Form A (White)
[See rule 7(1)]
Form of application for purchase of Kisan Vikas Patra (by direct investment)
  Serial No.      
 To
            The Postmaster …………..Post Office
I/We hereby tender Rs…………(Rupees…………..only) in cash/by cheque No………..for the purchase of Kisan Vikas Patra of the type Single/Joint A/Joint B.
(a) In the name(s)……………………and     
(b) In the case of minor, his date of birth…………..encashable by the minor's parent/guardian Shri/Smt
(c) The investment is not through any agent
2. I/We nominate the persons named below, who shall, on my/our death, receive payment.

SI. No.	Name of nominee	Full address	Date of birth of minor nominee

 3. I/We hereby agree to abide by the Kisan Vikas Patra Rules, 1988.
 4. The certificates/identity slip may be made over to my/our messenger who presents this application.
Signature/thumb impression of investor
                                                                                 Date
 Signature and address of                                        Address
 witness to nomination           
                                                                        Received the certificate(s) and identity slip
                                                                        Signature of investor/messenger
  Date
 Delete whichever is not applicable.
Identity slip
           
             Specimen signature of holder/holders
To be completed by the Post Office

Serial Nos. of certificates	Issue price Rs.	Date of encashment	Initials of the Postmaster	Remarks like transfer, issue of duplicate, etc. with initials
Total

Date : …………                                                                              Signature of Postmaster.