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Union of India - Section
Section 20 in The Sovereign Gold Bond Scheme
20.
All other terms and conditions specified in the notification of Government of India in the Ministry of Finance (Department of Economic Affairs) vide number F. No.4 (13) W&M/2008, dated the 8th October, 2008 shall apply to the Gold Bond issued under this scheme.Application form for Sovereign Gold Bond 2017-18 Series-III(Put √ wherever required)| Name of Receiving Office | Name of Branch : |
| Mode of Subscription | Cash | Cheque/ DD | Electronic Transfer |
| Grams of Gold Applied for | Cheque/ Demand Draft Drawn on (Name of the Bank & Branch) | Cheque/ Demand Draft | Dated | |
| (In Figures) | ||||
| (In words) |
| Amount: Rs. (in figures) (in words) | |||||||||
| ____________________________________________________________________________ |
| PAN number if applicable |
| Applicant status:Resident Individual [ ], Trusts [ ], Charitable Institution [ ], University [ ], others [ ], Please specify: _____ |
| Applicant(s) Detail(in block letters) | Existing RBI Investor ID, if any |
| First/ Sole Applicant's Name in Full | ||||||||||||||||||||||||||||||
| Date ofBirth (minor) |
| Second Applicant's Name in Full |
| Passport/Aadhar/ PAN/ TAN/ Voter ID No. (any one of the above) |
| Guardian (in case of minor) |
| Passport/Aadhar/ PAN/ TAN/ Voter ID No. (any one of the above) |
| First/ Sole Applicant's/ Guardian's Address in Full (Do Not Fill in Name Again) |
| Contact Details |
| Phone | Fax | |||||||||||||||||||||||||||
| Bank Particulars for Payment of Interest Warrant/ Redemption |
| Account Holder Name | |||||||||||||||||
| Bank Name | Account No. | {| | |||||||||||||||
| Nominee details-Nomination Form (as applicable) to be filledand attached |
| Depository participant details(to avail of option to Hold the bond in demat form) |
| Depository NameNSDLCDSL (For NSDL, enter 8 digit dp ID followed by 8 digit client ID,For CDSL enter 16 digit client ID) |
| DP/ Client ID |
| Declaration:I/ We hereby declare and undertake that (i) my/our aggregate investment in Sovereign Gold Bonds 2017-18 - Series III does not exceed 4 Kg for individual, 4 kg for HUF AND 20 Kg for trust and similar entities during the financial year 2017-18 and the annual ceiling will include bonds subscribed under different tranches during initial issuances by Government and tHOse purchase from the Secondary Market (ii) the Information furnished in this application form is correct, (iii) I have read and understood the details of information for the investors as well as rights and duties of investors (copy attached). The agent/bank has explained the features of the scheme. |
| Signature | Signature | Signature |
| 1stApplicant | 2ndApplicant | Guardian |
| Date | {| | ||||||
| Date,Bank Stamp & Signature of the autHOrized official of thebank/ Post Office |
| In case of thumb impression, attestation by two witnesses |
| Thumb Impression |
| Witnesses: | |
| Name of 1st Witness _________________________ | Name of 2nd Witness _________________________ |
| Address ___________________________________ | Address ___________________________________ |
| ___________________________________ | ___________________________________ |
| ___________________________________ | ___________________________________ |
| Signature __________________________________ | Signature __________________________________ |
| H.U.F. declaration(mandatory, if applicant is Karta of HUF) |
| Date of receipt of Application (DD/MM/YYYY) | BLA No. | CIF No. | Date of Credit to Govt.A/C (DD/MM/YYYY) | Nomination registered on (DD/MM/YYYY) | HUF declaration obtained (Y/N) | Total limit declaration obtained (Y/N) | NEFT/ECS mandate obtained (Y/N) | Any other information |