PRIZE MONEY CLAIM APPLICATION FORM – (PB-23)

The Chief Manager, Date D D - M M - Y Y

State Bank of Pakistan, CHECK LIST (please mark  )
SBP Banking Services Corporation Original and Copy of Prize Bond □
Photocopy of valid CNIC/SNIC (original seen) □
________________________
2 Signatures on reverse of Original & Copy of Prize Bond □
Dear Sir,
I enclose herewith the __________ Number of National Prize Bond(s) of Rs. _______________ denomination particularized
below and request to kindly arrange payment of the prize money as the enclosed Bond(s) has/have been declared
winning in draw mentioned there against.
CLAIMANT INFORMATION
Name
(as per CNIC)

CNIC No - - CNIC Expiry Date

Address
Contact No.
Taxpayer Status ⎕ Filer ⎕ Non-Filer Email ID
PRIZE BOND DETAILS
Prize Bond Details Date of Draw Place of Amount of Prize T-24 System ID
S No.
Series Serial No. Issue No. Issue Money (PKR) (for office use only)
1

10
Total Prize Money (PKR)
MODE OF PAYMENT OF Up to PKR 18,500/- ⧠ Cash only ⧠ Bank Credit
PRIZE MONEY PKR 93,000/- & above ⧠ Bank Credit ⧠ Payment Order
BANK ACCOUNT DETAILS
Bank Name Branch Name
Account Title
IBAN P K
U N D E R T A K I N G
I hereby declare and accept that:
1. The National Prize Bond(s) presented by me for prize money claim is/are “Genuine”. In case the bond(s) is/are found forged/tampered, SBP
BSC (Bank) reserves the right to take legal action against me as per the relevant laws.
2. The information provided above shall deemed to be true & complete and any misinformation/incorrect details or concealment of facts of any
nature whatsoever by me can result in legal action against me as per the relevant laws. In case of change in any of the aforementioned
information including taxpayer status i.e. Filer / Non-filer, it shall be my responsibility to inform in writing the respective SBP BSC office
immediately.
3. The aforementioned bank account is maintained singly in my name at the bank as stipulated above.
4. Any discrepancy found in the above bond(s) at later stage, the amount of prize money so released would be refunded by me.
5. In case of loss of payment order(s), duplicate instrument(s) will be issued against service charges of Rs. 200/- per payment order.
6. The Withholding Tax on prize money amount will be deducted at prevailing rates.

Signature / Thumb Impression of the Claimant Officer/S.O. (Original CNIC/SNIC Seen by SBP BSC Official)
DO NOT WRITE BELOW THIS LINE / FOR OFFICE USE ONLY
PAID CASH STAMP (Upto Rs. 18,500/-)
No :- KHI/LHR-_____________________________________
Date of receipt of claim ______________________________________
System generated acknowledgment receipt issued to claimant:
⧠ YES (No._____________________) ⧠ NO (Reason) _____________________
(PB-23) (To be filled by the SBP BSC Office). The particulars of Prize Winning Bond detailed below of Rs. __________________ denomination attached with the claim application have been verified from
our record and found in order in all respect / not found in order. The condition of the Bond is accepted / is not accepted.
T-24 System ID / Bond Details Amount of Withholding Tax Net Amount Bank Credit Details PO Delivery
S No. Draw No.
Payment Order No. Series Serial No. Prize Money Rate Amount (PKR) Payable (PKR) FT Number Date Date
1
2
3
4
5
6
7
8
9
10
Total
Prize money claim of aforementioned prize winning National Prize Bond(s) is admitted / rejected.

Officer / Sr.
Officer Senior Officer A.C.M (PBU) IMU Official D.C.M/C.M. ACM (PBU) IMU Official
Officer
CLAIMANT’S ACKNOWLEDGEMENT FOR OFFICE USE ONLY
Received [please tick () the relevant]: Payment made vide:
⧠ I authorize SBP BSC office to credit the prize money amount as well as face value (if applicable) to my bank account as provided on obverse. ⧠ Bank Credit

__________ No. of Payment Order(s) for prize money along with face value of Rs. ______________________
⧠ ⧠ Payment Order
(Rupees________________________________________ against __________ prize winning Bond(s) as detailed on obverse).

Cash Rs. ________________________ (Rupees_______________________________________________________________________) for prize money and face value (if
⧠ ⧠ Cash
applicable) against ________________ prize winning bonds.

Claimant’s Signature-1 Claimant’s Signature-2 Signature Verified