The document is a nomination form for a Public Provident Fund account, allowing the account holder to nominate one or more individuals to receive the funds in the account in the event of the account holder's death. It requests information about the nominee such as their name, address, date of birth, and proportion of funds to be received. The form also allows for the appointment of a guardian to receive the funds if the nominee is a minor at the time of the account holder's death.

1. FORM E
[See sub paragraph (1) of paragraph 12]
Nomination under the Public Provident Fund Scheme, 1968
To
The Agent/Manager
State Bank …………………..
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.
Name(s) of Full address(es) Date of birth Proportionate
Serial No the of nominee(s) amount for each
nominee(s) in case of nominee
minor
* As the nominee(s) at Serial No.(s) ………………………. specified above is/are minor(s), I
appoint Sri/Smt/Kumari ………………………………. 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 : Signature/Thumb impression of
Subscriber
Name and address :
Date
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TO BE USED BY THE ACCOUNTS OFFICE
The above nomination has been registered on ……………………………… and an entry
made in the Passbook.
Date …………………… Signature of Accounts Officer
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* Delete if not applicable