FORM B (CENTRAL) FORM B (CENTRAL)

(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

SUBSCRIBER’S COPY BANK’S 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* ` `
LOAN REPAYMENT* ` `
INTEREST ON LOAN* ` `
PENALTY / FEES* ` `
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 .00
500 X .00 500 X .00
100 X .00 100 X .00
50 X .00 50 X .00
20 X .00 20 X .00
10 X .00 10 X .00
5 X .00 5 X .00
Cheque / Demand Draft No. & Date:_________& ___/__/20__ Cheque / Demand Draft No. & Date: ___________ & _/__/20__

Bank /Branch on which drawn Bank / Branch on which drawn

____________________________ ___________________________

Depositor’s Signature Depositor’s Signature

Note: i) Cheque / DD in favourof “SUBSCRIBER” name and will be credited after realisationof proceeds only on realization date.
ii) * Select the proper type of payment as above.