Form A Application Form
Form A Application Form
(In figures)
(In words)
Applicant status: Resident Individual [ ], Trusts [ ], Charitable Institution [ ], University [ ], others [ ], Please specify:
Applicant(s) Detail (in block letters) EXISTING RBI INVESTOR ID, IFANY
FIRST/ SOLE APPLICANT’S / GUARDIAN’S ADDRESS IN FULL (DO NOT FILL IN NAME AGAIN)
CONTACT DETAILS
Phone Fax
Depository Name NSDL CDSL (For NSDL, enter 8 digit dp ID followed by 8 digit client ID, For CDSL enter 16 digit client ID)
DP/ Client ID
Declaration: I/We hereby declare and undertake that (i) my/our aggregate investment in Sovereign Gold Bonds 2019-20 –
Series I/II/III/IV does not exceed4kg for individual and HUF & 20 Kg for trust and similar entities during the financial year
2019-20 and (ii) the Information furnished in this application form is correct, (iii) I have read and understood the details of
information for the investors as well as rights and duties of investors (copy attached).The agent/bank has explained the
features of the scheme.
Date Place
Thumb Impression
Witnesses:
Name of 1st Witness Name of 2nd Witness
Address Address
Signature Signature
I,……………………………………………………………,residing at the address given against First Applicant ,do solemnly affirm that I am the Karta of the
Hindu Undivided Family and as such have full powers to sell, endorse, transfer or otherwise deal in the Sovereign Gold bonds 2019-20 – Series I/II/III/IV,
standing in the name of the HUF.
Specimen signature for and on behalf of the HUF (name of the HUF) ……………………………………………………………
Place
Date of receipt of BLA No. CIF No. Date of Credit to Nomination HUF declara- Total limit NEFT/ECS Any other
Application Govt. A/C registered on tion obtained declaration mandate information
(DD/MM/YYYY) (DD/MM/YYYY) (DD/MM/YYYY) (Y/N) obtained obtained
(Y/N) (Y/N)
Part of Form A
Information for Investors of Sovereign Gold Bond 2019-20- Series I/II/III/IV
Disclaimer:- I have read and understood the details of information for the investors as
well as rights and duties of investors. The agent/bank has explained the features of the
scheme to me.