FORM A ANNEXURE-I
(See subparagraph (I) of Paragraph 4)
Serial……………………………………….…
Bank/Post Office ……………………………
APPLICATION FOR OPENING A PUBLIC PROVIDENT FUND
ACCOUNT UNDER THE PUBLIC PROVIDENT FUND SCHEME – 1968.
To ………………………………………
………………………………………
(Name of the Bank/Post Office)
I, …………….……………………………………………………………………..……….…….hereby apply for
Opening an account under the Public Provident Fund Scheme, 1968, in my name/in the name of
Kumar/Kumari …………………………………………………….of whom I am the guardian and tender
herewith Rs. …………………………….(Rupees …………………………………..) in cash/cheque as the
initial subscription. Permanent address of subscriber/guardian ……………………………………………
………………………………………………………………………………………………………………………
I agree to abide by the provisions of the Public Provident Fund Scheme, 1968, and amendments
issued thereto from time to time.
ACCOUNT IN THE NAME OF MINOR
Date of Birth of Minor …………………………………………………………………………………………….
Applicant’s relationship with minor, if any ……………………………………………………………………...
*(i) I hereby declare that I am not maintaining any other Public Provident Fund Account.
*(ii) I hereby declare that I am not maintaining any other Public Provident Fund Account except an
account on behalf of a minor or an account for getting the benefit for Hindu Undivided Family under section
80C(2)(b)(i)(2) of the income-tax Act, 1961 (43 of 1961).
Date ………………… Signature or thumb impression
of subscriber/guardian
Additional Specimen
…….………………………..
...........................................
_____________________________________________________________________________________
Note 1: Under the Public Provident Fund Scheme normally and individual can have an account on his
own behalf or on behalf of minor of whom he is the guardian. However, an individual who is a
member of a Hindu Undivided Family can open another account for contributions to the Fund
on behalf of and out the income of the Hindu Undivided Family. In the latter case, the letters
“H.U.F” should be added after the name of the subscriber.
Note 2: *Delete whichever is not applicable.
_____________________________________________________________________________________
FOR THE USE OF ACCOUNTS OFFICE
The account has been opened on ……………………with Rs………………………..under
Public Provident Fund Account No. ………………
Pass Book No. ………………………………… has been issued
Date : …………………..
Accounts Officer.
PPF FORM E ANNEXURE-III
PPF FORM E FOR NOMINATION UNDER THE PUBLIC PROVIDENT FUND SCHEME, 1968
State Bank of India…………………………
……………………………………………….
To
The Branch Manager ………………………………..
State Bank of India …………………………………..
……………………………………………………….…
I, ……………………………………………………………………………………………………….……............
..……………………………………………………………………………………………….………hereby nominate
the person (s) 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 Public Provident Fund Account No. ………………..….at
the time of my death would be payable.
_____________________________________________________________________________________
Serial No. Name (s) of the Full Address (es) Date of Birth of Nominee
Proportionate
Nomination (s) in case of minor
amount for
each nominee
_____________________________________________________________________________________
_____________________________________________________________________________________
*As the nominee(s) at Serial No. (s)…..………………………………………………………specified above
is/are minor(s) I appoint Shri ……………………………………………………………………….…………………
Address …………………………………………………………………………………………………………………
………………………………………………………………..……….……..to receive the sum due under the said
account in the event of my death during the minority of the nominee(s).
Signature of witness :
Name and address :
Date :
Signature of witness :
Name and address :
Date : Signature or Thumb Impression
of Subscriber.
_____________________________________________________________________________________
FOR THE USE OF ACCOUNT OFFICE
The above nomination has been registered on …………………………………………………...........…and
entry made in the Pass Book.
Date : ………………….
*Delete it not applicable Signature of Account Officer
PPF FORM F ANNEXURE-IV
State Bank of India ………………………………….
APPLICATION FOR CANCELLATION OR VARIATION OF NOMINATION PREVIOUSLY
MADE IN RESPECT OF ACCOUNT NO. ………………………………..UNDER
PUBLIC PROVIDENT FUND SCHEME, 1968
Date : ……………………
To
The State Bank of India …………………………..
……………………………………………………….
I, ………………………………………………………………………………………………….………………….
……………………………………………………………………………………………………………………………
the subscriber in Public Provident Fund Account No. ……………………………………………………….……..
hereby cancel the nomination dated …………………………………………………………………………………
made by me in respect of the aforesaid Public Provident Fund Account.
*In place of the cancelled nomination, I hereby nominate the person(s) mentioned below who shall, on
my death become entitled to the payment of the sum due on the above account to the exclusion of all other
persons.
