Application for release of *National Savings Certificate (NSC)/

Kisan Vikas Patra (KVP)/. .. (name of the certificate) furnished as security

To,
The Commissioner, Commercial Taxes,
14, Beliaghata Road, Kolkata-700015
I,.*son/daughter of
residing at
on
my
*own
behalf/on
behalf
of
the
*Firm/Hindu
Undivided
Family/Company/Trust/.(specify others), do hereby apply for release
of the *National Savings Certificate (NSC) / Kisan Vikas Patra (KVP)
/.. (Name of the certificate) furnished as security at
. (Name of the Office where it was
submitted) on . (Date on which it was submitted).
The *NSC/KVP/ was furnished on behalf of the dealer
carrying on business under the name
and
having
Registration
Certificate
No.
.
The details of the *NSC/KVP/. is given below:I. Serial No. of the *NSC/KVP/..

II. Certificate amount (Rs)

III. Date of maturity

IV. Act under which the security was furnished

#The necessary certificate issued by the *Member of the Parliament/ M.L.A./Mayor/

Municipal Chairman/ Councillor/ Zilla Sabhadhipati/ Panchayat Samiti Sabhadhipati/
Panchayat Pradhan/ Group A Officer of the Central Government or State Government
as called for is enclosed with this application.

Signature
Date
Status of the applicant
Note:
1. In case the Registration Certificate No. of the dealer has already been cancelled, the RC
No. as it existed before cancellation is to be stated above.
2. # The Certificate will be required only where the dealer who had furnished the security in
the capacity of *Proprietor/Partner/Karta has died and the application is being made by
his/her legal heir.

Format of the Certificate to be issued by the Member of the Parliament/M.L.A./

Councillor/Sabhadhipathy/Gram Pradhan/Group A Officer of the Central Government
or State Government in their Letter Pad.

TO WHOM IT MAY CONCERN

Certified that Sri/Smt son/daughter of .
residing at . is personally known
to me since the last .. (Years) . (Months). His/her father had a business
under the trade name... at
(place of business) having certificate of registration No.
. under the .. (Name of the State Act).
I also certify that photograph as affixed below and attested by me is of the above named
person.

Signature