I /we nominate the person(s) named below under section 4 of the Government Savings Bank Act, 1873 (5 of 1873) to be sole recipient(s), in event of my/our death, of the amount standing at the credit of the account.

Name and address of nominee(s)	Date of birth	If nominee is minor, name and address of person who may receive the said amount during the minority of nominee
............................... ............................... ...............................	..................... ..................... .....................	.................................................................................. .................................................................................. .................................................................................

*
* The name(s) of nominee(s) may not be entered in the passbook.

/ Witness : Signature................ Name and address........................................  .............................................................................	Signature(s) or thumb impression(s) if   illiterate, of applicant(s)
* * Strike out if not required

7. /Specimen Signatures

/Account No.

Name 1. ............................... 2. ............................... 3. ..............................	.............................   ..............................   ..............................	/ Specimen Signature ...............................  ...............................  ..............................
Signature of Branch Postmaster	Signature of Sub-Postmaster	Signature of Postmaster