Claim Application Form for Settlement of Savings Certificate(s) of the Deseased Holder (Where the Claim is preferred on Legal Evidence of Heirship)

                                                         

To,

The Postmaster,

_____________________________

Sir,

                          In connection with the settlement of claim of Post Office Certificate(s) standing in the name ( deceased )______________________ ____________________________________________________________

in the books of _________________________________________( name of Post Office),  I/We______________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________ ( state full relationship  ) of the deceased , who died on_________________,  hereby claim the payment of the value of the Post Office NSCs/KVPs Certificate no(s) ________________________________________________

_______________________________________________________________________ . In support of the claim, I hereby, submit the original/ certified / attested copy of the followings:

(i)                A succession Certificate granted by____________________________________________________                           under No  ________________________ dated________________                                               

(ii)              Probate of will granted by ________________________________ _____________________________________________________

(iii)            Letter of Administration the Estate of the deceased granted by _____________________________________________________

 under No ___________________dated_____________________         

                                                              Yours Faithfully,

                                                  _____________________________

                                                  _____________________________

                                                  _____________________________                                        

                                                  _____________________________

                                                     Signatures or thumb impressions     

                                                         of the claimant if illiterate

Witness (1) ___________________________________(Signature)

Address ______________________________________

_____________________________________________

Witness (2) ___________________________________(Signature)

Address ______________________________________

_____________________________________________

                                                           (2)

Witnesses accepted,

____________________

Signature of Sr PM/PM/SPM

                                                                                          

                                                               _____________________________

                                                               _____________________________

                                                               _____________________________

                                                               _____________________________

                                                                Signature of the Claimants/Guardian    

                                                                           appointed to receive the                

                                                                          amount on behalf of minor  

                                                                                          Nominee(s)

                                                                Address of the Claimants/Guardian

                                                             ______________________________

                                                             _______________________________  

                                                             _______________________________

                                                             _______________________________                            

NOTE- Whenever copies of the original documents are produced , the claimants should get them attested by a Gazetted Officer / Sarpanch Gram Panchayat.