Form I

GOVERNMENT OF INDIA

Certificate of Holding

Inflation Indexed National Saving Securities-Cumulative (IINSS-C)

Certified that (Name of Subscriber) (Investor ID) is the holder of Inflation Indexed National Saving Securities-Cumulative (IINSS-C) as per details given below. 

Certificate ID.	Amount	No. of Units	Issue date	Maturity date
	Investing Bank IFSC	Investment ID	Nominee	
1								
2								

Repayment Account details:

Account no:
 
IFSC:

Account name:

This is issued subject to the terms and conditions laid down in the Govt of India Notification No   dated

Computer generated - does not require a signature.

FORM – IINSS-C
< Name of the bank >
< Name of the branch>
Application Number

APPLICATION FORM FOR 
INFLATION INDEXED NATIONAL SAVINGS SECURITY – CUMULATIVE (IINSS-C)
(Put √ wherever required. Fields with ‘*’ are mandatory)
For Office use only
Date  of  receipt of Application
(DD/MM/YYYY)	BLA No.	CIF No. 	Certificate No.	Date of Credit to Govt. A/C
(DD/MM/YYYY)	
					
Branch Name & Code 

Applicant(s) name(s) [in block letters]
1st Applicant:Mr/Mrs/Ms																														
                                                Last Name                   First Name                             Middle Name       
##Unique ID (1st Applicant) Aadhar No………………………… Passport No…………………… Driving License No……………………    
2nd Applicant:Mr/Mrs/Ms																														
                    Last Name                  First Name                             Middle Name
3rd Applicant:Mr/Mrs/Ms																														
                                               Last Name                  First Name                             Middle Name
Guardian : Mr/Mrs/Ms																														
                                              Last Name                   First Name                             Middle Name      
Guardian’s relationship with minor     [  ] Father                     [  ] Mother                   [  ] Legal Guardian
*Date of Birth: 1st Applicant (DD/MM/YYYY) ………/………/………..…..   Gender: M/F
*Date of Birth: 2nd Applicant (DD/MM/YYYY) ………/………/..…………..   Gender: M/F 
*Date of Birth: 3rd Applicant (DD/MM/YYYY) ………/………/……………..   Gender: M/F
Mother's maiden name																														
                                                Last Name                   First Name                             Middle Name
Communication address of the applicant:

Telephones (office/residence)																						
Email Address																						

Status:	[   ] Resident Individual		[   ] HUF
[   ] On behalf of minor		[   ] Charitable Institution  
[   ] Power of Attorney holder	[   ] University                            
Amount of Investment:	`…………………… (Rupees ……………………………………………………………………… only)
Mode of Holding:    		[   ] Single	[   ] Joint   	[    ] Anyone or Survivor
Mode of subscription:	[   ] Cash	[   ] Cheque/DD	 
Cheque/DD No……………………… dated ………/………/…………… drawn on (Bank/branch) 
   (DD/MM/YYYY)
 ……………………………………………………………………………………………………………………………………… for (Amount) `………………………………… (Rupees……………………………………………………………………………………………………only) 
*Bank details of 1st Applicant: (Please provide the following details for Interest/Redemption payment)   
Particulars of the Bank account: Bank name…………………………………………….. Branch………………………………………………….
Account Number												
Nine digit MICR Code number of the Bank & Branch												
IFSC Code												
*Bank details of 2nd Applicant: (Please provide the following details for Interest/Redemption payment)   
Particulars of the Bank account: Bank name…………………………………………….. Branch………………………………………………….
Account Number												
Nine digit MICR Code number of the Bank & Branch												
IFSC Code												
*Bank details of 3rd Applicant: (Please provide the following details for Interest/Redemption payment)   
Particulars of the Bank account: Bank name…………………………………………….. Branch………………………………………………….
Account Number												
Nine digit MICR Code number of the Bank & Branch												
IFSC Code												
*Income Tax PAN details@@:
	PAN	I.T. Circle/Ward/ District	
1st Applicant			
2nd Applicant			
3rd Applicant			

