The document is an application form for purchasing National Savings Certificates (VIII Issue) from the Department of Post, India. [1] It requests the purchase of the certificates in single/joint name using cash/cheque. [2] It also contains fields for nominating individuals to receive the funds in the event of the applicant's death. [3] The applicant agrees to abide by the rules governing the certificates. [4] The completed form can be submitted by the applicant, agent or messenger.

1. Hkkjrh; Mkd foHkkx
DEPARTMENT OF POST INDIA
jk"Vªh; cpr&i= ¼vkBoka fuxZe½ ds Ø; ds fy, vkosnu i=
APPLICATION FOR PURCHASE OF NATIONAL SAVINGS CERTIFICATES (VIII ISSUE)
lsok es/ To,
iksLVekLVj / The Postmaster..................................Mkd?kj / The Post................. Øe la[;k/ Serial No............................
1. eS@ge ,dy@la;qDr d@ la;qDr [k ----------------------------------------------------------- izdkj ds jk"Vªh; cpr&i= ¼vkBoka fuxZe½ ds Ø; ds fy,
udn@pSd la[;k ------------------------------ }kjk -------------------------------- #ñ ¼dsoy ---------------------------------- :i;s½ fufonr djrk g¡w@djrs gSaA
I/We hereby tender Rs.................................... (Rupees ................................................................. only) in cash/ by
Cheque No....................................... for purchase of National Savings Certificate (VIII Issue) of the type Single/JointA/ Joint B.
¼d½ ds uke ¼ukeksa esa½----------------------------------------------------------------------------- vkSj ---------------------------------------------------------
(a) In the name(s) of .......................................................................... and ..........................................................
¼[k½ vo;Ld dh n'kk esa] ftldh tUe dh rkjh[k ------------------------------------------------------ gS tks vo;LD ds ekrk ;k firk@laj{kd
Jh@Jherh --------------------------- }kjk Hkquk;k tk ldsxkA
(b) In case of minor, his date of birth .................................................................. encashable by the minor’s parent/
guardian Shri/Smt..........................................................
2- eSa@ge fuUufyf[kr O;fDr ¼O;fDr;ksa½ dks ukefunsZf'kr djrk g¡w@djrs gSa] tks esjh@gekjh e`R;q ij lank; izkIr djsxk@djsaxsA
I/We nominate the persons (s) named below who shall, on my/our death, receive payment.
Øe lañ ukefunsZf'krh dk uke iwjk irk vo;Ld ukefunsZf'krh ds tUe dh rkjh[k
Sl. No. Name of Nominee Full Address Date of birth of minor nomine
1 2 3 4
3- eSa@ge jk"Vªh; cpr&i= ¼vkBoka fuxZe½ fu;e] 1989 dk ikyu djus ds fy, djkj djrk g¡w@djrs gSaA
I/We hereby agree to abide by National Saving Certificates (VIII Issue) Rules, 1989,
4- i= esjs@gekjs vfHkdrkZ---------------------------------------- izkf/kdkj la[;k ---------------------------- ;k lans'kokgd dks] tks
bl vkosnu dks izLrqr djrk gS] ns fn;k tk,A
The Certificates may be made over to my/our agent/Shri Smt...................................................................................
Authority No. ........................................... or messenger who present the application.
fofu/kkudrkZ ds gLRk{kj@vaxwBs dk fu'kku
Signature/thumb Impression of Investor
rkjh[k/Date .............. .............................
irk/ Address .......... ........ .....................
............................. ......... ...................
.............................. .......... .................
ukefunsZ'ku ds lk{kh ds gLRk{kj vkSj irk%
Signature and address of witness to nomination:
...................................................... i= izkIr fd,
................................................... Recieved the certificate (s)
fofu/kkudrkZ @lans'kokgd@izkf/kd`r vfHkdrkZ ds gLRk{kj
tks ykxw u gks mls dkV nsaA Signature of investor/messenger/authorised agent
Delete whichever is not applicable. rkjh[k/Date .......................................................

2. Mkd?kj }kjk Hkjs tkus ds fy,
TO BE COMPLETED BY THE POST OFFICE
i= dh Øe lañ fuxZe ewY; Hkquk, tkus dh rkjh[kk iksLVekLVj ds izkfIr lkf{k fVIi.kh;kW] tSls varj.k]
Sl. No. Issue Price Date of encashment iz k {kj nwljh izfr dk tkjh fd;k tkuk vkfn
Certificates Initial fo the Remarks like transfer, issue
:ñ/Rs. Postmaster of duplicate etc. with initials
1 2 3 4 5
;ksx/Total
rkjh[k/Date ......................................... iksLVekLVj ds gLrk{kj
Signature of Postmaster