SB-7A

Payment Order
ACCOUNT CLOSURE FORM
Date

Pass Book must accompany this form Payment on account of Closure of Account No.
Interest Rs. and deposit Rs.
Name of the Post Office
Totaling to Rs. (Rupees
Account No Date
) is sanctioned in
favour of this depositor.
Please close the above account and pay self / messenger (whose signature is
*Recovery of overpaid interest Rs. deduction of Rs.
given below) the interest of Rs. and deposit of Rs.
and other charges (to be specified) Rs. Totaling
TOTAL (Interest + Deposit) Rs. (Rupees
to Rs. (Rupees
) *after adjustment
) has been adjusted.
of overpaid interest and / or deduction equal to Percent of the deposit,
amounting to Rs. (Rupees NET AMOUNT PAID Rs.
) and any other charges, recoverable in respect of
(Rupees
the account in question immediately.
)

Name of the Messenger

Signature of Postmaster

Signature of Messenger
Acquittance

Received Rs.

Signature or thumb impression of depositor

Date Signature