Application form for renewal of MPKBY Agency

To
The Sr. Accounts Officer, Directorate of Small Savings & Lotteries
th
5 Floor, N-Block, Vikas Bhawan, ITO, New Delhi-110002

Sub:- Request for renewal of MPKBY Agency No. SS/MBA/_ _ _ _ _ _ _ _

Sir,
Please renew my MPKBY agency for the next 3 years. My particulars are as under :-
1. Agent’s Name (in Block Letters)
2. Date of Birth Place of Birth :
3. Educational Qualification
4. Spouse name
5. Father’s name
6. Mother’s Name
7. Present Address
Since ……………………
8. Permanent Address

9. Criminal History (Yes/ No)

10. Category (SC/ST/ General)
11. Validity of MPKBY Agency From to
12. Police Station District
13. My total Annual Turnover during the last 03 years under MPKBY Agency is as under:-
Financial Year Nos. of Accounts Annual Turnover Commission Earned
maintained
20 – 20

20 – 20
20 - 20

I hereby affirm and declare that the information given above and in the enclosed documents is true and
correct to the best of my knowledge and belief and nothing material has been concealed therein. I am well
aware that concealment of facts and giving false information is punishable offence and in case I am guilty of
giving false information or concealment of facts therein, I will be liable to be punished with imprisonment and
/or fine as per the relevant provisions of law. I also undertake that the benefits availed by me by furnishing
such false information or concealment of the facts shall be liable to be summarily withdrawn. Further, I
hereby undertake to abide by all the rules & regulations and terms & conditions in force and as may be
amended from time to time.
Enclosures:-
1. Application Form ASLAAS-I(B) duly filled.
2. Declaration by the agent on Affidavit (Rs. 10/-)
3. Nomination Form of the agent
4. Conduct Certificates from Two Gazetted Officers
5. Copy of Address Proof (i.e. voter I.D./ Passport, Ration/AADHAR Card ) : Self attested
(Original to be shown at the time of submission of application)
6. Original Certificate of Authority & one photocopy (self attested)
7. Three (03) ticket size recent photographs.

Mobile No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Signature of Agent _ _ _ _ _ _ _ _ _ _ _ _ _ _

Name ___________________
 FORM ASLAAS-1 (B)

GOVERNMENT OF NATIONAL CAPITAL TERRITORY OF DELHI

(SMALL SAVING & LOTTERIES)
5th. Floor, N-Block, Vikas Bhawan, I.P. Estate, New Delhi

APPLICATION FORM FOR AN INDIVIDUAL FOR APPOINTMENT AS AN AUTHORISED AGENT

UNDER MAHILA PRADHAN KSHETRIYA BACHAT YOJNA
To,
The Joint Director
Small Savings & Lotteries
Govt. of N.C.T. of Delhi.

Sub: Application for appointment as an Authorised Agent (MPKBY)

Sir,
I request that I may be appointed as an Authorised Agent under the Mahila
Pradhan Kshetriya Bachat Yojna for canvassing and securing deposit in 10-Year Post
Office Cumulative Time/5-Year Recurring Deposit Accounts on a commission (at such
rate as may be notified by the Govt. of India from time to time) in the
……………………………………………… area (Municipal House No./Plot
No………………….to………………………………………………………..which consists of
………………………………………………………….families).

2. I agree to abide by all the rules and regulations regarding the appointment of
authorised agent in force and as may be amended from time to time.
3. I shall provide a security of Rs. 2000/- (Rupees Two Thousand Only) in the
shape of 6-Year National Savings Certificate duly pledged in favour of the
President of India.
4. The agreement (Form ASLAAS-3) will be executed by me immediately on
hearing from you about the approval of my appointment as an authorised agent.
5. I enclose herewith, in triplicate, my specimen signature.
Yours faithfully

…………………………………………..
Name and full address of the applicant
Place ……………………
Date…….…….................
 FORM ASLAAS-3 (REVISED)

AGREEMENT

ARTICLES OF AGREEMENT made at ………………………... this ………………………………

day of…………………………………… Two thousand ………………………………..between the
President of India hereinafter called the “Government” of the one part
and……………………………. (name and full address of the Individual/Institution or Organisation
hereinafter called the Agent/Agent-Organisation) which expression shall be deemed to include
her/its successors wherever the context admits or requires of the other part.

WHEREAS with a view to expending the Small Savings Scheme the Government are
desirous of appointing Organisations or institutions, individual Women of the area concerned as
authorized agents under the “Mahila Pradhan Kshetriya Bachat Yojna” for canvassing and
securing investments in P.O. Cumulative Time Deposit/Recurring Deposit Accounts.

AND WHEREAS the Agent/Agent-Organisation has agreed to act as such authorized

agent on the terms and conditions hereinafter appearing.

AND WHEREAS it is one of such terms and conditions that the Agent/Agent-
Organisation should as security for due fulfillment, of the said contract furnish to the Appointing
Authority a Savings Certificate (issued under the Government Savings Certificate Act, 1959) for
Rs. 2000 (Rs. Two thousand only) duly pledged to the President of India.

