SC-I

Registration No.

Serial No.

NATIONAL SAVINGS CENTRE

APPLICATION FOR PURCHASE OF
DEFENCE SAVINGS/SPECIAL SAVINGS CERTIFICATES (Registered)/REGULAR INCOME CERTIFICATES
Name (s)/Address of Purchaser(s)
1.
(i) Name
(ii) Address

MODE OF PAYMENT
1.

Cash Rs.

2.

Cheque(i) No./Date
(ii) Bank Name
(iii) Amount Rs.
(Rupees

(iii) N.I.C. No.

2.

(i) Name
(ii) Address

(Rupees

FOR MINORS
Date of Birth

1.

(iii) N.I.C. No.

2.
During minority this certificate can be encashed by:

Single
Joint
* Joint A: Payable to holders Jointly or to either with the
written consent of the other.
* Joint B: Payable to either.

Name
Address
Relationship with minor

Strike out whichever is not applicable.

Number and Value of Certificates required
Denomination
Number
Value
Rs. 500/=
Rs.1,000/=
Rs.5,000/=
Rs.10,000/=
Rs.50,000/=
Rs.100,000/=
Rs.500,000/=
Rs.1,000,000/=
Rs.5,000,000/=
Rs.10,000,000/=
I/We hereby agree to abide by the Rules applicable for the
Certificates Purchased.

FOR PUBLIC BODIES

Name of public bodies
and individual or fund
for whom purchased.
(Detail of documents attached)
(i)
(ii)
(iii)
NOMINATION
In the event of my/our death I/We nominate the following to
receive the value of the certificate(s) in proportion stated against their
names.
Name & Address

Signature(s) or thumb
impression(s) of
Purchaser(s).

(i)
(ii)

Share

Received Certificates mentioned on reverse.

Signature(s) or thumb
impression(s) of
(i)
Purchaser/ Agent/
Messenger.
(ii)

Signature(s) or Thumb impression(s) of Purchaser(s).

DECLARATION
I/We am/are follower(s) of the figh
(i)

and

An attested copy of my/our declaration in Form CZ-50 annexed to the Zakat (Collection and Refund) Rules, 1981, duly executed, is
enclosed with this application.

(ii)

I/We have already filed an attested copy of my/our declaration in Form CZ-50, annexed to the Zakat (Collection and Refund)
Rules, 1981, duly executed, with this National Savings Centre under Serial No.

on

Hence Zakat may not be deducted on compulsory basis in respect of this asset/investment.

Signature of Purchaser (s):

Date

(i)

(ii)

Signature of IInd Officer

(Name & Designation)

Signature of Officer Incharge

(Name & Designation)

TO BE COMPLETED BY OFFICE OF ISSUE

Name(s) of holder(s)

Transaction
Date

NOTE:-

Transaction
Date

N.B.-

Signature of purchaser(s)

Name
Address

Particulars of Certificates
Denomination
Serial
and quantity
Number

Registration No.

PRINCIPAL AMOUNT
Issued for
Discharged
Rs.
for Rs.

Balance
Rs.

Signatures
Official
Officer

Every change effecting the certificates such as transfer, issue of certificates in exchange for damaged certificates
surrendered (C), issue of duplicate certificates in lieu of lost etc. should be noted in red ink just below the last
transaction and authenticated by the Issuing Authority.
PROFIT, ZAKAT & TAX ACCOUNT
Profit
Zakat/Tax
Receipt
No. and Period Amount Rs.
Year
Amount of Rs.
Issued No.

Please attach an additional such sheet for purchase of Regular Income Certificate if required.

Signature
Official
Officer