FORM - 1
[See sub-paragraph (1) of paragraph 3]
(Application for opening an account)
To,
Paste photograph of
applicant/s
The Postmaster/Manager
…………………………………………………
…………………………………………………
Sir,
I ……………………………. (account holder/guardian) hereby apply for opening of an account under
Public Provident Fund Scheme.
I tender herewith Rs .................................
(Rs…………………………………………………………………………….) in cash/Cheque/DD.
No………………… date……………. as initial deposit. My particulars are as under:-
1. Name of account holder
……………………………………………………………
Husband/Father /mother’s name
……………………………………………………………
Date of Birth ……… ..……… ………………
(DD / MM / YYYY)
(In words)……………………………………………………
OR
2. Name of minor account holder
……………………………………………………………
Father /mother’s name or the guardian
……………………………………………………………
Date of Birth ……… ..……… ………………
(DD / MM / YYYY)
(In words)……………………………………………
3. Aadhaar Number of account holder/guardian
…………………………………………………………..
4. Permanent Account Number (PAN) of account holder /guardian
…………………………………………………………..
5. Present Address ………………………………………………………….
…………………………………………………………..
Permanent Address ………………………………………………………….
………………………………………………………….
6. Contact details Telephone Number……………………………..
Mobile Number…………………………………
Email ID…………………………………………
7. Type of Account Single or through Guardian for Minor or
person of unsound mind or blind or differently
abled through authorized person.
8. (*) Details of date of birth proof
……………………………………………………….
(Applicable in case of minor account)
d) Certificate No.
……………………………………………………………………..
e) Date of Issue
…………………………………………………………………….
f) Issuing authority
…………………………………………………………………….
9. (*) Name of Guardian (Natural/Legal)
…………………………………………………………
(In case the account is opened on behalf of a Minor/person of unsound mind)
10. Details of other KYC documents attached 1. Proof of identification
…………………………………………………….
2. Address proof
(The following documents are accepted as valid documents for the purpose of identification and
address proof:
1. Passport 2. Driving license 3. Voter’s ID card 4. Job card issued by NREGA signed by the State
Government officer 5. Letter issued by the National Population Register containing details of name
and address); ………………………………………………………
11. The operation of the account will be:- (a) By the Guardian till the account holder attains
majority. (b) By the account holder on attaining majority,
12. Specimen Signatures
1………………………… 2……………………………. 3..……………………………
(Name)………………… Name……………………………. Name ……………….............
I hereby declare that I have not opened a Public Provident Fund Account in the name of myself/minor
mentioned at serial number 1 in any of the Post office/Bank in the country.
I further declare that I will abide by the ceiling of maximum deposit in the accounts opened in my name
and in the name of minors as per provision of paragraph 4 and any deposit in excess of the ceiling will
be treated as in contravention to the Scheme.
I further declare that I and the minor both are Resident citizen of India and undertake to inform the
account office of any change in our residency/citizenship status in future.
I hereby undertake to abide by the scheme provisions and Government Savings Promotion rules-2018
applicable on the Scheme and amendments issued thereto from time to time.
Signature or thumb impression of account holder /guardian
Date:……………………
Nomination
13. I hereby nominate the person(s) mentioned below to whom to the exclusion of all the persons
in the event of my death the amount standing to my credit at the time of my death would be payable.
S.No. Name(s) of the Full address (s) Aadhaar Date of birth Share of Nature of
nominee(s) and number of of nominee in entitlement entitlement
relationship nominee case of minor Trustee or
(optional) owner
1
2
3
4
As the nominee(s) at Serial No.(s) specified above is/are minor(s), I appoint Shri
/Smt/Kumari………………………………………………..S/o,D/o,W/o………………………………
…………………………………………..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 & Address……………………………………………..
Signature of witness…………………………………….
Name & Address……………………………………………..
Signature or thumb impression of account holder or guardian
Place:
Date:
For use of Post Office/Bank
The account has been opened in the name of…………………………………on …………………..
with initial deposit of Rs ………………… with Account No. dated ……………
Customer identification Number………………………………..
Nomination has been registered vide No………………………………………………….…………..
dated………………………………………..
Signature and seal of competent authority
