D E P A R T M E N T O F P O S T S – I N D I A

APPLICATION FOR CANCELLATION OR VARIATION OF NOMINATION PREVIOUSLY MADE IN RESPECT OF POST OFFICE SAVINGS BANK ACCOUNT 				 UNDER GOVERNMENT SAVINGS BANK ACT, 1959.

(In the case of an account which stands in the books of a Sub Post office an application may be made through the Sub or Branch Post office)

To,

The Post Master 						

Under provisions of section 3(1) of the Govt. Savings Bank Amendment act, 1959.  I 					 the depositor of Post Office Savings Bank Account No. 		 here by cancel the nomination dated 			 in favour of 			 made by me in respect of the aforesaid account.

In place of the cancelled nomination, I hereby nominate the person(s) mentioned below who shall in the event of my death before the closure of the above account shall be entitled to the payment of sum due on the above account to under mention of all other persons.  The passbook is enclosed.

Sl. No.	Name of the Nominee	Full Address	Date of Birth of nominee
(in case of minor)	

As the nominee(s) at serial No(s) 				 is/are minor(s) I appoint Sri 			    							                   	(name and full address) as the person to receive the sum due on the savings bank account on the event of my death during the minority of the nominee(s).

Address:									yours faithfully,

									(Signature of the depositor)
Witness:
(1)

(2)

Orders of Post Master accepting the nomination:
Date stamp
	
							Signature of Head Post Master.