PHILATELIC DEPOSIT ACCOUNT APPLICATION

To

            The Officer Incharge

            PHILATELIC BUREAU

            __________________

            __________________

  Please open a Deposit Account in my name.

  Full Name: Shri/Smt/Kum____________________________________________

  Address:________________________________________________________

 

 

PIN:___________________

 

My initial payment of Rs.____________________ (In figures)* Rupees_______

 

________________________________________(In words) is attached.

                                                                                                    Yours faithfully

 

                                                                                                (Name and Signature)

(* Minimum for initial and subsequent deposit is Rs.200/-)

Account No:__________________

(To be allotted by Bureau)

Name of recipient (if different from above)____________________________

Delivery Address: ________________________________________________

 

  Pin:______________________

 

ORDER FORM

Description                                                                            Required Number

                                                                                    Definitive            Commemorative

1. Stamps

2. First day cover

            a) Blank

            b) Affixed with stamp & cancelled

3. Information brochure

            a) Blank

            b) Affixed with stamp & cancelled

4.Annual Pack/Collector’s pack

5. Any other item

 

Date:                                                                                       Signature of applicant