FORM -1
Application for opening an account
To
The Postmaster/Manager
…………………………………………………
………………………………………………… Paste photograph of applicant/s
Sir,
I/We ………………………..(Applicant/s) hereby apply for opening of an account under Senior Citizen
Savings Scheme in your Post Office/Bank.
I/We tender herewith Rs……………………../-
(Rs…………………………………………………………………………….) in cash/Cheque/DD.
No………………… date………. as initial deposit. My/our particulars are as under:-
1. Name of First Account holder
……………………………………………………………
Husband/Father /mother’s name or Guardian appointed by Court
……………………………………………………………
Date of Birth ……… ..……… ………………
(DD / MM / YYYY )
(In words)……………………………………………
2. Name of Second Account holder (spouse only)
……………………………………………………………
Husband/Father /mother’s name
……………………………………………………………
Date of Birth ……… ..……… ………………
(DD / MM / YYYY )
(In words)……………………………………………
3. Aadhar Number (a) of first account holder
(b) of second account holder
…………………………………………………………..
4. Permanent Account Number (PAN) (a) of first account holder
(b) of second account holder
…………………………………………………………..
5. Present Address ………………………………………………………….
…………………………………………………………..
Permanent Address ………………………………………………………….
………………………………………………………….
6. Contact details Telephone Number……………………………..
Mobile Number…………………………………..
Email ID……………………………………………..
7. Type of Account Single or Joint
8. Details of proof of date of Birth of account holder/s
……………………………………………………….
a) Certificate No.
……………………………………………………………………..
b) Date of Issue
…………………………………………………………………….
c) Issuing authority
…………………………………………………………………….
9. Details of other KYC documents attached 1. Proof of identification
…………………………………………………………
2. Address proof
…………………………………………………………
(The following documents are accepted as officially valid documents for the purpose of identification and
address proof: 1. Passport 2. Driving license 3. Voter’s IDcard 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;
1. Specimen Signatures
1…………………………2……………………………. 3.,……………………………
(Name)…………………………………………………………
1…………………………2……………………………. 3.,……………………………
(Name)…………………………………………………………
I declare that I/we 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.
Details of my/our other accounts under the Scheme are as under:
S.No. Name of Scheme Date of Amount Customer Account Name of
opening of deposited Identification number Post
account Number office/Bank
1. Senior Citizen
Savings Scheme
(SCSS)
Signature or thumb impression of guardian
Date:……………………
Nomination
10. I/we…………………………………………..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
……………………………………..(Name of Scheme) 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
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).
1. Signature of witness…………………………………….
Name & Address……………………………………………..
2. Signature of witness…………………………………….
Name & Address……………………………………………..
Signature or thumb impression of account holder/s
Place:
Date:
For use of Post Office/Bank
The account has been opened in the name of…………………………………on……………………..with
initial deposit of Rs……………………………………….under……………………………………………..(name of
the scheme) vide Account No.__________________________ dated______________________________.
Customer identification Number………………………………..
Nomination has been registered vide
No……………………………………..dated………………………………………..
Signature and seal of competent authority.
