Department of Posts

APPLICATION FOR AVAILING OF THE FACILITY OF CHEQUE SYSTEM

                                                                                                                                                                                              Date..........................

To,
The Post Office Savings Bank

.....................................Post Office

Please permit me/us to avail of the facility of the cheque system and issue a cheque book for my/our Savings Bank Account No................................................ standing open at your office with a balance of Rs................................

2. I/we hereby declare that I/we have read the conditions governing the facility of cheque system in the Post Office Savings Bank Accounts as laid down in Rule 28-A of the Post Office Savings Bank Rules 1881 and that I/we accept all the aforesaid conditions, and such amendments thereto as may be issued from time to time, as binding upon me/us.

Name(s) of Depositor(s) (in block letters) ...........................................................................................................................................

....................................................................................................................................................................

*3. The cheque book should be sent to me by registered post at the following address :-

........................................................................................

........................................................................................

                                                                                                                                                                   ......................................................

                                                                                                                                                                     Signature(s) of Depositor(s)
* Delete if not applicable

CERTIFICATE OF INTRODUCTION

I...........................................................................................................................................do hereby certify that ............................................................................................................................................................ the depositor(s) of Post Office Savings Bank Account No. ...........................................standing open at.............................................Post Office is / are known to me and has/have signed this application in my presence.

Introduction accepted                                                                  ........................................................

..........................................................                                                    Signature of introducer

Signature with date of postmaster                                             Address (with A/c No. if he is a SB Depositor)

                                                                                                              ....................................................................