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    Electoral Bond Application Form English

    Uploaded by

    Jitendra Raval
    This document is an application form for electoral bonds from State Bank of India. It contains fields for the applicant to provide payment details for the bonds, including payment mode and denomination. The form also requests applicant details like name, address, identity information. Finally, the applicant must declare that the information provided is correct and acknowledge their rights and duties as an electoral bond holder.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Electoral Bond Application Form English

    Uploaded by

    Jitendra Raval
    26 views2 pages
    This document is an application form for electoral bonds from State Bank of India. It contains fields for the applicant to provide payment details for the bonds, including payment mode and denomination. The form also requests applicant details like name, address, identity information. Finally, the applicant must declare that the information provided is correct and acknowledge their rights and duties as an electoral bond holder.

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    © © All Rights Reserved

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    This document is an application form for electoral bonds from State Bank of India. It contains fields for the applicant to provide payment details for the bonds, including payment mode and denomination. The form also requests applicant details like name, address, identity information. Finally, the applicant must declare that the information provided is correct and acknowledge their rights and duties as an electoral bond holder.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    26 views2 pages

    Electoral Bond Application Form English

    Uploaded by

    Jitendra Raval
    This document is an application form for electoral bonds from State Bank of India. It contains fields for the applicant to provide payment details for the bonds, including payment mode and denomination. The form also requests applicant details like name, address, identity information. Finally, the applicant must declare that the information provided is correct and acknowledge their rights and duties as an electoral bond holder.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    State Bank of India

    Application Form for Electoral Bond Scheme 2018


    Branch Code: Name of Branch:
    (Tick  your choice of payment option fill details in the table below) Date: / / 20
    Details of Payment
    Tick Mode of Subscription Details
    Cheque Drawn on Bank: Cheque No: Date of issue (ddmmyyyy):

    Debit Ac/ No:


    Demand Draft Drawn on Bank: DD No: Date of issue (ddmmyyyy):

    RTGS/ NEFT from .................................... UTR No:


    (Name of the Bank)
    SBI Internet Banking INB Reference No:
    SBI Direct Debit
    Denomination & Number of Electoral Bonds Required
    Denomination Number of Electoral Bonds Amount
    Rs. 1,000 Rs.
    Rs. 10,000 Rs.
    Rs. 1,00,000 Rs.
    Rs. 10,00,000 Rs.
    Rs. 1,00,00,000 Rs.
    Total Rs.
    Total Amount in Words: Rs.
    Details of Applicant(s) (in block letters using Black/Blue ink only)
    Applicant Status (As per clause 3(i) of the Gazette Notification No 20 dated 2nd January 2018)
    (Tick  the appropriate box)

    Individual HUF Company Firm Charitable Trust Others


    First/Sole Applicant’s Name in full:

    PAN No.: TAN No. (if applicable):

    Details of Identity (any 1) Passport No. Aadhaar No. Voter ID

    Second Applicant’s Name in Full:

    Details of Identity (any 1) Passport No. Aadhaar No. Voter ID

    Third Applicant’s Name in Full:

    Details of Identity (any 1) Passport No. Aadhaar No. Voter ID

    First/Sole Applicant’s Address in Full:

    Contact Details Mobile/Phone: Email:

    Application Receipt
    I/We understand that this slip is only an acknowledgement of the receipt of the Electoral Bonds Application Form by the
    Bank and the Bank will issue the Electoral Bonds as per above details only after receiving the funds in its designated account
    through the mode of subscription opted for by the Applicant(s).

    Signature of Applicant(s)/Authorised Representative Signature & Seal of Authorised Branch Official


    Declaration
    I/We hereby declare and undertake that :
    (i) The information furnished in this Application Form is correct in all aspects.
    (ii) I/We have read and understood the details of information for the Applicant/ Purchaser of Electoral Bonds as well as the
    rights and duties of the Electoral Bond holder.

    Signature of 1st Applicant Signature of 2nd Applicant Signature of 3rd Applicant


    In case of thumb Impression, attestation by two witnesses:

    1st Witness (Signature with Details) 2nd Witness (Signature with Details)
    HUF Declaration
    I, ____________________________________ residing at the address given against the First Applicant, do solemnly affirm that I
    am the Karta of the Hindu Undivided Family and as such have full powers to purchase and other wise deal in the Electoral Bonds
    standing in the name of the HUF.
    Specimen signature for and on behalf of the HUF (Name of the HUF):

    Place
    Date __ __ /__ __ / 20 __ __ Signature of the Karta

    For Office Use


    Date of receipt of application BLA No./ CIF No. HUF Status Any other information

    Yes ___
    No ___

    Authorization

    I/We Applicant of Electoral Bond hereby authorize Shri./Smt.

    whose signature is attested below to collect Electoral Bond(s) on my/our behalf.

    Signature of Authorised Representative Signature of Applicant(s)

    Electoral Bond Delivery


    I/We hereby confirm that I/we have received the Electoral Bonds from the Bank as per details filled in the Electoral Bonds
    Application Form.

    Signature of Applicant(s)/Authorised Representative Signature & Seal of Branch Official

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