Classification - Internal
Annexure 19
Format of Claim Application from Legal Heirs under Fast Track
The Branch Manager, Date:
HDFC Bank
____________ Branch
Dear Sir,
Re: Claim for Balances and Other Assets
I/We, the undersigned, hereby declare that I/We am/are the rightful legal heir(s) of the deceased
______________________________________, entitled to –
a) receive the amount due on the deposit(s) detailed below,
b) receive the contents of safe deposit locker(s)/articles in safe custody,
c) shares/securities held in safe custody.
Accordingly, I/We hereby submit my/our claim and furnish the requisite particulars/ documents/indemnities,
etc. as
prescribed by the bank.
1. Full name of the deceased account holder
2. Details of Deposit Account(s) Account Number, Balance
3. Details of Safe Deposit Locker(s)
4. Details of Articles in Safe Custody
5. Details of Shares & Securities in
Safe Custody
6. Details of Overdrafts if any
7. Particulars of all the legal heir(s) Name, Age, Relation to the Deceased
8. Are there any other claimant(s)/heir(s) other than those
mentioned above and joining in the Indemnity Bond who
are also entitled to the share in the property left by the
deceased as per the Personal Laws applicable to the
deceased?
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9. Has the deceased left a Will? Who are the executors named
in such will and whether probate is obtained? If not, why
Probate has not been obtained?
10. If the deceased has not left a Will, has any legal
representation been obtained to his estate, such as
Succession Certificate, Letters of Administration,
Administrator General Certificate? If so, by whom?
11. If the deceased was married, did he/ she leave a
widow/widower and/or a child or children of a predeceased
child? Any minors? If so, is there a legal or natural
guardian?
12. 'If the deceased did not leave a Widow/Widower and a
child or children or issue, did he/she leave him/her
surviving any parent, "brother, sister or children of a
predeceased brother, or sister?
13. Is the property left by the deceased a part of the Joint
Hindu Undivided Family property? If yes, who was and is
the Karta of HUF?
14. Was the deceased doing any business or was he in service?
If the service, was he entitled to any provident Fund? If he
was whom did he nominate to receive such Provident
Fund? Have Provident Fund dues been paid? If so, to
whom?
15. Proof of claimant(s)' right to claim the amount lying to the
credit of the deceased and other assets with the bank, in
the absence of the representations to the estate of the
deceased
16. Whether the claimant(s) has/have any liability (for advance
raised from the Bank) or indirect liability (as guarantor for
advance raised by others), If so, please state the amount
and name of the borrowers. If not, state accordingly.
17. Whether the claimant(s) is/are in possession of Cheque
Book(s) / ATM Card / Deposit Advice/Locker Key/Safe
Custody Receipt, etc. Furnish details and enclose these
18. If not, the reasons why the claimant(s) is/are not in
possession of these items
19. How did the claimant(s) come to
know the details of above referred accounts and other
banking relationships of the deceased
20 Any other facts which the applicant(s) want(s) to state in
support of his/her/ their claim
I/We hereby declare that the above statements and answers are true. I/We enclose an Indemnity Agreement
signed by me/all of us along with our witnesses. I/We request that bank to –
▪ pay the balances, and/or
▪ deliver the contents of safe deposit locker, and/or
▪ articles in safe custody, and/or
▪ shares & securities in safe custody,
to –
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Name of legal heirs
1)
2)
3)
who is/are hereby irrevocably authorised by me/us to receive the above stated sums/other assets and give a
valid discharge/receipt (binding me/all of us) to the bank? I/We also enclose a separate Letter of Disclaimer in
Form 'A'
prescribed by the bank.
I/We hereby authorise the bank to recover the outstanding, together with interest thereon, any overdraft/loan
account
standing in the name of the deceased. The bank may also recover the outstanding service charges, or any
other dues
payable by the deceased.
I/We request the bank to kindly sanction my/our claim made above.
Name of Claimant(s) Signature of Claimant(s)
1. _____________________________ __________________
2. _____________________________ __________________
3. _____________________________ __________________
4. _____________________________ __________________
5. _____________________________ __________________
Thumb Impression of claimant (if illiterate)
Name of the Claimant(s) ______________________
Witness for Thumb Impression
Name ____________________________________________
Address _____________________________________________________
Note:
In case the claimant is illiterate, he/she should affix his/her Thumb impression in the specimen for signature of
the claimant, which should be witnessed by a person known to the Bank.
