Format of Claim Application from to be obtained from Nominee
To
The Branch Manager
HDFC Bank Limited
1. Name in full
2. Occupation
3. Address – Office
- Residence
4. Date of birth & Age of Nominee
5. Name of the nominees
father/husband
6. Name of the deceased customer
7. Address of the customer
8. Age of the customer
9. Relationship, if any, of the Nominee
with deceased constituent
10. Whether the nominee is in
possession of cheque book/ATM
card/Deposit Advice/Locker key/
Acknowledgement of nomination
11. If not, the reasons why the
nominee is not in possession of the
same
12. How did the nominee come to
know of the nomination
13. Name of the bank and branch with
whom the nominee is having an
account
14. Particulars of deposits and lockers
on which the Nominee claimant is
registered
I request the Branch Manager, HDFC Bank Limited, _______________________ branch, to pay the
proceeds of the deposits/deliver the contents of the locker mentioned above to me as nominee
of ________________________________________ (deceased constituent). I hereby declare that the
above information furnished is all true, correct and full and that I have not omitted or suppressed
any information called for under any of the above columns.
Date:
Place:
_____________________________
Signature of the Claimant (Nominee)
For Official Use of the Bank
Views/Recommendations of the Personal Banker:
(Furnish details of the deposits and enclose duly signed inventory of locker contents)
___________________________
Date : Signature of the Personal Banker
Branch Manager Comments and Sanction:
After proper scrutiny of the claim application, personal interview with the claimant(Nominee) and
verification of the death certificate and declaration, I sanction the above claim as recommended
by the Personal Banker.
___________________________
Signature of the Branch Manager
Date:
Format of Declaration from the Appointee of a Minor Nominee
To
The Branch Manager
HDFC Bank Limited
_______________Branch
I, Shri/Smt./Kum _____________________________ Nominee/appointed on behalf of the minor nominee
hereby declare that I am the Nominee /appointed on behalf of the minor nominee of the deceased Shri/Smt.
_____________________________. I further declare that I am nominated to claim the deposit monies/articles
held in Safe Custody/Safety Locker with _____________________ branch by Shri/Smt. deceased.
The deposit monies/articles held in Safe Custody/Safety Locker are held in account No(s).
________________________ Locker No. (s) __________________ / Safe Custody Receipt No.
________________________________ of Shri/Smt. ___________________________deceased.
Shri/Smt.____________________________
Address ______________________________ Signature ___________________
(Nominee/appointed on behalf of minor nominee) Date ________________________
Witness:*
1. Magistrate or Judicial Official 2. An officer of Central or State Govt.
Name ____________________________ Name ____________________________
Address __________________________ Address __________________________
__________________________________ __________________________________
Signature _________________________ Signature _________________________
3. An officer of a Bank
Name ____________________________
Name of the Bank / Branch ___________
Signature _________________________
OR
4. Two persons acceptable to the bank
Name ____________________________ Name ____________________________
Address __________________________ Address __________________________
__________________________________ __________________________________
Signature _________________________ Signature _________________________
(*Strike out whichever is not applicable)
