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English-PB-23 Prize Bond Form

1) The document is a prize money claim application form submitted to the State Bank of Pakistan to claim prize money from winning national prize bonds. 2) It requests payment of prize money for the enclosed winning bond(s) and provides details of the claimant such as name, CNIC number, tax filing status, and contact information. 3) It also includes details of the prize bond(s) such as series, serial number, date of issue, draw number, place of issue, and amount of prize money won. It requests the mode of payment and provides the claimant's bank account details.

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NASIR BANGASH
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618 views2 pages

English-PB-23 Prize Bond Form

1) The document is a prize money claim application form submitted to the State Bank of Pakistan to claim prize money from winning national prize bonds. 2) It requests payment of prize money for the enclosed winning bond(s) and provides details of the claimant such as name, CNIC number, tax filing status, and contact information. 3) It also includes details of the prize bond(s) such as series, serial number, date of issue, draw number, place of issue, and amount of prize money won. It requests the mode of payment and provides the claimant's bank account details.

Uploaded by

NASIR BANGASH
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PRIZE MONEY CLAIM APPLICATION FORM (PB-23)

Date D D - M M - Y Y
STATE BANK OF PAKISTAN CHECK LIST (please mark  )
BANKING SERVICES CORPORATION Original and Copy of Prize Bond □
_______________________ Office Photocopy of valid CNIC/SNIC (original seen) □
2 Signatures on reverse of Original & Copy of Prize □
Bond
Dear Sir,
I enclose herewith the Number of National Prize Bond(s) of Rs. denomination particularized
below and request to kindly arrange payment of the prize money as the enclosed Bond(s) has/have been declared
winning in draw mentioned there against.
C L A I M A NT I NF O R M A T I O N
Name
(as per CNIC)

CNIC No - - Expiry
D D - M M - Y Y
Date
Taxpayer Status Filer Non-Filer Contact No.

P R I Z E B O ND D E T A I L S
Prize Bond Details Date of Draw Place of Amount of FOR OFFICE USE ONLY
S No.
Series Serial No. Issue No. Issue Prize Money T-24 System FT No.
(PKR) ID
1

10
Total Prize Money (PKR)

MODE OF PAYMENT OF Up to PKR 18,500/- Cash only Bank Credit


PRIZE MONEY PKR 93,000/- & above Bank Credit
B A NK A C C O U NT D E T A I L S
Bank Name Account Type Conventional Branchless
Account Title
IBAN P K

F O R O F F I C E U S E O NL Y
No :- KHI/LHR- PAID CASH STAMP (Upto Rs. 18,500/-)
Date of receipt of claim
System generated acknowledgment receipt issued to claimant:
YES (No. ) NO (Reason)
UN D E R T A K I N G
I hereby declare and accept that:
1. The National Prize Bond(s) presented by me for prize money claim is/are “Genuine”. In case the bond(s) is/are found forged/tampered, SBP
BSC (Bank) reserves the right to take legal action against me as per the relevant laws.
2. The information provided above shall deemed to be true & complete and any misinformation/incorrect details or concealment of facts of any
nature whatsoever by me can result in legal action against me as per the relevant laws. In case of change in any of the aforementioned
information including taxpayer status i.e. Filer / Non-filer, it shall be my responsibility to inform in writing the respective SBP BSC office
immediately.
3. The aforementioned bank account is maintained singly in my name at the bank as stipulated above.
4. Any discrepancy found in the above bond(s) at later stage, the amount of prize money so released would be refunded by me.
5. The Withholding Tax on prize money amount will be deducted at prevailing rates.

Signature of the Claimant (as per CNIC) Officer/S.O. (Original CNIC/SNIC Seen by SBP BSC Official)

F O R O F F I C I A L U S E O NL Y
The particulars of Prize Winning Bond detailed on the obverse and attached with this claim application have been verified from
our record and found in order in all respect / not found in order.
Prize money claim of the prize winning National Prize Bond(s) presented at this office is admitted / rejected.

Officer Sr. Officer ACM (PBU) IMU Official DCM/ CM Officer/Sr. Officer ACM (PBU) IMU Official

CUSTOMER’S ACKNOWLEDGEMENT FOR OFFICIAL USE ONLY


Received [please tick () the relevant]: Payment made vide:
I authorize SBP BSC office to credit the prize money amount as well as face value (if Bank Credit
applicable) to my bank account as provided on obverse.
Cash for prize money and face value/bonds (if applicable) Cash

Signature of the Claimant (as per CNIC) Signature Verified

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