P.O. S.B. Manual Vol. III - India Post

92TO BE COMPLETED BY THE POST OFFICESerial No. ofcertificatesTotalDateIssue priceRs.Date ofencashmentInitials of thePostmasterRemarks liketransfer, issue ofduplicate etc. withinitialsSignature of PostmasterFORM A1 (COLOURED)[See Rule 7(1)]FORM OF APPLICATION FOR PURCHASE OF KISAN VIKAS PATRA(BYINVESTMENT THROUGH AGENTS)ToThe Postmaster…………………………………….. Post officeSerial No……………………I/We hereby tender Rs…………………….(Rupees…………………………… only) in cash/bycheque No…………………………………… for the purchase of Kisan Vikas Patra of the typesingle/Joint A/Joint B.a) In the name(s)……………………….and ……………………….b) In the case of minor, his date of birth……………………encashable by the minor’s parent/guardian Shri/Smt ……….c) Agent’s name ……………………………..d) Certificate of Authority No……………………..2. I/We nominate the persons named below, who shall, on my/our death, receivepayment :Sl No Name of the nominee Full address Date of birth ofminor nominee3. I/We hereby agree to abide by the Kisan Vikas Patra Rules, 1988.4. The Certificate/Identity slip may be made over to my/our agent Authority No……………….. ormessenger who presents this application.Signature & address ofWitness to nominationDelete whichever is not applicable.Signature/thumb impression of investorDate……………………………..Address………………………………Received the certificate(s) & identity Slip……………………………………………..Signature of Investor /Messenger/Authorised agentDate :_______________________