FORM-B FORM-B

(See sub paragraph (3) of paragraph 4) (See sub paragraph (3) of paragraph 4)
PUBLIC PROVIDENT FUND SCHEME, 1968 PUBLIC PROVIDENT FUND SCHEME, 1968
COUNTERFOIL 1 COUNTERFOIL-2
SUBSCRIBERS COPY BANKS COPY
BRANCH NAME : Date: / /20 BRANCH NAME : Date: / /20
NAME OF SUBSCRIBER: NAME OF SUBSCRIBER:
PPF A/C NO : PPF A/C NO :
AMOUNT OF DEPOSIT CASH / CHEQUE
AMOUNT OF DEPOSIT CASH / CHEQUE
SUBSCRIPTION* SUBSCRIPTION*
LOAN REPAYMENT* LOAN REPAYMENT*
INTEREST ON LOAN* INTEREST ON LOAN*
PENALTY / FEES* PENALTY / FEES*
TOTAL AMOUNT TOTAL AMOUNT
Amount In Words (Rupees ________________________
_ _ )
Amount In Words (Rupees_______________________________________________
_ _ _ )
DETAILS OF CASH DEPOSIT AMOUNT DETAILS OF CASH DEPOSIT AMOUNT
1000 X .00 1000 X
500 X .00 500 X
100 X .00 100 X
50 X .00 50 X
20 X .00 20 X
10 X .00 10 X
5 X .00 5 X
Cheque / Demand Draft No & Date
.. & //20
Cheque / Demand Draft No & Date: ... & //20
Bank / Branch on Which Drawn
.
Bank / Branch on Which Drawn: .
Depositors Signature Depositors Signature
Note:
(i) Cheque / DD in favour of SUBSCRIBER name and will be credited after
realisation of proceeds only on realisation date.
(ii) * Select the Proper type of payment as above