(Following declaration to be given by the claimant who is illiterate or who does not understand English)
"I declare that above questions were explained to me and the answers thereto have been recorded at my
instance
as per my instructions and the same have been read over to and understood by me and that I have affixed my
signature/thumb impression hereinabove after satisfying myself that they been correctly recorded".
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Witness ______________________
Signature of the Claimant(s)
Thumb Impression/ Signature of the Claimant(s)
---------------------------------------------------------------------------------------------------------------------------------------------------
------------
ACKNOWLEDGEMENT
We acknowledge receipt of Claim Application form in respect of the Account No (s)________ / Locker
No_______ / Articles or Shares in Safe custody___________ of
______________________________(Name of the deceased).
Yours faithfully,
Date: ___/___/_____ Signature of Bank Official with Seal
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Format of Form 'A’ – Letter of Disclaimer
The Branch Manager,
Date:
HDFC Bank
____________ Branch
____________ City
Dear Sir,
Re: Refund/Delivery of Balance and Other Assets belonging to the Deceased
Shri/Smt. _______________________________ who holds the following accounts/assets with you died on
_________________.
Account No./Locker No./Safe Custody No., etc. Balance
I/We, the undersigned is/are the legal heirs of the deceased have applied to you for refund/delivery of the
amount(s)
outstanding in the above account(s) and delivery of the contents of locker(s), articles in safe custody, shares &
securities
in safe custody.
I/We hereby authorise Shri/Smt. _____________________________________ and Shri/Smt.
______________________________to receive the claim money/assets detailed above on our and their own
behalf.
I/We declare that the claimant Shri/Smt. _______________________________ and Shri/Smt.
____________________is/are the legal representative entitled to receive the amount of deposit/other assets
in the name of the deceased and that I/We have no objection, if the Bank in pursuance of the request by
me/us,
refunds/delivers the amount/assets to him/her/them.
Legal heir’s details
Sr. Name of Legal Heir Age Relation Address OVD Type & No.
No.
Thanking you,
Yours faithfully,
(Legal heir’s)
_________________
_________________
_________________
_________________
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Classification - Internal
Annexure 21
Format of Letter of Indemnity
(on applicable state stamp paper)
HDFC Bank Ltd.
_____________ Branch
_____________ City
IN CONSIDERATION OF your paying or agreeing to pay the balances, delivering or agreeing to deliver contents
of safe deposit locker,
articles kept in safe custody, shares & securities in safe custody held at the credit of and/or in the name
of Shri/ Smt __________________, the deceased as mentioned hereunder:
Account No. Nature of Deposit Balance/Principal Amount
Safe Deposit Locker Details of the Inventory of the Locker/Articles in Safe Custody
No./Sealed Box in Safe
Custody Account No.
Description Weight Value
Shares/ Securities Details of Shares & Securities
Custody A/c. No.
Date of Issue, Name of the Company, Distinctive Nos./ Folio No., No. of Shares/
Securities, Face Value, Total Face Value, Total Market Value as on _______
without production of Letters of Administration or a Succession Certificate to his/her estate or a certificate from
the Controller of
Estate
Duty to the effect that estate duty has been paid or will be paid or none is due.
I/We;
1)
2)
3)
4)
5)
being the claimant(s) of the deceased, do hereby, for above-mentioned 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, losses, damages, charges and expenses which may be raised against or incurred by you by reason
or in consequence
of your having agreed to pay/or paying the said sum as aforesaid, having delivered or agreed to deliver the above
mentioned
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Classification - Internal
assets of the deceased to the claimant(s).
Signed, sealed, and delivered by the above named on this ___________ day of __________
Two thousand ____________ at _________________.
Signed and Delivered
1. ______________________
2. _______________________
3. _______________________
4. _______________________
5. _______________________
(Heirs of the Deceased)
Signed and Delivered
by the above named
1.______________________
2._______________________
(Witnesses)
(If claim amount is above Rs 50,000)
(Please take OVD of the witnesses
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