(38264)

(Form PB-23-A) For Prizes above Rs. 10,000/-

The Chief Manager,

State Bank of Pakistan,

Dear Sir,
PRIZE WINNING BONDS—CLAIM 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
held on the . . . . . . . . . . . . . . . . . . : -- (Number of draw)
(Date 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,

Signature|Thumb Impression of
the Claimant
_ _
Identity Card No.
(Please Enclose Photo Copy)
Address of the claimant:
Present . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Permanent . . . . . . . . . . . . . . . . . . . . . . . . . . .
...................................... Full name of the Claimant in Block Letters
Date: ________________________ Nationality . . . . . . . . . . . . . . . . . . . . . . .

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

upto Rs. ____________ will also be paid at Scheduled Bank|Post Office|National
Savings Offices.
**Applicable in case of 11 Rupee Prize Bonds.
(Contd……(2)
(PB-23-A)
(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.

Payment Order No. . . . . . . . . . . . . . . . . . . Date . . . . . . . . . . . . . . . . . . . . .

Issued|Delivered to . . . . . . . . . . . . . . . . . . On . . . . . . . . . . . . . . . . . . . . .
Vide letter No. . . . . . . . . . . . . . . . . . . . . . . Dated . . . . . . . . . . . . . . . . . . . .

Assistant Accounts Officer. Accounts Officer.

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