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.
Serial No
Name(s) of
the
nominee(s)
Full address(es)
Date of birth
of nominee(s)
in case of
minor
Proportionate
amount for each
nominee
* 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