Signature/Thumb Impression	   Signature/Thumb Impression		Signature/Thumb Impression
    (1st Applicant)				(2nd Applicant)				(3rd Applicant)
(Thumb impression to be attested by two witnesses)
Witnesses:
Name of 1st Witness…………………………………………… 		Name of 2nd Witness……………………………………………
Address…………………………………………………………………         	Address………………………………………………………………
………………………………………………………………………………              	………………………………………………………………………………
Signature…………………………………………………………………         	Signature…………………………….…….……………………………

DECLARATIOM CUM UNDERTAKING TO BE FURNISHED BY THE INVESTORS OF INFLATION INDEXED NATIONAL SAVINGS SECURITY-CUMULATIVE (IINSS-C) 
I/We, as first investor, hereby declare and undertake that my/our aggregate investment in Inflation Indexed National Savings Security-Cumulative:
1)	As an individual
a)	in my individual capacity
b)	in individual capacity on joint basis
c)	in individual capacity on any one or survivor basis
d)	on behalf of a minor as Father/mother/Legal Guardian
2)	As a Hindu Undivided Family (HUF)
3)	As a Charitable Institution or University
Does not exceed ` 5,00,000/- (Rupees five lakh only) during the 12-month period commencing from April 01, ………… to March 31, …………..
I/We also declare and undertake that I/We shall adhere to the limit on investments as provided for by the Central government from time to time, which is ` 5,00,000/- (Rupees five lakh only) during the 12-month period commencing from April 01, ………… to March 31, ………….. 
In case, at any time, the said declaration is found untrue/false, no interest shall be payable to me/us, the subscriber(s) on the amount of investments found in excess of the prescribed limit.

Date: …………………………				    Signature or thumb impression 
							             of the Subscriber
Place: …………………………				(Thumb impression to be attested by two witnesses)
Witnesses:
Name of 1st Witness…………………………………………… 		Name of 2nd Witness……………………………………………
Address…………………………………………………………………         	Address………………………………………………………………
………………………………………………………………………………              	………………………………………………………………………………

Signature…………………………………………………………………         	Signature…………………………….…….……………………………

NECS/NEFT Mandate Form
(For credit of redemption amount/interest to bank account)
1. Name of the First Applicant
Mr/Mrs/Ms																														
                                                Last Name                   First Name                             Middle Name       
2. Particulars of the Bank account: Bank name…………………………………………….. Branch………………………………………………….
Nine digit Code number of the Bank & Branch 
appearing on the MICR Cheque issued by the bank												
IFSC Code												
(Please attach a photocopy of the Cheque leaf or a cancelled cheque issued to you by the bank for verification of the Code number)
3. Account Type    [   ] S. B. account                [    ] Current Account                   
Account Number 																
Ledger Number																
Ledger Folio No.																
I, hereby authorize ………………………………………………………….……………. (name of the bank) to credit my interest/redemption amounts through NECS/NEFT. I hereby declare that the particulars given above are correct and complete. If the transaction is delayed at all for reasons of incomplete or incorrect information, I would not hold the user institution responsible. I hereby agree to discharge the responsibility expected of me as a participant under the scheme.

Date: …………………………				    Signature or thumb impression of the Subscriber

Place: …………………………				(Thumb impression to be attested by two witnesses)
Witnesses:
Name of 1st Witness…………………………………………… 		Name of 2nd Witness……………………………………………
Address…………………………………………………………………         	Address………………………………………………………………
………………………………………………………………………………              	………………………………………………………………………………
Signature…………………………………………………………………         	Signature…………………………….…….……………………………
Bank Certification (Not required if photocopy of the cheque is submitted)
…………………………………………………………………………………………………………………………..……………………………………………………
Certified that the particulars furnished above are correct as per our records.     

 (Date, Bank Stamp & Signature of Authorised Official)

H.U.F. declaration form
(Mandatory, if applicant is Karta of HUF)

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 Inflation Indexed National Savings Security-Cumulative (IINSS-C) standing in the name of the HUF.

