FROM AAS-1 GOVERNMENT OF INDIA NATIONAL SAVINGS ORGANISATION Application from for Appointment as Authorised Agent (To be used by Individuals only) To, _______________________________ ________________________________ ________________________________ Sir, I desire to act as an Authorised Agent for the sale of 7 years National Savings Certificates Second, Third, Fourth & fifth Issues, 2, 3, & 5 years Time Deposits, National Development Bond, 15 years National Saving Annuity Certificates and other Small Savings Securities, which may be notified by the Government of India from time to time as securities which Authorised Agent may canvass. 2 (a) My Full Name is _______________________________________ (b) My Father's Name is _______________________________________ (c) My Occupation is _______________________________________ (d) My Business/Office address is _______________________________________ (e) My Residential address is _______________________________________ (f) My Age is _____________________ years _________________________________ 3. I declare that: - (a) I am not a close relative (i.e. wife, husband, legitimate child or step child, father, mother sister or brother) of a gazetted officer worker in the Post & Telegraphs Departments. (b) I am not a close relative ( i.e. husband, wife, legitimate child or step child, father, mother, sister or brother) of or a relative depending upon non-Gazetted Officer working in the employee of the National Savings Organisation. 4. (a) I request that for the sale of certificates issued through post offices, I may be attached to the under noted Post Office(s):- (i) ____________________________________(G.P.O/H.P.O/S.P.O/B.P.O) (ii) ____________________________________(G.P.O/H.P.O/S.P.O/B.P.O) (iii) ____________________________________(G.P.O/H.P.O/S.P.O/B.P.O) (c) I respect of certificates issued through other agencies I may be attached to the following Office(s):- (i) __________________________________________________________ (ii) __________________________________________________________ (iii) __________________________________________________________ 5. In the event of my appointment being approved, I shall:- (a) Put up two acceptable sureties each guaranteeing to the extent of the Rs _____________________________ OR (b) Furnish security in cash or in the shape of Government securities totaling the issue price of Rs. _______________________________ (c) Furnish one surety of a bank for Rs. __________________________ (d) Furnish a Fidelity Guarantee Policy of the value of Rs. ___________ 6. I agree to abide by all the rules, regulations, instructions etc. regarding the appointment of authorised agent at present in force and as may be amended from time to time. 7. I previously worked as Authorised Agent at ______________________ during the Year(s)_________________________ OR I have not so far worked as Authorised Agent. 8. I may be allowed to obtain Receipt Books from _________________________________ _______________________________________(Name and address of Issuing Authority) Place : _____________________ Date : _____________________ Yours Faithfully, Signature of the Applicant (To be filled up only if the application is recommended by somebody) I recommend this application : - Name ____________________________ Signature __________________ Full Address _______________________ Designation ________________ Date _____________________ (TO BE FILLED UP IN THE OFFICE OF THE APPOINTING AUTHORITY) (i) Application scrutinized by __________________________________________ Signature ______________________ Designation _______________________ (ii) Applicant's appointment as Authorised Agent approved on ______________ (Date) after verifying the solvency of the sureties, in cases where sureties are put up. (iii) Agreement completed on ____________________________________________ (iv) Certficate(s) of Authority bearing number(s) ________________________ (v) Issued on _____________________ (Date) (vi) Signature of Appointing Authority _____________________________________ (vii) Designation of Appointing Authority ___________________________________ Date: ______________
