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Union of India - Section
Section 19 in Sovereign Gold Bond Scheme 2018-19 - Series -I
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(2) W&M/2018, dated the 27thMarch, 2018 shall apply to the Gold Bond issued under this scheme.Application Form for Sovereign Gold Bond 2018-19 - Series I(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 Application'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 availof 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 2018-19 - Series I does not exceed 4kg for individual and HUF & 20 kg for trust and similar entities during the financial year 2018-19 and (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) |
| I,..........................................................................................residing at the address given against First Applicant, dosolemnly affirm that I am the Karta of the Hindu Undivided Familyand as such have full powers to sell, endorse, transfer orotherwise deal in the Sovereign Gold bonds 2018-19 – SeriesI, standing in the name of the HUF. |
| Specimensignature for and on behalf of the HUF (name of the HUF)............................................................................................................... |
| Place ____________________ | |
| Date _____________________ | (Signature of the Karta with seal 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 | Total limit declaration obtained (Y/N) | NEFT/ECS mandate obtained (Y/N) | Any other information |