(38284)
For Prizes above Rs. 200/- and
(Form PB-23-C)
upto Rs. 10,000/- to be used by
offices of State Bank of Pakistan
The Chief Manager,
and Public Debt Offices in respect
State Bank of Pakistan,
of Prize Bonds pertaining to the
Other Public Debt Office.
Dear Sir,
PRIZE WINNING BONDS—CLAIM FOR PRIZES
I forward herewith the National Prize Bond particularized below and request you to kindly
arrange for the payment of the prize money as the number of the enclosed Bond has been
declared in the Prize List of
. . . . . . . . . . . . . .
draw
: --
Denomination of Bond
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Series and No. of Bond
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date of Issue
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Place of Issue
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Amount of Prize money claimed
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I am, therefore, entitled for the prize of Rs.
. . . . . . . . . . . . .
which may please be paid
to me at the State Bank of Pakistan / National Bank of Pakistan / Treasury/Sub-Treasury /
Scheduled Bank */* Post Office /* National Savings Office
. . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Block Letters)
I declare that the above-mentioned Bond was purchased by me on or before
the
. . . . . . . . . . . . . . . . . . . . . . . .
19 /** on or before the closing date of the series of Bond as
notified in the Gazette of Pakistan.
Yours faithfully,
Identity Card No
(Please Enclose Photo Copy)
Signature/Thumb Impression of
_ _
the Claimant
Address of the claimant:
Present
Full name of the Claimant
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Permanent
. . . . . . . . . . . . . . . . . . . . . . . . . . .
in Block Letters
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date:
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Nationality
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
*All the prizes will be paid at S.B.P/N.B.P./Treasury/Sub-Treasury. However, prizes up
to Rs.
. . . . . . . . . . . .
will also be paid at Scheduled Bank/Post Office/National Savings
Offices.
**Applicable in case of 11-Rupee Prize Bonds.
Contd……p/2….
(To be filled in by the paying Office).
The particulars of Prize Winning Bond attached with the claim application have been
verified from our record and found in order in all respects/not found in order. The con-
dition of the Bond is accepted/is not accepted.
Claim is admitted/rejected.
Assistant Accounts Officer. A.O./A.C.M./D.C.M./C.M.
Claim for Rs.
. . . . . . . . . . . . . . . . . . . .
in order.
Pay Cash
Paid Cash
A.A.O. A.O.
Stamp
Received prize money of Rs.
. . . . . . . . . . . . . . .
(Rupees
. . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Only) along with Prize Winning Bond.
Signature/Thumb Impression
of the Claimant.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No.
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Date
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Received from Mr.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
National Prize Bond
Series
. . . . . . . . . . . . . . . . . . .
No.
. . . . . . . . . . . . . . . . .
of Rs.
. . . . . . . . . . . . . .
denomination
together with a claim for a Prize of Rs.
. . . . . . . . . . . . . . . . . .
in respect thereof. He should call at
this office on
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
in this regard.
p. Chief Manager.