ANNEXURE I A

Place:

Date:

From : ________________________
______________________________
______________________________

To

The Regional Director
Reserve Bank of India
Public Debt Office
_______________________________

Dear Sir,

Repayment of 9% Relief Bonds Scheme 1999

I / We request and authorise that the following investment in my/our BLA under 9% Relief Bonds scheme 1999 may please be paid by credit to my/our SB /Current Account No. ______________________

with your branch / a Payment Order / credited to my / our account as per the ECS mandate(Strike out whichever is not applicable):

BLA No.	Date of Investment	Amount invested	Date of Maturity	Interest	Total Amount
GRAND TOTAL

Particulars of Savings Bank / Current Account: No…………….…..Bank / branch name……………. (Applicable if the Payment Order is to be sent by post)

Yours faithfully

Signature(s)

Name(s)

---

ACQUITTANCE

Received from (Branch Name …………………Rs. ( Rupees __________________________________________________ only) being the principal amount with accrued interest due on 9% Relief Bonds 1999 against my /our BLA as per details given above.

No. Name(s) Income Tax PAN

( if amount exceeds Rs.1 lakh)

(Revenue Stamp) Signature(s)

i.

ii.

iii.

Place:

Date: