FORM B
[See sub-paragraphs (2), (3) and (7) of paragraph 7]

[Name of the Deposit Office]
Serial No.

Application for conversion of accounts under the Capital Gains Accounts Scheme, 1988
To
The Manager
[Name and address of the Deposit Office]
I, [Name of the applicant/ depositor], hereby
apply for transfer of the principal amount of Rs.[in figures] (Rs.) [in words] together with the amount of interest accrued in account-B No. (Deposit Receipt No.) maintained with your office in my name/ the name of [Name and address of the depositor]
1. (a) To account-A No. , Pass book No.
maintained with your office in my name/ the name of the aforesaid depositor ;
(b) To a new account-A which may please be opened in my name/ in the name of aforesaid depositor.
I submit herewith the aforesaid Deposit Receipt No. (for the purpose of
transfer of said amount to afores aid account -A which is maintained with your office/ which is to be opened.
2. (i) Opening a new account-B in my name/ in the name of
[Name and address of the depositor] for a period of days/month/year with effect from [date] and to transfer the sum of Rs. [in figures] (Rupees ) [in words] to the credit in such new account-B, out of the balance standing to the credit in account-A No. (Pass book No.), maintained with your office in my name/ in the name of the said depositor
[Name of the depositor]
(ii) I submit herewith the aforesaid pass book No. for the purpose of transfer of
said amount to a new account -B.
3. The application is made by me as guardian on behalf of afores aid [Name of
the depositor] who is a minor.
4. The application is made by me as karta of the aforesaid Hindu
undivided family.
5. The application is made by me as authorised officer of the aforesaid firm /
company/ association of persons/ body of individuals.
Signature/Thumb impression of the Depositor/the
Guardian/Karta/ Authorised Officer of the Depositor
Date : .
Place : . Additional specimen
FOR THE USE OF DEPOSIT OFFICE
1. The deposit in aforesaid account-B No. Deposit Receipt No. has
been allowed to be withdrawn before maturity/ on maturity/ after maturity and total sum of principal
amount Rs. [in figures] (Rupees) [in words] and sum of Rs.
[in figures] (Rupees) [in words] of interest accrued in said account-B No
has been transferred on [date] to account-A No. a pass book No.
which is already maintained/ which has been opened on [date], in the name of the aforesaid depositor and the pass book No. of the newly
opened account-A No. has been delivered on [date] to the above mentioned
applicant/ depositor.
2. A new account-B No. deposit receipt No. for sum of Rs.
[in figures] (Rupees ) [in words] has been opened on [date] for a
period of days/month/year/s in the name of aforesaid depositor
[Name of the depositor] and the sum of Rs. [in figures] (Rupees )
[in words] has been transferred to said new account-B No. on [date]
out of the balance standing to the credit in the aforesaid account-A No of the said
depositor.
Date : . Officer-in-charge
Notes:
1. Score out whichever is not applicable.
2. If space provided in a column or columns is not sufficient to furnish the requisite details, same may be furnished by way of using separate enclosure and referring the same under the respective column.