_____________________________________________________________________________________
Serial No.Name (s) of the Full Address (es) Date of Birth of Nominee Proportionate
Nomination (s) in case he/she is a minor amount for each nominee
_____________________________________________________________________________________
_____________________________________________________________________________________
*To be filled in case of variation only
*As the nominee(s) at Serial No. ……………………………………………………………………………...is/
are minor(s) I appoint Shri/Shrimanti/Kumari ……………………………………………………………………….
(name and full address)
……………………………………………………………………………..…………………as the person to receive
the sum due on the above account in the event of my death during the minority of the nominee(s).
*Delete if not applicable
Subscriber’s Address Signature or Thumb impression of Subscriber.
(1) Signature of Witness : (2) Signature of Witness : Name :
Name : Name :
Address : Address :
_____________________________________________________________________________________
FOR THE USE OF ACCOUNTS OFFICE
The above cancellation/variation of the nomination has been registered in the ledger and entered in
the Pass Book.
Date : ……………………. Signature of the Accounts Officer.
FORM D ANNEXURE-V
(See Paragraph 10)
APPLICATION FOR A LOAN UNDER
THE PUBLIC PROVIDENT FUND SCHEME, 1968.
To The Agent/Manager,
State Bank of ________________
___________________________
Sir,
I wish to take a loan from Public Provident Fund Account No. ……………………………….of a sum of
Rs. ………………………………………………………………………………………) which I undertake to repay
with interest within the period of thirty six months as prescribed in paragraph 11 of the Public Provident
Fund Scheme, 1968,
2. I has taken a loan of ……………..(Rupees ….……………………………………………………….)
on …………………..(date), which has been repaid in full with interest on …………………(date).
*3. Certified that the amount for which loan is applied for is required for the use of .……………….
………………………..which is alive and is still a minor.
4. The pass book is enclosed.
Date : ……………………. Signature or thumb-impression of
Subscriber/Guardian
*To be given only when a loan is sought from a minor’s account.
_____________________________________________________________________________________
TO BE USED BY THE ACCOUNTS OFFICE
Date of initial subscription ________________________________________________________________
Amount available in the Public Provident Fund _______________________________________________
Account ______________________________________________________________________________
Amount available for loan in accordance with para 10 __________________________________________
of the Public Provident Fund Scheme ______________________________________________________
Amount of loan actually sanctioned ________________________________________________________
Date …………………… Signature of Accounts Officer
_____________________________________________________________________________________
Received a sum of Rs. _____________________(Rupees __________________________________
_______________) by way of loan from Provident Fund Account No. _____________________________
Date : ……………………. Signature or thumb-impression of
Subscriber/Guardian
FORM C ANNEXURE-VI
(See subparagraph (1) and (3) of Paragraph 9)
APPLICATION FORM FOR WITHDRAWAL UNDER THE PUBLIC
PROVIDENT FUND SCHEME, 1968.
To The Agent/Manager,
State Bank of _______________
__________________________
I wish to withdraw from Public Provident Fund Account No. ……………………….……………a sum of
Rs. …………………….(Rupees …………………………….) A period of …………………….years has expired
from the end of the year in which the initial subscription was made.
1A. I have not made any withdrawal in the currend year.
*2. Certified that the amount sought to be withdrawn in required for the use of ……………………..
. ……………….who is alive and is still a minor.
3. The Pass Book is enclosed.
Date : ………………… Signature or thumb-impression of
Subscriber/Guardian
*Score out whichever is not applicable.
_____________________________________________________________________________________
TO BE USED BY THE ACCOUNTS OFFICE
Account No. __________________________________________________________________________
Date of initial subscription ________________________________________________________________
Amount available in the Public ____________________________________________________________
Provident Fund Account _________________________________________________________________
Date of which last withdrawal was allowed ___________________________________________________
Amount available for withdrawal in accordance with para 9(1) 9(3) of the scheme ____________________
Withdrawal of a sum of Rs. ____________________________________________________sanctioned.
Date : ………………… Signature of Accounts Officer
Received a sum of Rs. _____________________(Rupees __________________________________
_________) by way of withdrawal from Provident Fund Account No. ______________________________
Date : ………………….. Signature or thumb-impression of
Subscriber/Guardian
PPF FORM G ANNEXURE-VIII
State Bank of India
APPLICATION FOR WITHDRAWAL BY NOMINEES/LEGAL HEIRS
UNDER THE PUBLIC PROVIDENT FUND SCHEME, 1968
To
The Branch Manager,
State Bank of India ………………………………
……………………………………………………..
I/We ………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………
the nominee(s) /legal heirs(s) of late …………………………………………………………………………………
wish to withdraw the entire amount standing to the credit of the deceased in the said accounts.
Please find enclosed :
(i) A certificate in regard to the death of the subscriber.
*(ii) Certificate in regard to the death of Shri/Shrimati/Kumari……………………………………………
..........................................................................................................................................................................
and Shri/Shrimanti/Kumari …………………………………………………………………………………………….
