SB/CQE-4 Department of Posts APPLICATION FOR AVAILING OF THE FACILITY OF CHEQUE SYSTEM Date.......................... To, The Post Office Savings Bank .....................................Post Office Please permit me/us to avail of the facility of the cheque system and issue a cheque book for my/our Savings Bank Account No................................................ standing open at your office with a balance of Rs................................ 2. I/we hereby declare that I/we have read the conditions governing the facility of cheque system in the Post Office Savings Bank Accounts as laid down in Rule 28-A of the Post Office Savings Bank Rules 1881 and that I/we accept all the aforesaid conditions, and such amendments thereto as may be issued from time to time, as binding upon me/us. Name(s) of Depositor(s) (in block letters) ........................................................................................................................................... .................................................................................................................................................................... *3. The cheque book should be sent to me by registered post at the following address :........................................................................................ ........................................................................................ ...................................................... Signature(s) of Depositor(s) * Delete if not applicable CERTIFICATE OF INTRODUCTION I...........................................................................................................................................do hereby certify that ............................................................................................................................................................ the depositor(s) of Post Office Savings Bank Account No. ...........................................standing open at.............................................Post Office is / are known to me and has/have signed this application in my presence. Introduction accepted ........................................................ .......................................................... Signature of introducer Signature with date of postmaster Address (with A/c No. if he is a SB Depositor) .................................................................... TO BE FILLED IN BY POST OFFICE Account No.............................. Cheque Book containing ...................................... Ledger No............................... Cheques Nos..................................... to ..................................issued Noted in ledger .................................................. ............................................. Initials with date of Postmaster Initials with date of postmaster ACKNOWLEDGEMENT OF DEPOSITOR(S) FOR CHEQUE BOOK I/We hereby acknowledge receipt of the Cheque Book containing cheques No......................................... to ............................... which I/we have counted and found correct and in proper serial order. ............................................ Signature(s) of Depositor(s)
