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Union of India - Section
Section 19 in The Sovereign Gold Bond Scheme, 2016
19.
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.Form 'A'[See Paragraph 5(i)]Application Form for Sovereign Gold Bond 2016(Put √ wherever required)| Name of Bank/Post Office | Name of Branch: |
| Mode of Subscription | {| |
| Grams of Gold Applied for | Cheque/ Demand Draft Drawn on(name of theBank & Branch) | Cheque/Demand Draft No. | Dated | |
| (In figure) | ||||
| (In words) |
| Amount : Rs. (In figure) | (in words) | |||||||
| {| | ||||||||
| PAN number if applicable |
| Applicant status:Resident Individual [],Trust [],Charitable Institution [],University [],other [],Please specify : ____________ |
| Applicant(s) Detail(in block letters) | Existing Investor ID, if any | |||||
| First / Sole Applicant's Name in full, | {| | |||||
| Date of Birth (minor) | ||||||||||||||||||
| Passport/Aadhar/PAN/TAN/Voter ID No. (any one of the above) |
| 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 Applican's / Guardian's Address in Full (Do notfill in Name again) | ||||||||||||||||
| {| | ||||||||||||||||
| Contact Details | ||||||||||||||||
| {| | ||||||||||||||||
| Phone | Fax | |||||||||||||||
| Bank Particulars for Payment of Interest Warrant/Redemption | |||||||||||||
| Account Holder Name | |||||||||||||
| Bank Name | Account No. | {| | |||||||||||
| Depository participant details(to avail of option tohold the bond in demat form) | ||||||||||||||
| Depository NameNSDLCDSL (For NSDL, enter 8 digit dp ID followed by 8 digitclient ID, For CDSL enter 16 digit client ID) | ||||||||||||||
| {| | ||||||||||||||
| DP / Client ID |
| Signature 1st Applicant | Signature 2nd Applicant | Signature Guardian |
| Date | {| | ||||
| Date, Bank Stamp & Signature of the authorized official ofthe bank/Post Office |
| Thumb Impression |
| Witnesses : | |
| Name of 1stWitness____________________________________ | Name of 2ndWitness____________________________________ |
| Address_______________________________________________________________________________________________________________________________________ | Address_______________________________________________________________________________________________________________________________________ |
| Signature ____________________________________________ | Signature ____________________________________________ |
| H.U.F. declaration(mandatory, if applicant is Karta ofHUF) |
| 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 |