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

60FORM-D(See sub-rule (1) of rule 3 and rule 10)Serial No…………………..Pay – in – slip for deposits under Senior Citizens Savings Scheme, 2004Counterfoil (1)Depositor’s copyName of Deposit Office……………………Name of depositor………………………….Address:Father’s/Husband’s Name:Counterfoil (2)Deposit Office’s copyName of Deposit Office………………….Name of depositor………………………….Address:Father’s / Husband’s Name:*Name of Agent (in case of accountintroduced through agent) with agency codeNo., date andvalidity………………………………………………………………………………………..Account No…………. Date………………(to be filled in by deposit office)Ledger Folio……………….(to be filled by deposit office)*Name of Agent (in case of account introducedthrough agent) with agency code No., date andvalidity………………………………………………………………………………………..Account No……….. …….Date……………(to be filled in by deposit office)Ledger Folio……………….(to be filled by deposit office)Amount of Deposit (Rs.)# Amount of Deposit (Rs.)#Cheque/Demand DraftCheque/Demand Draftrealisation charges (Rs.)##realisation charges (Rs.)##Account Transfer Fee (Rs.)#Account Transfer Fee (Rs.)#Fee for issue of Duplicate Pass Book Fee for issue of Duplicate Pass Book(Rs.)##(Rs.)##Other charges, if any. (Rs.)##Other charges, if any. (Rs.)##TOTAL AMOUNT (Rs.) TOTAL AMOUNT (Rs.)Total Amount in words [Rupees………………………………………..…………………….)Details of CASHDEPOSIT:1000 x 1000 x500 x 500 x100 x 100 x50 x 50 x20 x 20 x10 x 10 x05 x 05 x02 x 02 xTOTAL (CASH):Cheque /Demand Draft No. and date:…………………………………..Bank / Branch on which drawn:Total Amount in words (Rupees……………….….…………………………………………………….)Amount Details of CASH DEPOSIT: AmountTOTAL (CASH):Cheque /Demand Draft No. and date:……………………………………….Bank / Branch on which drawn:…………………………………………..AMOUNT (RUPEES):By (Depositor’s signature)…………………………………………………AMOUNT (RUPEES):By (Depositor’s signature)