(38284)

(Form PB-23-C)

For Prizes above Rs. 200/- and

upto Rs. 10,000/- to be used by
offices of State Bank of Pakistan
and Public Debt Offices in respect
of Prize Bonds pertaining to the
Other Public Debt Office.

The Chief Manager,

State Bank of Pakistan,
Dear Sir,

PRIZE WINNING BONDSCLAIM FOR PRIZES

I forward herewith the National Prize Bond particularized below and request you to kindly
arrange for the payment of the prize money as the number of the enclosed Bond has been
declared in the Prize List of . . . . . . . . . . . . . . draw: -Denomination of Bond . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Series and No. of Bond . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date of Issue

.......................................

Place of Issue

.......................................

Amount of Prize money claimed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I am, therefore, entitled for the prize of Rs. . . . . . . . . . . . . . which may please be paid
to me at the State Bank of Pakistan / National Bank of Pakistan / Treasury/Sub-Treasury /
Scheduled Bank */* Post Office /* National Savings Office . . . . . . . . . . . . . . . . . . . . . . . . . .
............................................................................
(Block Letters)
I declare that the above-mentioned Bond was purchased by me on or before
the . . . . . . . . . . . . . . . . . . . . . . . . 19 /** on or before the closing date of the series of Bond as
notified in the Gazette of Pakistan.
Yours faithfully,
Identity Card No
(Please Enclose Photo Copy)
_

Signature/Thumb Impression of
the Claimant

Address of the claimant:

Present . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Full name of the Claimant

Permanent . . . . . . . . . . . . . . . . . . . . . . . . . . .

in Block Letters . . . . . . . . . . . . . . . . . . . . . . . . . . .

......................................

.........................................

Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nationality . . . . . . . . . . . . . . . . . . . . . . . . . . . .

........................................................................................

*All the prizes will be paid at S.B.P/N.B.P./Treasury/Sub-Treasury. However, prizes up

to Rs. . . . . . . . . . . . . will also be paid at Scheduled

Bank/Post

Office/National Savings

Offices.
**Applicable in case of 11-Rupee Prize Bonds.
Contdp/2.

(To be filled in by the paying Office).

The particulars of Prize Winning Bond attached with the claim application have been
verified from our record and found in order in all respects/not found in order. The condition of the Bond is accepted/is not accepted.

Claim is admitted/rejected.

Assistant Accounts Officer.

A.O./A.C.M./D.C.M./C.M.

Claim for Rs. . . . . . . . . . . . . . . . . . . . . in order.

Pay Cash

A.A.O.

Paid Cash
Stamp

A.O.

Received prize money of Rs. . . . . . . . . . . . . . . . (Rupees . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Only) along with Prize Winning Bond.

Signature/Thumb Impression
of the Claimant.

............................................................................
No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Received from Mr. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . National Prize Bond

Series . . . . . . . . . . . . . . . . . . . No. . . . . . . . . . . . . . . . . . of Rs. . . . . . . . . . . . . . . denomination
together with a claim for a Prize of Rs. . . . . . . . . . . . . . . . . . . in respect thereof. He should call at
this office on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . in this regard.

p. Chief Manager.