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FORM - D

 

FORM - D

(See sub-rule (1) of rule 3 rule 10)

 

(See sub-rule (1) of rule 3 rule 10)

Serial No.........................

 

Serial No.........................

PAY - IN SLIP FOR DEPOSITS

 

PAY - IN SLIP FOR DEPOSITS

UNDER SENIOR CITIZENS SAVINGS SCHEME, 2004

 

UNDER SENIOR CITIZENS SAVINGS SCHEME, 2004

Counterfoil (1)

 

Counterfoil (2)

Depositor's copy

Deposit     Office's copy

Name of  Deposit Office Name of  Deposit Office
Name of depositor.......................................
Address :
 
Name of depositor.......................................
Address :
 
Father's /Husband's name : Father's /Husband's name :
 *Name of Agent (in case of account introduced through
  agent) with agency code No., date and validity........... ................................................................................
*Name of Agent (in case of account introduced through agent) with agency code No., date and validity .......... .................................................................
 Account No......................Date............................
 (to be filled in by deposit office)
Account  No.....................Date................................
(to be filled in by deposit office)
 Ledger Folio..................(to be filled by deposit office) Ledger Folio........................(to be filled by deposit office)
     
 Amount of Deposit             (Rs.) #   Amount of Deposit            (Rs.) #  
 Cheque/Demand Draft
 realisation charges              (Rs.) ##
  Cheque/Demand Draft
realisation charges              (Rs.) ##
 Account Transfer Fee         (Rs.) #   Account Transfer Fee         (Rs.) #
 Fee for issue of Duplicate Pass Book(Rs.) ##   Fee for issue of Duplicate Pass Book  (Rs.) ##
 Other charges, if any.    (Rs.) ##   Other charges, if any.    (Rs.) ##
 TOTAL AMOUNT  (Rs.)   TOTAL AMOUNT  (Rs.)
 Total amount in words 
 (Rupees..............................................
 ..................................)
  Total amount in words (Rupees....................................................
...................................)
 Details of CASH DEPOSIT:

AMOUNT

Details of CASH DEPOSIT:

AMOUNT

 1000       x   1000       x
  500       x     500       x
  100       x     100       x
    50       x       50       x
    20       x       20       x
    10       x       10       x
    05       x       05       x
    02       x       02       x
    01       x       01       x
 COINS   COINS
 TOTAL (CASH):   TOTAL (CASH):

 Cheque/Demand Draft No. and date:
.......................................................

 

Cheque/Demand Draft No. and date:
.......................................................

 Bank / Branch on which drawn:
......................................................
  Bank / Branch on which drawn:
......................................................
 AMOUNT (RUPEES) :   AMOUNT (RUPEES) :
 By (Depositor's signature)   By (Depositor's signature)  

 

   Continued from prepage........................   Continued from prepage........................
TO BE COMPLETED BY DEPOSIT OFFICE

TO BE COMPLETED BY DEPOSIT OFFICE

   Head of  Government  Account  (to be entered by
   Deposit Office) # / # #.............................................
   ................................................................................
Head of  Government  Account  (to be entered by
   Deposit Office) # / # #.............................................
   ................................................................................

  Received Rs. .................... (Rupees..........................
  .................................................................................)
  as detailed hereinabove. For deposit in Account  No............................................
    *Agent's Commission at the rate of .......... per cent of deposit amounting to Rs................................
  (Rupees...........................................................................
   ......................................) # # # has been paid at source (under receipt).

Cashier's scroll No............................

Received Rs. .........................(Rupees...............................
........................................................................................)

as detailed hereinabove. For deposit in Account
  No...............................................
 
  *Agent's Commission at the rate of .................. per cent of deposit amounting to Rs................................
  (Rupees...........................................................................
   ...........................................) # # # has been paid source (under receipt).

Cashier's scroll No............................

Signature of Cashier  
(with name and office seal)  


Supervisor / Incharge   
of deposit office alongwith office seal   

Signature of Cashier   
(with name and office seal)   


Supervisor / Incharge   
of deposit office alongwith office seal   

    Note :  1.  the cheque / demand draft should be in favour of the Deposit Office, or in favour of the depositor duly endorsed in favour of the deposit office.
   2.  Cheques / demand drafts are subject to realisation
    of the proceeds.

  * score out if not applicable 
  # : In respect of Deposits :- Major Head: 8001 -
 
National Savings Deposits.

  # # : In respect of various charges :- Major Head
  8008
-   Income and Expenditure of NSSF.00.104.
  Other Incomes

    # # : In respect of agency commission to agents:
    Major Head : 8008 -
Income and Expenditure of
    NSSF.03.104.

   Note :  1.  the cheque / demand draft should be in favour
   of the Deposit Office, or in favour of the depositor duly
   endorsed in favour of the deposit office.
   2.  Cheques / demand drafts are subject to realisation
    of the proceeds.

  * score out if not applicable 
  # : In respect of Deposits :- Major Head: 8001 -
 
National Savings Deposits.

  # # : In respect of various charges :- Major Head
  8008
- Income and Expenditure of NSSF.00.104.
   Other Incomes

    # # : In respect of agency commission to agents:
    Major Head : 8008 -
Income and Expenditure of
    NSSF.03.104.