(FORM – B)
[See Para 11(i)]

% RELIEF BONDS FORM OF NOMINATION

I,
( NAME AND ADDRESS )
THE HOLDER OF BOND LEDGER ACCOUNT NO:
NOMINATE THE FOLLOWING PERSON/S WHO SHALL ON MY DEATH HAVE THE RIGHT TO THE
BOND / RECEIVE PAYMENT OF THE AMOUNT FOR THE TIME BEING DUE ON THE BOND
SPECIFIED BELOW :
PARTICULARS OF NOMINEE
DATE OF ISSUE AMOUNT
Rs.
DATE OF REPAYMENT
FULL NAME WITH
EXPANDED
INITIALS AND
ADDRESS OF
NOMINEE
DATE
OF
BIRTH
RELATIONSHIP
TO
HOLDER
PARTICULARS
OF BANK
ACCOUNT
$ AS ……………………….. THE SOLE NOMINEE ABOVE IS A MINOR ON THIS DATE, I
APPOINT SHRI / SMT. / KUM.
…………………………………………………………………………… TO RECEIVE THE
AMOUNT FOR THE TIME BEING DUE ON THE ABOVE BOND IN THE EVENT OF MY
DEATH DURING THE MINORITY OF THE SAID NOMINEE $$ ………….
+ THE NOMINATION IS IN SUBSTITUTION OF THE NOMINATION DATED …………………..
MADE BY ME AND REGISTERED ON YOUR BOOKS AT …………… WHICH SHALL
STAND CANCELLED ON REGISTRATION OF THIS NOMINATION.
@ TO BE FILLED IN BY THE BANK OPENING THE ACCOUNT
_________________________________________
( SIGNATURE / THUMB IMPRESSION OF HOLDER )
PLACE:
DATE :
@
- 2 -
SIGNATURE WITH NAME AND ADDRESS OF WITNESS :
1.
___________________________________________________
2.
___________________________________________________
$ TO BE FILLED IN, IF NOMINEE IS A MINOR
$$ NAME OF NOMINEE (MINOR)
+ THE PARA MAY BE STRUCK OUT IF THE NOMINATION IS NOT IN SUBSTITUTION OF THE
ONE ALREADY MADE.