Specimen signature for and on behalf of the HUF (name of the HUF) ……………………………………………………………
							  (Signature of the Karta with seal of HUF)

Place: …………………………    
Date: ……………………………              

Nomination facility (optional)

I,  …………………………………………………………………………………… residing at…………………………………………………………………………
………………………………………………………………………………………, and holder of Bond Number ………………………………
……………………………… nominate the following person/s who shall on my death have the right to the bond / receive payment of the amount  for the time being due on the bond(s) specified below :
Particulars of Nominee /s	
Sr. No.	Date of
issue	Amount
(`)	Date of
repayment	Full name with expanded initials and address of nominee	Date of
birth	Relationship
to holder	Particulars of bank account	

								
If nominee is minor, please fill in the line below:
As………………………………………………………..the sole nominee above is a minor on this date, I appoint Mr/Mrs/ Ms ………………………………………………………….. to receive the amount for the time being due on the above bond(s) in the event of my death during the minority of the said nominee…………………………………………………(name of the nominee who is a minor). 
Change/cancellation of nomination:  This nomination is in substitution of the nomination dated ……/…../………. made by me and registered on your books at…………………………………………………………………………. which shall stand cancelled on registration of this nomination.

Place: ……………………… 
Date: ………………………        
Signature / Thumb impression of the 1st Applicant 
(Thumb impression to be attested by two witnesses)

Witnesses:
Name of 1st Witness……………………………………………… 		Name of 2nd Witness………………………………………………
Address…………………………………………………………………          	Address……………………………………………………………………
…………………………………………………………………………………              	…………………………………………………………………………………

Signature…………………………………………………………………         	Signature…………………………….…….……………………………

INFORMATION FOR INVESTORS IN  
INFLATION INDEXED NATIONAL SAVINGS SECURITY-CUMULATIVE (IINSS-C) 

Government of India has introduced Inflation Indexed National Savings Security-Cumulative (IINSS-C) vide their Notification F.No. 4(16) W&M/2012 dated December 19, 2013. The main features of the Scheme are as under:-

Item	Inflation Indexed National Savings Security-Cumulative	Remarks	
1)	Category of Investor	Individual, HUF, 
University, Charitable Institution.	Non resident Indians are not eligible to invest in these bonds	
2) Limit of investment	Minimum `5,000/- and Maximum investment `5,00,000/- per investor per annum		
3)  Date of Issue of 
     bonds	Date of receipt of  funds/realization of cheque/draft		
4)  Forms of Bonds	Demat	Bond Ledger Account (BLA)	
5)   Interest Option	Cumulative i.e.  interest is payable at the time of maturity	Half-yearly interest compounding	
6) Post Maturity   
    Interest	Post Maturity Interest is not payable		
7)  Bank account	It is mandatory for the investors to provide bank account details  to  facilitate payment of interest /maturity value		
8)  Nomination  
      Facility 	The sole Holder or all the joint holders may nominate one or more persons as nominee 	Including NRIs	
9)  Maturity period	After 10 years		
10)  Premature
      redemption	After one year from date of issue for senior citizens i.e 65 years and above of age, and for all others after three years. 	Penalty charges @ 50% of last coupon payment. Allowed only on coupon dates.	
11)  Transferability  	Limited to nominee(s) on death of holder (only for individuals).	
	
12)  Loans from banks against the security of these Savings bonds	The holders of the said securities shall be entitled to create pledge, hypothecation or lien in favour of scheduled bank, FIs, NBFCs.	
	
13)  Application forms  	Branches of SBI and Associate banks, 20 Nationalised banks, 3 Private Sector banks  viz. HDFC Bank Ltd., ICICI Bank Ltd. and Axis Bank Ltd., and Stock Holding Corporation of India Ltd.		

