(1)
FORM FOR CLAIM OF BALANCE IN THE SAVINGS ACCOUNT
OF DECEASED DEPOSITOR
(Application
for closure of Savings/RD/TD/MIS/NSS
Account by Nominee/Legal Heirs)
To,
The Sr PM/PM/SPM
____________________________________________________________
Subject- Application for Withdrawal/ Closure of
Account
Sir,
I/We___________________________________________________________________________________________________________________________________________________________________________________ the
Nominee(s)/Legal Heir(s) of Late Shri/Smt _____________________
__________________________________, the Depositor of the Savings/ RD/TD/MIS/NSS Account No- __________________________________
_____________________________________________________________
_____________________________________________________________ standing at PO ________________ _______________________________ wish
to Withdraw the entire amount standing to the credit of the deceased in the
said account including interest admissible as per rules.
Please find
enclosed:-
I. Certificate to the death of the Depositor.
II. Pass Book of the Depositor.
*III. Certificate in regard to the Death of the
Nominee/Nominees appointed by the Depositor.
**IV. Succession Certificate / Letter of
Administration / Probate of Will of the
Deceased Depositor under the Provisions of the Indian Succession Certificate
Act, 1925
@V. Letter of Indemnity
@VI. Affidavit
@VII. Letter of Disclaimer on
Affidavit
_______________________________________________
Signature or Thumb Impression of
Claimant / Legal Heirs
Date______________________
Place_____________________
(2)
Witness:
(1)______________________________(Signature)__________________________________________________________________________________________________________________(Name
and Address)
(2)______________________________(Signature)__________________________________________________________________________________________________________________(Name
and Address)
(FOR USE OF POST OFFICE)
Witness Accepted
Signature of Sr PM/PM/SPM/BPM
(With Designation Stamp)
Withdrawal of Rs__________________________________________
only (Rs_____________________________________________________ only) is
sanctioned which pertains to balance in the account of deceased inclusive of
interest admissible as per rules.
Signature
of Sr PM/PM/SPM/BPM
(With Designation Stamp)
Received Cheque No ______________________
__________________ dated_______________________
for the sum of Rs______________only
Rs_____________________________________________ _________only )
From _________________________________(Name of Post
Office) as per details furnished above in the settlement of our claims.
Date__________________
Place_________________
________________________________________
Signature /Thumb
Impression of the claimant(s)
*Delete wherever is
not applicable.
**Strike off if
there is valid nomination.
@To be produced by
legal heirs, in absence of nomination(s) for claims exceeding prescribed limit
of Rs 1 lac.
(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)
Standing in the account
No________________________ ___________ ___ under__________________________________________(name
of scheme) 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
solemny 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 ___________________________________ 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
balance of Rs________________________________________
in
account No ____________________________________________
________________________________________________________ of ________________________________________(name
of scheme)
at
____________________________________( name of 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:
1.______________________________________________
2.______________________________________________
3.______________________________________________
4.______________________________________________
5.______________________________________________
6.______________________________________________
(2)
DEPONENT 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.______________________________________________
DEPONENT
I identify the deponent(s) who is/are personally known
to me and who has /have signed in my presence
Dated______________________
OATH COMMISSIONER