United States Savings Bond Election Form - South Carolina Office Of Comptroller General
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1STATE OF SOUTH CAROLINA
OFFICE OF COMPTROLLER GENERAL
UNITED STATES SAVINGS BOND ELECTION FORM
Change – Enter Bond Owner SSN
Add
Delete
Temporarily Inactive – Do Not Refund Account Balance
Effective Payday
EMPLOYEE INFORMATION
Social Security Number
Employee Name
Agency Code
Agency Name
BOND OWNER INFORMATION
Complete If “Other” Checked
(Check One Box Only)
Same As Employee
Social Security Number:
(Use Payroll Name and Address
Name:
Street:
Other
City:
State:
Zip:
BOND DENOMINATION (and Purchase Price) - (Only Check One Box Under Either Series EE or I)
Series EE
Series I
$
100.00
($ 50.00)
$
50.00
($
50.00)
$
200.00
($ 100.00)
$
75.00
($
75.00)
$
500.00
($ 250.00)
$
100.00
($ 100.00)
$ 1,000.00
($ 500.00)
$
500.00
($ 500.00)
$ 1,000.00
($ 1000.00)
Complete This Section Only If The Employee Wishes to Name a Co-Owner or Beneficiary
(Check One Box Only)
Co-Owner
Co-Owner/Beneficiary Name:
Beneficiary (POD)
(Print)
I certify that the above information is correct and may be used by the Office of Comptroller General in the administration of
my payroll savings bond deduction account.
Employee Signature:
Date:
CG-Bond 1.1
REV. 01/01/99
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