To,
The Postmaster,
______________________________
Sir,
In
connection with the settlement of the claim of Post Office NSCs/KVPs
Certificate(s) standing in the name of the deceased ____________________________________________________________
,
I hereby claim the payment of
the value of the Post Office Certificate(s) detail of which is given below:
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SL No
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Scheme
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Registration numbers and
date of issue
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Office of issue
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Amount
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1
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2
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3
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4
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5
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6
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7
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8
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9
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10
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In support of the claim, I
hereby submit:
(i)
Proof of Death of
the deceased issued by appropriate authority in original.
(ii)
Letter of
Indemnity in original duly attested by Notary Public.
(iii)
Affidavit and
Letter of Disclaimer on Affidavit duly attested by Oath Commissioner.
Yours Faithfully,
_______________________
____________________________
Signature or thumb impression of
the claimant if
illiterate
Address_____________________
____________________________
(2)
Witness (1)
____________________________(Signature)
Address_____________________________________________
Witness (2)
____________________________(Signature)
Address_________________________________
(1)
ANNEXURE-I
(LETTER OF INDEMNITY)
To,
The Postmaster
________________________________________(Name
of the Post Office)
In consideration
of your payment or agreeing to pay me/us________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________________
name(s) of the legal
heir(s)], the sum of Rs______________________only (Rupees_____________
____________________________________only)
Pertaining to NSC/KVP
certificate registered under Nos__________________________ ___________
____________________ _____________________________________________________________
_____________________________________________________________
with your Post Office in the
name of ___________________________
____________________________________________without
production of Letter of Administration
0r a Succesion Certificate to the estate of the deceased __________________________________(name
of the depositor), I/we and we___________________________________________________
_____________________________________________________________ (sureties) do hereby for ourselves and our
heirs , legal representatives, executors and administrators jointly and
severally undertake and agree to indemnify you and your successors and assigns
against all claims, demands proceedings , loss damage, charges and expenses
which may be raised against or incurred by you by reason or in consequence of
having agreed to pay / or paying me /us the sum as aforesaid.
In witness
whereof we have hereunto set my/our hands at this ______ __________________ day
of ________________________ in presence of witnesses.
____________________________________________
___________________________________________
Signed
and delivered by the above named heirs of the deceased.
(2)
Signed and delivered by the above named sureties,
(Signatures, names and
addresses)
1.___________________________________________________________
2.____________________________________________________________
Signatures, names and addresses of
witnesses,
1._________________________________________________________________________________________________________________________
2.___________________________________
ATTESTED
NOTARY PUBLIC
(1)
ANNEXURE-II
(Affidavit)
To,
The Postmaster,
________________________________________(Name
of the Post Office)
I/we_________________________________________________________
_______________________________________________________________________ ___________________________________________________
Husband/ wife of Late
____________________________________________________
aged_____________,aged_______________,aged______________,aged____________
aged_____________ and aged
_______________ sons/daughters of said Late ________ ________________________
,resident of_______________ _____________________________________________________________
_____________________________________________________________ do hereby declare
and solemnly affirm as under :
(1) That I/we am/are the only heir(s) of the
deceased__________________________ who died at_____________
____________________ on______________________ I/we alone represent the estate
of Shri/Smt ______________________________
(2) That the deceased________________________________________
did not leave any will and therefore I/we are the only successor(s) to the
estate of the said deceased.
DEPONENTS 1.__________________________________________________
2.__________________________________________________
3.__________________________________________________
4.__________________________________________________
5.__________________________________________________
6.__________________________________________________
DEPONENTS
(2)
Verification: I/we ,the above named deponents do hereby on solemn affirmation in
_____________________________( name of place ) that the contents of this
affidavit are true to the best of my/
our knowledge and nothing materials have been concealed.
Date_______________________
1.__________________________________________________
2.__________________________________________________
3.__________________________________________________
4.__________________________________________________
5.__________________________________________________
6.__________________________________________________
DEPONENT
ATTESTED
OATH COMMISSIONER
(1)
ANNEXURE
III
(LETTER
OF DISCLAIMER ON AFFIDAVIT)
To,
The Postmaster,
__________________________________________________(name of the Post Office)
I/we:
(i)___________________________________________________ Husband/wife of
_____________________________________,Resident of _____________________________________________________________
_____________________________________________________________ (ii)
_______________________son/daughter of ______________________ (iii) _______________________son/daughter of
______________________
(iv) _______________________son/daughter
of ______________________
(v) ___________
____________son/daughter of __________________ ___ (vi)
_______________________son/daughter of ______________________
do hereby
declare and solemnly affirm as follow:
(1) That Shri/Smt _______________________________________died
in estate on leaving behind us__________________________________
__________________________________________his/her only heirs.
(2) That I/we _________________________________heir(s) of
our Late father/mother for my/ourselves and on behalf of my/our heir(s),
executors, representatives and assigns to hereby relinquish our claims to the
NSCs/KVPs with maturity value of Rs___________________________________________
_______only
Is
issued by _________________________(name
of the Post Office)
in
the name of the estate of the objection whatsoever in the balance in the above
referred account(s) together with interest, if any, accrued thereon being paid
by the Post Office to Shri/Smt::
DEPONENTS 1.______________________________________________
2.______________________________________________
3.______________________________________________
4.______________________________________________
5.______________________________________________
6.______________________________________________
(2)
DEPONENTS VERIFICATION: I/we the above named deponents do hereby verify on
solemn affirmation that the contents of this affidavit are true to the best of
my knowledge and nothing material has been concealed .
Dated _____________________
1.______________________________________________
2.______________________________________________
3.______________________________________________
4.______________________________________________
5.______________________________________________
6.______________________________________________
DEPONENTS
I identify the deponent(s) who is/are personally known
to me and who has /have signed in my presence.
Dated______________________
OATH COMMISSIONER