Pradhan Mantri Garib Kalyan Deposit Scheme 2016 shall come into force from the 17th day of December, 2016 and shall be valid till 31st day of March, 2017.This Scheme shall be applicable to every declarant under the Taxation and Investment Regime for Pradhan Mantri Garib Kalyan Yojana, 2016. An application for the deposit under this Scheme shall be made in Form II clearly indicating the amount, full name, Permanent Account Number , Bank Account details (for receiving redemption proceeds), and address of the declarant: However if the declarant does not hold a PAN, he shall apply for a PAN and provide the details of such PAN application along with acknowledgement number. The application shall be accompanied by an amount which shall not be less than twenty-five per cent. of the undisclosed income. Application Form II has to be accompanied by Form III (Nomination)
Following is the Application Format for making Application under PMGKDS 2016 for deposit of 25%
FORM II
[See paragraph 6(1)]
APPLICATION FORM FOR PRADHAN MANTRI GARIB KALYAN DEPOSIT SCHEME, 2016
Application No.
Bank: …………………………………………………………………… Branch:
………………………………………………
Applicant(s) name(s) [in block letters]
| Name | Date of Birth
(DD/MM/YYYY) | Gender | PAN |
Communication address of the applicant:
| City: | State: | Pin Code: | ||
| Telephones No. | Email: | Mobile No. | ||
Amount of Deposit: Rs …………………. (Rupees ……………………………………………………………… only)
Mode of subscription: [ ] Cash [ ] Cheque or DD [ ] Electronic Transfer
Cheque/DD No……………………… dated ………/………/…………… drawn on (Bank/branch) ………………..
………………………………………………………………… for (Amount) Rs. ……………………..
(Rupees………………… ……………………………………………………………………………..only)
Bank Details (for Redemption payment): Bank name……………………………………………………
Branch…………………………………………………….
| Account Number | |||||||||||||||
| IFSC |
Particulars of Nominee
| Sr. No. | Full name and address of nominee | Date of birth | Relationship with the holder of
Bonds Ledger Account |
Note: Additional information may be provided in the respective form available with the bank/branch.
I have read and understood the details of the scheme and the other information provided for declarants including rights and duties.
Signature/Thumb Impression (Applicant)
DATE: _____________
Place: _______________
Witnesses: (Only in case of thumb impression the same has to be attested by two witnesses)
Name of 1st Witness…………………………………… Name of 2nd Witness………………………………
Address…………………………………………………
Address………………………………………………
Signature……………………………………………… Signature…………………………………………….
Acknowledgement Receipt for declarant
Application No.
Date ………/………/…………………
Received from Mr/Mrs/Ms ………………………………………………… Cash/ Demand Draft/Cheque No./Electronic Transfer/ ……………………………… dated ……/………/………… drawn on (Bank and branch)………………………………………………………………………… for Rs……………… (Rupees……………
………………………………………… only) for the acceptance of deposits under Pradhan Mantri Garib Kalyan Deposit Scheme, 2016 for a period of four years of the nominal value of Rs…………………
(Rupees………………………………………………………only).
Date, Bank stamp and signature of the authorised official of the bank.
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