I/Werequ.est you, to jjlease sanction a loan of Rs

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1 The 13rnuch l\l1a;nagrrr ~Vesl Bengal SI.al.eCo-o/)erative Bank Lul.... Branch... Deaf Si1; Sub : Apj)lication Jor loan. against Lien ojnsc/kvp/up I/Werequ.est you, to jjlease sanction a loan of Rs (RU/}(IIIS ) only against Lien/Assignment of1ll),/()li.r NSC/KVP with the Post 0ffice/S1t1"fw,dervalnf. of L.I.Polir.J' o] m)/onr life, as notell hereu:lule?: //lvejurnish below the particulars mul ill/onnation, which l/ioe solem,n(v declare are true omd correct to the best of my/our knowledge and belief 1. Full Name/s of the ajjplicant/.5 2. Address 3. Nature of security offered: (Details of certijicaie/s, Patra/s & Policy/cies) a) Name oj lite Purchaser/Policy-holder b) No. & Date ojthe Certificate/Policy c) Name of the issuing Post Office/U OJfice el) Am.onnt - (i) Face Value (ii) Surrender Value e) Date oj Matu.rity j) Am.ou.nt oj loan applied Jor g) Purpose of the loan. I /We am/are furnishing tlte Certificate/Policy alongwith NC-41 form in

2 duplicate and relinquish my/our claim. thereloin!avoufo!),our Please anoange to credit my/ our SB/CD A/c. No issue your manager's cheque in my/our [auout: Bank. with ovou/ 10U1:5 faithfully, l:kj,me& Address of.. the Witness 1. signature of the a-/j/jlicanl/suiitl: q[fice Seal II 2. II Dated, the J For Office use only Recommendation.- 1. Ap/)licatioll. received 011. I 2. Certijicale/Patra send to the Post Office /U Office 011. ; 3. Received bad, from P.0/ L.! OjJiceduly notiil,g of TRANSFER / Assignment (In 4. Loan. sanctioned Rs 01~., 5. Amount disbursed on and adjus; to SB/Gn a/c. No / issued manager's cheque No. Branch Manager

3 Form No. 200 APPLICATION FORM FOR NOMINAL MEMBERSHIP The ManagiNg Director, West Bengal State Co-operative Bank Ltd. Kolkata. Dear Sir, IIWe on behalf of ~-,a Co-operative Society I firm I limited company registered under the Act of..desireto be a Nominal Member of your Bank in terms of the Bye-law No. 12 of your Bank. (/We have read the Bve-Iaws of your Bank or they have been read out to me/us. I/We agree to abide by the Nominal Member. Bye-laws of your Bank, if I am/we are admitted as I am/we are sending herewith the necessary certificate* and or resolution of our Committee of Management / Board of Directors'" Yours faithfully, I/We further authorise you to debit our Current Deposit/S. B. Acco nt with you with a sum of Rs. 50/- (Rupees fifty) only / tender herewith Cheque No. Dated on favouring yourselves for Rs 50/- (RUpees fifty) only towards payment of Admission fees tor nominal Membership of your Bank. ThankiJlgyou, Common Seal ( Signature of authorlsed Officers/applicant with Seal & Designation) Encl. : as stated Place Date * In case the applicant is a Co-operative Society within the jurisdiction of a Central Co-operative Bank, a No-objection Certificate from the concerned Central Bank should also be furnished with the application Strikeout whichever is not applicable. S.P.E

4 .,. '. W.B.S.C.B. Form No.1 09 Rs. Kolkata 200 ON DEMAND I/We promise to pay the West Bengal State Co-operative Bank Limited, or order the sum of Rupees from this date at the rate of together with Interest on such sum percent. per annum with half yearly I quarterly rates for value received.

5 The Branch Manager West Bengal State Co-operative Bank Ltd Branch Dear Sir, On security ofnscikvpilip amounting to Rs (Rupees ) only with Post Office/Branch, I/\Ve request you to please allow me/us a Demand Loan of. Rs ( Rupees ) only against the captioned certificate/s Parras as hereunder is/are enclosed for keeping at your possession. NSC/I(VP/LI Policy No. Amount liwe am/aloe agree to your Bank-holding the certificates with/without accrued interest thereon as the case may be. I/\Ve renunciate all my/our claims on the abovenoted facts and hereby undertake not to call back certificate/s until the loan with interest is fully adjusted. If at any time you wish to call back the loan, you are at liberty to do so and do hereby authorise you to appropriate any amount that may be necessary to get the loan adjusted from the proceeds of the Certlflcates/patras deposited to you as security. Yours faithfully, Witness: 1. Signature: Signature: 'Name: Name : Address: Address:

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