Form-C Application For Nomination/change/cancellation Of Nomination Under Senior Citizens Savings Scheme, 2004
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1FORM-C
(See rule 6)
APPLICATION FOR NOMINATION/CHANGE/CANCELLATION OF NOMINATION
UNDER SENIOR CITIZENS SAVINGS SCHEME, 2004
To,
The Chief / Branch Manager
State Bank of India
____________________
____________________
Sir / Madam
1. I nominate the following person / persons, mentioned below, to whom, to the exclusion of all other
persons, in the event of my death the amount standing to my credit in the account would be
payable in accordance with the provisions contained in rule 6:
TABLE
Name(s) of the
Date(s) of birth of
Share of the
Sl.
nominee(s) along with
nominee(s) in case
nominee(s)
Permanent Address
No.
relationship with the
of a minor/ age in
in amount
depositor
other case(s)
payable.
Signature/Thumb impression of the
Photograph(s) of the Nominee(s)
Nominee(s)
2. * As the Nominee(s) at Serial No.(s) _____ above is/are minor(s), I appoint Shri / Smt. / Kumari
__________________________________________________________ [Name(s) with Permanent
Address(es) of the person(s) in respect of each minor nominee] to receive the sum due under the
said account in the event of my death during the minority of the nominee(s).
3. * This is in supersession of the nomination(s), made by me earlier at the time of opening of
account/vide my application dated ___/___/20___.
4. * I __________________________, hereby request to cancel the nomination made by me earlier
vide my application dated ___/___/20___.
Witnesses(Signature, name and address):
Signature/Thumb impression of the Depositor(s)
1)
_______________________________
2)
_____________________________
_______________________________
_____________________________
Date
: ____/___/20___
At (Place) ____________________
*Score out whichever is not applicable.
**********************************************************************************
FOR THE USE OF BRANCH
The above nomination has been registered on ___/___/20__ AND/OR the earlier nomination dated
__/___/20__ has been Changed/Cancelled. Necessary entries have been made in the Pass Book No __
Date
: ___/___/20___
(Branch / Service Manager)
SBI FORMS BY 4577825
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