NOW IT IS HEREBY AGREED by and between the parties hereto as follows :-

1. The Agent/Agent-Organisation Shall-

(i) Canvass for and secure deposits in 10-year C.T.D. and 5 year Recurring Deposit
Accounts in POSB in accordance with the rules governing, the two aforesaid deposit
account. The Agent-Organisation shall work the agency through not more than six/three
workers (thereinafter referred to as “Authorised Workers”).

(ii) make necessary entry for any amount received from the depositors under this scheme,
in the printed card (No. ASLAAS-5) form prescribed by the Government of India and
supplied to her/it.

(iii) deposit the monies so received in the Post Office to which the Agent/authorized worker
is attached for making deposits under the scheme, within 5 (five) days of receipts of the
monies but not later than the end of the month and pending such deposits to hold the
monies in trust for and on behalf of the Government of India.

(IV) receive from the deposit accepting Post Office the Pass Book(s) covering each and
every deposit made by the Agent/authorized worker and deliver the same Pass Book(s)
to the depositor(s) within 10 days of receiving it from the Post Office.

(V) obtain from the depositor(s) his/her acquaintance with signature and date in the
appropriate column of the card in token of having received the Pass Book(s).

(VI) notify immediately to the “Appointing Authority”, the District Savings Officer of the area
and the local police of the area the loss of cards/certificate of Authority if such loss takes
place while the documents are in the custody of the agent/authorised worker and to
publish the loss as a public notice in at least one local newspaper at her/its cost.

(VII) follow all directions and instructions as may be issued to her/it from time to time by the
Government of India or by persons duly authorised by the Government.
(VIII) be entitled to commission only on deposits made during the period of this agreement in
the following types of accounts, namely.

(a) account opened by her/it under this agreement Mahila Pradhan Kshertiya Bachat Yojna,
and.

(b) accounts transferred by the “appointing authority” to her/it from another Agent/Agent
Organisation who has opened such accounts and is not in a position to discharge her/its
responsibilities in terms of her/its agreement in respect of such accounts.

(IX) not be entitled to claim any commission on the deposits received in respect of any other
account not opened by her/it, and.

(X) not assign or otherwise transfer the benefit of this agency or any part thereof to a third
party.

2. The Agent/Agent-Organisation shall be entitled to receive a commission (at such rate as

may be notified by the Government of India from time to time) on total investments
received and completed according to the aforesaid terms and conditions in the P.O.
Cumulative Time Deposit Accounts and P.O. Recurring Deposit Accounts from the
depositor(s) residing in the area for which she/it is authorized. The commission shall be
payable to her/it by the “Paying Authority” on submission of commission claim in the
prescribed manner. The Agent/Agent-Organisation shall not be entitled to any other
commission, remuneration or payment whatsoever for the work done under the presents
except the commission as aforesaid notwithstanding any expenses she/it may incur for the
purpose.

3. Subject to the provision for earlier termination hereinafter contained the period of the
agency shall be three years commencing from the date of this agreement, and thereafter
the agency may, on an application being made in this behalf by the agent, be renewed at
the option of the Government for further periods not exceeding three years at a time.

4. The agency would be liable to be terminated by the “Appointing Authority” without notice, if
the work or conduct of the Agent/Agent-Organisation is adversely commented upon by the
supervising authorities or if she/it, in the opinion of the “Appointing Authority” which shall
be final and binding, is found guilty of breach of any provision of this Agreement, or if she/it
becomes insolvent, or runs into liquidation or it is discovered that a part or the whole of the
business was secured by her/it with the help or connivance of an official of the Posts and
Telegraph “Department or National savings Organisation; the commission earned on such
business would also be liable to forfeiture and if the commission on such business has
already been paid, the Agent/Agent-Organisation must refund it to the Government, failing
which the Government shall have the right to recover the amount of such commission paid,
from the Agent/Agent Organisation as an arrears of land revenue.

5. Notwithstanding anything contained in paragraphs 3 and 4, this Agreement may be

terminated by either party by giving three months notice to the other; provided, however,
that the “Appointing Authority” shall be at liberty to terminate the agency at any time
without notice and without assigning any reasons for the same.

6. On termination of this Agreement, however occasioned, or as and when called for by the
“Appointing Authority” the Agent/Agent-Organistion shall be responsible for the return to
the “Appointing Authority” of all the documents and papers concerning the agency. The
Agent/Agent-Organisation shall indemnify the Government of India against any or all
losses or plaints that may arise on account of any default of the Agent/Agent-Organisation
or its authorized worker(s).
7. The terms “Appointing Authority” and ‘Supervising Authorities” used in this agreement shall
be the authorities as specified in Mahila Pradhan Kshetriya Bachat Yojna issued by
National Savings Organisation and Executive instructions issued there under.

8. In the event of the death of the agent, the amount due and payable to her as commission
in terms of this agreement, shall be payable to her nominee(s) specified by her in
Schedule ‘A’ hereunder written.

