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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 {|
 
| Cash|
 
| Cheque/DD|
 
| Electronic Transfer|}
  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            
Email                                
|}
Bank Particulars for Payment of Interest Warrant/Redemption
Account Holder Name  
Bank Name Account No. {|
                           
|-| Branch Name / Address| IFSC Code|
                           
|-||| 1. Account TypeSB AccountCurrent Account|-| Nominee details - Nomination Form (as applicable) to be filled and attached|}
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                            
|-| Declaration:I/We hereby declare andundertake that (i) my/our aggregate investment in Sovereign Goldbonds does not exceed 500 Grams during the financial year 2015-16and (ii) the Information furnished in this application form iscorrect, (iii) I have read and understood the details ofinformation for the investors as well as rights and duties ofinvestors (copy attached). The agent/bank has explained thefeatures of the scheme.|}
Signature 1st Applicant Signature 2nd Applicant Signature Guardian
Date {|
           
| Place|
                         
|}
  Date, Bank Stamp & Signature of the authorized official ofthe bank/Post Office
In case of thumb impression, attestation by two witnesses
  Thumb Impression
Witnesses :  
Name of 1stWitness____________________________________ Name of 2ndWitness____________________________________
Address_______________________________________________________________________________________________________________________________________ Address_______________________________________________________________________________________________________________________________________
Signature ____________________________________________ Signature ____________________________________________
H.U.F. declaration(mandatory, if applicant is Karta ofHUF)
I, ......................................., residing at the address given against First Applicant, do solemnly affirm that I am the Karta of the Hindu Undivided Family and as such have full powers to sell, endorse, transfer or otherwise deal in the Sovereign Gold bonds 2016, standing in the name of the HUF.Specimen signature for and on behalf of the HUF (name of the HUF).......................................Place_____________________Date_____________________(Signature of the Karta with seal of HUF)For Office use only
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