NC 71

DEPARTMENT OF POSTS, INDIA

Oblong M.O. Stamp

APPLICATION FOR PURCHASE OF NATIONAL SAVINGS CERTIFICATES (VIII ISSUE)

/ To,

/ The Postmaster................................................. Post Office

/ Serial No...........

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 Shri/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)

Delete whichever is not applicable	Signature of investor/messenger/authorised agent / Date ...........................................................