…………………………………………………………………………………………………………………………….
also the nominee(s) appointed by the subscriber.
*(iii) Succession certificate /Letters of Administration/attested copy of the probated will of the
deceased subscriber issued by ………………………….High Court.
(vi) Pass-Book of the Subscriber.
Place : ……………………..
Date : ……………………… Signature(s) or Thumb impression(s) of Claimant(s)
_____________________________________________________________________________________
FOR USE OF ACCOUNTS OFFICE
Withdrawal of Rs. ………………………….(Rupees ……………………………………………………………
…………………….) sanctioned.
Date : …………………………….. Accounts Officer
_____________________________________________________________________________________
RECEIPT TO BE SIGNED BY THE CLAIMANTS
Received the sum of Rs. …………………………(Rupees …………………………………………………
……………………….) from the State Bank of India ……………………….in full settlement of my/our claim.
Place : ………………….. STAMP
Date : ……………………. Signature(s) or Thumb impression(s) of Claimant(s)
_____________________________________________________________________________________
*Delete if not applicable
*Strike off if there is a valid nomination
ANNEXURE I to FORM G
(Letter of indemnity)
To
The manager/Post Master
____________________________
______________________(Name of the Bank/Head Post Office)
In consideration of your paying or agreeing to pay me/us …………………………………………………………
………………………………………(Names of Legal heirs) the sum of Rs. ………………………………………
standing in Public Provident Fund Account No. …………………………………….with your Bank in the name
of ..……………………………………………….without production of letters of administration or a succession
certificate to the estate of the deceased …………………………………………….(Name of the subscriber) or
a certificate from the Controller of Estate Duty to the effect that estate duty has been paid or will be paid or
none in due, I/We ……………………………………….and we …………………………………………(sureties)
do hereby for ourselves and our heirs, legal representatives, executors and administrators joinrly and
severally undertake and agree to indemnify you and your successors and assigns against all claims,
demands, proceedings, losses, damages, charges and expenses which may be raised against or incurred
by you by reason or in consequence of having agreed to pay/or paying me/us the sum as aforesaid.
In witness whereof we have hereunto set your hands ……..……………………………………..…..on this
……………………………………………..day of ………………………………in the presence of withnesses.
Signed and delivered by the above named
heir/heirs of the deceased
Signed and delivered by the
above named sureties
1.
2.
Names and addresses of witnesses :
1. Attested
2. Notary Public
ANNEXURE II to FORM G
(Affidavit)
To,
The Manager/Post Master,
____________________________
____________________(Name of the Bank/Head Post Office)
I/We ______________Husband of /wife of late ____________aged _____________aged__________
aged ___________ sons/daughters of the said late ___________resident of _________do hereby declare
and solemnly affirm as under :-
(1) That I/We am/are the only heir(s) of the deceased _______________who died at _______________
on ___________, I/We alone represent the estate of the Shri/Smt.
(2) That the deceased ______________did not leave any will and therefore I/We am /are the only
successor(s) to the estate of the said deceased.
1.
2.
3.
4.
DEPONETNS
VERIFICATION : I/We, the above-named deponents do hereby verify on solemn affirmation in __________
(name of place) that the contents of this affidavit are true to our knowledge and nothing material has been
concealed.
Dated : 1.
2.
3.
4.
Attested
Oath commissioner DEPONENTS
ANNEXURE III to FORM G
(Letter of diclaimer on Affidavit)
To,
The Manager/Post Master
________________________
_____________________(Name of the Bank/Head Post Office)
I/We, (i) _____________________________husband of/wife of __________________________________
_____________________________________________________________________________________
Residents of ___________________________(ii)____________________son of/daughter of __________
Do hereby solemnly affirm and declare as follows :-
(1) That Shri/Smt. _______________________________died intestated on ______________________
leaving behind us _____________________his only heirs _________________________________
(2) That we _____________heirs of our late father/mother for ourselves and on behalf of our heirs,
executor, representatives and assigns do hereby relinquish our claims to the balance of
Rs. ___________which may be credited to the account sought by our mother/father to be opened in
your Branch in the name of the estate of the said _______________deceased father/mother after
the realization of Draft No. ___________on ____________________________ issued by
________________ (name of Bank) and we have no objection whatsoever in the balance in the
above referred account No. _______________together with interest, if any accryed thereon being
paid by the Bank to our said mother/father Mrs./Mr. _______________________________
1.
2.
3.
DEPONENTS
VERIFICATION : We the above-named deponents do hereby verify on solemn affirmation that the contents
of this affidavit are true to our knowledge.
Dated ________________________ DEPONENTS
I identify the deponent who is personally
Known to me and who has signed in my presence.
Dated _________________________
ATTESTED
Oath Commissioner
(Annexure I to III to Form G added vide Ministry of Finance (DEA)
Notification No. F.3(6) – PD/86 dated 23-6-186)
