FOR OFFICE USE ONLY

SOURCING BRANCH :

FORM A

BAR CODE NO

: 801

SERVICE REQUEST :
APPLICATION DATE :
Field with *( STAR ) marked are mandatory

APPLICATION FOR OPENING PUBLIC PROVIDENT FUND ACCOUNT UNDER PPF SCHEME 1968
Name of
the applicant:

Mr

Miss

Ms

Please affix
latest coloured

Mr
Guardian
Name (incase of Minor)

Miss

Ms

passport size
photograph of
applicant

Permanent Address /
Communication Address :

ICICI Bank Account (if any)

*PAN

Retail Infinity ID (if any)

*Account opening Sol Id/ Branch :

*Initial Contribution

: CHEQUE / DD NO.

BANK NAME :

BRANCH :
AMOUNT IN FIGURES ____________________ Rs. ________________________________________________
__________________________________________________
*Debit Mandate

: Rs. __________________________________________________________________________________

*Debit Account No

*Standing Instructions
Frequency

: Amount in figures ___________________

: Date of Debit ( Start date ____________________ & End Date ___________________ )

SOURCING BRANCH

ACCOUNT IN THE NAME OF SELF / MINOR (S)

*DATE OF BIRTH OF MINOR

*Applicant Relationship with Minor : ___________________________________________________________

Declaration : i ) I hereby declare that I am not maintaining any other Public Provident Fund Account.
ii) I hereby declare that I am not maintaining any other Public Provident Fund Account, except an account on behalf of minor.
iii) I hereby declare that the details of other Public Provident Fund Accounts opened earlier by me are as under
Sl

Description

Name / Address of the bank / Post Office and Account No

iv) I also declare that I shall adhere to the ceiling on deposits as provided for by Central Government from time to time which is
Rs. 1.5 Lac in a financial year at present in each of the following types of Public Provident Fund Account. Individuals
Self Account(s) of whom I am the guardian. In case, at any time the said declaration is found untrue / false, no interest shall be
payable to me / the subscriber on the amount of deposit in excess of the prescribed limit .
v) I shall be investing the services of Shri / Ms _______________________________ PPF AGENCY NO _____________ who has
canvassed for opening of this PPF Account. CR I shall be investing directly and not through any agent.
vi) I agree to abide by the provisions of the Public Provident Fund Scheme 1968 and amendments issues thereto from time to time.

DATE :

Signature / Thumb Impression

(Subscriber / Guardian)

FORM E
Application of Nominee Under Public Provident Fund Scheme, 1968
I, _____________________________________________ hereby nominate the person (s) mentioned below to whom to the exclusion of all other
persons in the event of my death, the amount standing to my credit in the PPF Account no _____________________ at the time of my death would
be payable (not applicable for Minor account).
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Name (s) of the Nominee (s)
No.
& Relationship

Full Address

Date of Birth of Nominee

in case of Minor

Proportionate amount
for each Nominee

As the nominee(s) at Serial no. (s) ___________________ specified above is/are minor(s), i appoint Shri __________________________ residing
at ___________________________________to receive the sum due under the said account in the event of my death during the minority of the
nominee (s).

WITNESS 1 : Name
____________________________________________________________
Address
____________________________________________________________

Signature

____________________________________________________________
____________________________________________________________
WITNESS 2 : Name
____________________________________________________________
Address
____________________________________________________________

Signature

____________________________________________________________
____________________________________________________________

Signature / Thumb Impression

(Subscriber / Guardian)
BRANCH AUTHROISATION :
BM / BSM / CSO Authorization
Branch Remarks (If any)
DOCUMENTS :
PPF NEW ACCOUNT OPENING DOCUMENTS :
1) Pan Copy

2 ) Address Proof (as per Resident Account Circular)

3 ) Birth Certificate (in case of Minor)

PPF TRANSFER IN ACCOUNT OPENING DOCUMENTS :

1) Form A

2) Photograph

3) PAN NO

4) Address Proof
(as per Resident
Account Circular)

5) Transfer in
Cheque / DD

6) Certified copy
of Ledger

FOR OFFICE USE ONLY :

The account has been opened on.______________with Rs ______________ under Public Provident Fund
Account No. _________________________
Passbook No._________________ has been issued
Date : ___________________

Accounts Officer

Form amemded vide Ministry of Finance (DEA) Notifications No. 908 (E) dates 06/12/2000 No. GSR 679 (E) dates 04/10/02
and GSR 768 (E) dates 15/11/2002.