9. The stamp duty on this Agreement will be paid by the Government.

IN WITNESS WHEREOF THE President has caused the

……………………………………….. (Designation of the Appointing Authority)

to set his hand and ……………………………………………………….. has/have set his/her/their

hand on behalf of ………………………………………… (The name of the Agent-leader/Agent-
Organisation) on the day, month and year first hereinabove written.

Signed and delivered by the Applicant.

…………………………………………………………………………………on behalf of
…………………..……………………………………………… (The name of the Agent-
leader/Agent-Organisation) in the presence of (Signature and address of Witness)

1 …………………………………………………………………………..

2 ……………………………………………………………………………..

Signed and delivered by the (Name and Designation of the Appointing Authority)

………………………………………

On behalf of the President of India in the presence of (Signature and address of Witness)

1. ……………………………………………………………………………………………….……

2. ………………………………………………………………………………………………..……

On behalf of the President of India in the presence of

(Signature and address of witness)

…………………………………………………………………………….
…………………………………………………………………………….
 CONDUCT CERTIFICATE

Certified that Shri/Smt./Ms ……………………………………………………………

S/o,W/o,D/o………………………………………...R/o……………….………………………
…............................................. is personally known to me for the
last…………………years (not less than 2 years) and to be of my knowledge and belief
he/she is a person of integrity and good conduct. He/She is not related to me.

Signature ……………………………
Place……………. Name
Date……………. Address

Seal

CONDUCT CERTIFICATE

Certified that Shri/Smt./Ms ……………………………………………………………

S/o,W/o,D/o………………………………………...R/o………………………………………....
......................................... is personally known to me for the last…………………years
(not less than 2 years) and to be of my knowledge and belief he/she is a person of
integrity and good conduct. He/She is not related to me.

Signature ……………………………
Place……………. Name
Date……………. Address
Seal
 NOMINATION FORM

I, ……………………………………………………………………………….the agent
under this Agreement hereby nominate the person(s) mentioned below, who shall, on
my death, become entitled to any amount due and payable to me by way of commission
in terms of this Agreement, to the exclusion of all other persons.
_____________________________________________________________________
Sr. No. Name of the nominee(s) Relation Full Address
Age (Date of birth
in Case of minor)
______________________________________________________________________

______________________________________________________________________

As the nominee(s) at Serial No.(s) above is/are

minor………………………………………… I appoint the following persons to received
the aforesaid amount.
Name ………………………………
Witness : Signature of Agent …………….
1. Name ….………………………..
Address

C/A No. of the Agent

2.

In the event of the death of the Agent, the amount due and payable to her as
commission in terms of this agreement, shall be payable to him/her nominee(s)
specified by him/her in Schedule ‘A’ hereunder written.

Signature of Agent………………………

Name in Block Letters.…………………

Dated…………………………
 DECLARATION

TO BE FURNISHED BY THE APPLICANT FOR APPOINTMENT AS SAS/MPKBY/ PPF AGENT

I W/o, S/o & D/o
R/o solemnly affirms as under:-
1. That my date of birth is ……………………………
2. That I am not an employee of the State Govt./Central Govt. and Union Territory and undertake to
inform the appointing authority and give up the agency whenever I enter such employment.
3. That none of my near relative is working in the P & T Department in a non-gazetted capacity in the
same Division where the agency falls.
4. That none of my near relative is working in the P & T Department in a non-gazetted capacity in the
same State or Union Territory where the agency falls.
5. That none of my near relative is working in National Savings Organisation in the same State or
Union Territory where the agency falls.
6. That none of my near relative is working in the P & T Department of the National Savings
Organization in a Gazetted capacity anywhere in India.
7. That I would apply for renewal of my agency 60 days in advance from date of expiry of validity.
8. That whenever I shall shift/change my residence I will inform the appointing authority within 15
days.
9. That during the last financial year i.e. ____________, I had mobilized the business of Rs.
__________
10. That I would procure business myself.
11. That I would not sit in the post office. If I am found without any business in the Post Office, my
agency may be terminated.
12. I further declare that none of my near relatives i.e. my wife / husband / legitimate child or step
child/ my father/ step father/ mother / step mother, brother / step brother, sister / step sister, father
in law, mother in law, brother in law, sister-in-law, son in law or daughter in law is employed under
the Central or State/ Union Territory Government (& in Nationalised Banks in case of PPF only).
13. I give below the particulars of my near relatives i.e. my wife, husband, legitimate child or step child,
my father/ step father/ mother / step mother, brother / step brother, sister / step sister, father in
law, mother in law, brother in law, sister-in-law, son in law or daughter in law who are employed
under the Central or State/ Union Territory Government (& in Nationalised Banks in case of PPF
only).
Sr. Name of relative Age Relationship with Name & address of office
No. the applicant where employees
1
2
3

I attached the communication (s) in original from the Head (s) of office/ Department where the
above mentioned person (s) is/ are employed to the effect that there is no objection to my being
appointed as agent under the SAS/MPKBY/PPF Agency.

DEPONENT
I verify that the affirmations made by me as above are correct to the best of my knowledge and
belief and that no material facts have been concealed by me.

DEPONENT
Signed in my presence :-
Witness (s)
1.
2.