NOTE EXCHANGE FORM

  Annexure-2

Request slip for exchange of withdrawn Old series of  

Banknote   In denomination of Rs 500/- and 1000/-

Name of the BANK / POST OFFICE   …………………………………………………………………

Name of the Tenderer (In capital Letters )
Indentity Proof Original  to be shown at the counter	Aadhar Card  / Pen Card/DRIVING LICENCE /VOTER CARD/ PASS PORT/ NAREGA CARD
Identification Number (Number Mentioned in the Identity proof submitted)
Datails of withdrawan Old series Note submitted for exchange	Denomination Number of Note value 500 1000 TOTAL TOTAL VALUE OF WORDS ( शब्दों में)
Sinnature of Tenderer
Place : Date :	MOBLIE NUMBER ………………………………………………….

Series of note number: -