DUTIES OF INVESTOR/ APPLICANTS
a)	Please fill up the application in all respects.
b)	Incomplete applications are liable to result in delay of issue of the securities (at the cost of the investor).
c)	In case the application is submitted by a Power of Attorney (POA) holder, please submit original POA for verification, along with an attested copy.
d)	In case the application is on behalf of a minor, please submit the original birth certificate from the School or Municipal Authorities for verification, together with an attested copy.
e)	Please note that nomination facility is available to a Sole Holder or all the joint holders (investors) of an IINSS-C Bond. 
f)	In case nominee is a minor, please indicate the date of birth of the minor and a guardian can be appointed.
g)	Nomination facility is not available in case the investment is on behalf of minor.
h)	Please notify the change of address immediately.
i)	POST MATURITY INTEREST IS NOT PAYABLE AFTER DATE OF MATURITY.  HENCE PLEASE OBTAIN REDEMPTION PROCEEDS ON THE DUE DATE.
j)	Indicate your date of birth/age.
k)	Provide your bank account details for receiving payment through Electronic mode
l)	Any information regarding tax applicability may be provided to the bank/branch.
                                               RIGHTS OF THE INVESTOR
a)	The Bond (Certificate of Holding) will be issued on the day receipt of funds/realization of cheque/draft.
b)	The interest on the bond compounds half-yearly. The redemption proceeds (principal and interest) will be credited to the bank account of the holder directly, as per the details provided by him/her in the application form.
c)	Maturity intimation advice will be issued one month before the due date of the bond.
d)	Facility for payment of interest and principal by 'demand draft free of cost or at par cheques' for is available.
e)	The facility of intra-bank branch and inter bank branch transfer of the bonds is available.
f)	Application forms for investments, redemption, NECS/NEFT Mandate, etc. in respect of IINSS-C Bonds are available on the website at www…………com (Banks and SHCIL website).
g)	A sole holder or all the joint holders may nominate one or more nominees to the rights of the bonds. Non-resident Indians can also be nominated
h)	The nomination will be registered at the Office of Issue and a Certificate of Registration will be issued to the holder.
i)	The nomination can be varied by registering a fresh nomination.
j)	The existing nomination can be cancelled by a request to the Office of Issue.
k)	The redemption is due on expiry of ten years from the date of investment, unless applied for premature redemption as applicable.
l)	The investor is entitled to receive repayment amount within five clear working days from the date of tender of acquaintance.
m)	To avoid delay in receipt of interest/redemption proceeds applicants may indicate his choice, for availing of half yearly interest/redemption proceeds through NECS/NEFT/ RTGS or direct credit to the bank account.
n)	Investors are entitled for compensation for delayed payments at the rate decided by RBI (in respect of Relief and Savings bonds) vide their circulars issued from time to time. 

In case the bank does not comply with the above, you may lodge a complaint in writing in to the nearest office of Reserve Bank of India as under: 

THE REGIONAL DIRECTOR, 
RESERVE BANK OF INDIA,
CUSTOMER SERVICE DEPARTMENT/
BANKING OMBUDSMAN
(LOCATION)
--------------------------------------
YOU MAY ALSO ADDRESS YOUR COMPLAINT TO:

THE CHIEF GENERAL MANAGER IN-CHARGE
DEPARTMENT OF GOVERNMENT AND BANK ACCOUNTS
CENTRAL OFFICE
BYCULLA, OPP. BOMBAY CENTRAL RAILWAY STATION
MUMBAI-400 008, MAHARASHTRA         

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.                               

Signature of the applicant

------------------------------------------ TEAR AWAY HERE ---------------------------------------

Acknowledgement of Application Form
  Application No. 

Bank branch…………………………………………………………………………………………		Date ………/………/…………………       

Received from Mr/Mrs/Ms…………………………………………………………………………………… Cash/online through Internet banking/Draft/Pay Order/Cheque No. ………………………………………………… dated ……/………/………… drawn on (Bank and branch) …………………………………………… …………………………………………………………………… for  `……………… (Rupees…………………………………………………………… only) for the purchase of Inflation Indexed National Savings Security for a period of 10 years, interest payable on cumulative basis of the nominal value of `………………………… (Rupees ……………………………………………………… only). 

Date, Bank Stamp & Signature of the authorized official of the bank.