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["FORM II"]
["[See paragraph 6(1)]"]
["APPLICATION FORM FOR PRADHAN MANTRI GARIB KALYAN DEPOSIT SCHEME, 2016"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"Application No."]
[]
["Bank:",null,null,null,null,null,null,null,null,null,"Branch:"]
[]
["Applicant(s) name(s) [in block letters]"]
["Name",null,null,null,null,null,null,null,"Date of Birth (DD/MM/YYYY)",null,null,null,"Gender",null,null,"PAN"]
["Ram Kishore Verma",null,null,null,null,null,null,null,"1975-01-16",null,null,null,"Male",null,null,"AAAPL5555K"]
[]
["Communication address of the applicant:"]
["Telephones No.",null,null,null,null,null,null,null,null,null,"City:"]
["Email:",null,null,null,null,null,null,null,null,null,"State:"]
["Mobile No.",null,null,null,null,null,null,null,null,null,"Pin Code"]
[]
["Amount of Deposit:",null,null,null,null,"Rs.",54056138]
[]
[]
["Mode of subscription",null,null,null,null,null,"Cash",null,"Cheque or DD",null,null,null,"Electronic Transfer"]
["Cheque/DD No",null,null,null,15489,null,null,"dated",null,"2017-01-01",null,null,"drawn on",null,"Bank of Baroda, "]
["New Delhi",null,null,null,"for (Amount)  Rs.",null,null,null,{"$f":"G18","v":54056138}]
[{"$f":"CONCATENATE(Sheet2!H6,Sheet2!H7)","v":"Rupees Five Crores Forty  Lakhs Fifty Six Thousand One Hundred Thirty Eight Only"}]
[]
["Bank Details (for Redemption payment): "]
["Bank name"]
[]
["Branch"]
[]
["Account No."]
["IFSC"]
[]
["Particulars of Nominee"]
[]
["Sr. No.","Full name and address of nominee",null,null,null,null,null,null,null,null,"Date of birth",null,null,"Relationship with the holder of Bonds Ledger Account"]
[]
[]
["I have read and understood the details of the scheme and the other information provided for declarants including rights and duties."]
[]
[]
["Dated:",null,null,null,null,null,null,null,null,null,"Signature/Thumb Impression (Applicant)"]
["Place:"]
[]
["Witnesses:"]
["Name of 1st Witness",null,null,null,null,null,null,null,null,null,"Name of 2nd Witness"]
[]
["Address",null,null,null,null,null,null,null,null,null,"Address"]
[]
["Signature",null,null,null,null,null,null,null,null,null,"Signature"]
[]
["Acknowledgement Receipt for declarant"]
["Dated:",null,"00/00/0000",null,null,null,null,null,null,null,null,null,"Application No."]
[]
[{"$f":"Sheet2!B22","v":"Received from Mr/Mrs/Ms  Ram Kishore Verma Cheque or DD 15489 dated 42736 drawn on Bank of Baroda,  for Rs. 54056138/- Rupees Five Crores Forty  Lakhs Fifty Six Thousand One Hundred Thirty Eight 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.  54056138/- Only"}]
[]
["Date, Bank stamp and signature of the authorised official of the bank"]

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[]
[null,null,null,null,null,null,null,"cash",false,"Cash",null,null,true,{"$f":"IFERROR(VLOOKUP(M2,I2:J4,2,FALSE),\"\")","v":"Cheque or DD"}]
[null,"Received from Mr/Mrs/Ms ",null,null,null,null,null,"cheque",true,"Cheque or DD"]
[null,{"$f":"CONCATENATE(D4,E4)","v":" Ram Kishore Verma"},null," ",{"$f":" Sheet1!A11","v":"Ram Kishore Verma"},null,null,"elec",false,"Electronic Transfer"]
[null,{"$f":"CONCATENATE(D5,E5)","v":" Cheque or DD"},null," ",{"$f":"N2","v":"Cheque or DD"}]
[null,{"$f":"CONCATENATE(D6,E6)","v":" 15489"},null," ",{"$f":"Sheet1!E22","v":15489},null,null,{"$f":"spellnumber(Sheet1!G18)","v":"Rupees Five Crores Forty  Lakhs Fifty Six Thousand One Hundred Thirty Eight"}]
[null," dated",null,null,null,null,null," Only"]
[null,{"$f":"CONCATENATE(D8,E8)","v":" 42736"},null," ",{"$f":"Sheet1!J22","v":"2017-01-01"}]
[null," drawn on"]
[null,{"$f":"CONCATENATE(D10,E10)","v":" Bank of Baroda, "},null," ",{"$f":"Sheet1!O22","v":"Bank of Baroda, "}]
[null," for"]
[null," Rs. "]
[null,{"$f":"CONCATENATE(Sheet1!G18,C13)","v":"54056138/-"},"/-"]
[null,{"$f":"CONCATENATE(D14,E14)","v":" Rupees Five Crores Forty  Lakhs Fifty Six Thousand One Hundred Thirty Eight Only"},null," ",{"$f":"Sheet1!A24","v":"Rupees Five Crores Forty  Lakhs Fifty Six Thousand One Hundred Thirty Eight Only"}]
[null," for the acceptance of deposits under Pradhan Mantri Garib Kalyan Deposit Scheme, 2016 for a period of four years of the nominal value of"]
[null,"  Rs. "]
[null,{"$f":"CONCATENATE(D17,E17)","v":" 54056138/-"},null," ",{"$f":"B13","v":"54056138/-"}]
[null," Only"]
[]
[]
[]
[null,{"$f":"CONCATENATE(B3,B4,B5,B6,B7,B8,B9,B10,B11,B12,B13,B14,B15,B16,B17,B18)","v":"Received from Mr/Mrs/Ms  Ram Kishore Verma Cheque or DD 15489 dated 42736 drawn on Bank of Baroda,  for Rs. 54056138/- Rupees Five Crores Forty  Lakhs Fifty Six Thousand One Hundred Thirty Eight 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.  54056138/- Only"}]

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["Macros must be enabled to use this form"]