD / MM / YYYY )
(In words)……………………………………………
2. Name of Guardian ……………………………………………………………
Husband/Father /mother’s name
……………………………………………………………
Date of Birth ……… ..……… ………………
(DD / MM / YYYY )
(In words)……………………………………………
3. Aadhar Number of guardian
…………………………………………………………..
4. Permanent Account Number (PAN) of guardian
…………………………………………………………..
5. Present Address
………………………………………………………….
Permanent Address
………………………………………………………….
………………………………………………………….
6. Contact details Telephone Number……………………………..
Mobile
Number…………………………………..
Email
ID……………………………………………
1
7. Type of Account Minor
8. (*)Details of Birth Certificate of the depositor
……………………………………………………….
a) Certificate No.
……………………………………………………………………..
b) Date of Issue
…………………………………………………………………….
c) Issuing authority
……………………………………………………………………
9. Details of other KYC documents attached 1. Proof of identification
………………………………………………
…………
2. Address proof
………………………………………………
…………
(The following documents are accepted as officially valid documents for the purpose of
identification and address proof: 1. Passport 2. Driving license 3. Voter’s IDcard 4. Job card
issued by NREGA signed by the State Government officer 5.Letter issued by the National
Population Register containing details of name and address;
10. The operation of the account will be:-
(a) By the Guardian till the depositor attains majority.
(b) By the depositor herself on attaining majority,
11. Specimen Signatures
1…………………………2……………………………. 3.,……………………………
(Name)…………………………………………………………
I hereby declare that I have not opened a SukanyaSamriddhi Account in the name of the
depositor mentioned at serial number 1 in any of the Post office/Bank in the country.
I further declare that I and the depositor both are Resident citizen of India and undertake
to inform the account office of any change in our residency/citizenship status in future.
I hereby undertake to abide by the scheme provisions and Government Savings
Promotion rules-2018 applicable on the Scheme and amendments issued thereto from time
to time.
Signature or thumb impression of guardian
Date:……………………
2
Nomination
17. I…………………………………………..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 ……………………………………..(Name of Scheme) at the time of my death
would be payable.
S.No. Name(s) of Full address Aadhar Date of Share of Nature of
the (s) number of birth of entitlement entitlement
nominee(s) nominee nominee in Trustee or
and (optional) case of owner
relationship minor
1
2
As the nominee(s) at Serial No.(s)…………………………………….specified above is/are
minor(s), I appoint
Shri/Smt/Kumari…………………………………S/o,D/o,W/o………………………………………
…………………………………..Address……………………………………………………………
………………………………………………………………………………………………….to
receive the sum due under the said account in the event of my death during the minority of
the nominee(s).
1. Signature of witness…………………………………….
Name & Address……………………………………………..
2. Signature of witness…………………………………….
Name & Address……………………………………………..
Signature or thumb impression ofguardian
Place:
Date:
For use of Post Office/Bank
The account has been opened in the name
of…………………………………on……………………..with initial deposit
ofRs………………………………………… with Account No.__________________________
dated______________________________.
Customer identification Number………………………………..
Nomination has been registered vide
No……………………………………..dated………………………………………..
Signature and seal of competent authority.
