Annexure – 2

Settlement of Claims in respect of deceased Depositors

Check-list of Documents

Claims Document obtained : Yes/ No

1. Accounts with Nomination clause:
(i) Application for Deceased Claim
from
Nominee/Guardian of nominee
(Annexure-3)
(ii) Copy of Death Certificate (Verified
with
(iii) Identity proof (as defined in Part=
5)
2. Joint Accounts with Either of Survivor clause:
(i) Application for Deceased Claim
from
Survivor(s) (Annexure – 3)
(ii) Copy of Death Certificate (Verified
with
original)
3. For cased other than Nomination/ Joint Accounts
with survivor clause:
(for amounts upto threshold limit)
(i) Application for Deceased Claim
(Annexure
-4)
(ii) Copy of Death Certificate
(iii) Letter of Indemnity signed by
claimant(s)
(Annexure – 5)
4. Receipt (Annexure -6)
 Annexure – 3
Application for Deceased Claim
( To be used when account has nomination or is a joint account with
survivor clause)
From
_____________________
_____________________
_____________________
To
The Branch Manager,
……….. Bank
_________________ Branch
Dear Sir,
Re: Deceased Account
Late Shri/Smt …………………
Account No (s) ……………….…
I/We advise, the demise of Shri/Smt. _______________________________ on
_____________. He/She holds the above account(s) at your branch. The account is in
the name(s) of :
______________________________________________________________
A. In case of Nomination
I, ………………………………… son/daughter of Shri …………………………………
…………………………………. residing at………………………………………………
………………………………………………………………………………………… am
(i) the registered nominee in the above account (s)
(ii) the person authorized to receive payment on behalf of Master/ Miss
………………………………………………………………………………. who
is the nominee in the above account(s) and is a minor as on the date of the
claim.
Please settle the balance in the account in the name of the nominee. I/We receive the
payment as trustee(s) of the legal heirs of the deceased.
B. In the case of joint account
I/We request you to delete the name of deceased person and continue the account in
my/our name(s) with same mode of operations.
I/We submit photocopy of the following document(s) together with originals. Please return
the original to us after verification.
Death Certificate issued by _______________________
Identity proof (required in nomination cases) _______________________
Place: Yours faithfully,
Date : {Claimant(s)}
 Annexure – 4
Application for deceased claim
(To be used for cases other than nomination/joint account with survivor
clause)
From,
_____________________
_____________________
_____________________
To,
The Branch Manager
____________ Bank
____________________ Branch
Dear Sir,
Re: Deceased Account
Late Shri/Smt. ……………………..
Account No (s)…………………….
I/We advise, the demise of Shri/Smt. _______________________________ on
_____________. He/She holds the above account(s) at your branch. The account is in
the name(s) of :
______________________________________________________________
I/We lodge my/our claim for the balances with accrued interest lying to the credit of the
above named deceased who died in testate. I/We am/are the legal heirs of the above
named deceased and lodge my/our claim for payment as per the bank’s rules and
discretion. The relevant information about the deceased and the legal heirs are as under:
1. Names in full of the parents of the deceased:
Father____________________________________________________________
Mother ___________________________________________________________
2. Religion of the deceased: _____________
3. Details of living (i) Husband (ii) Wife (iii) Children (iv) Father (v) Mother (vi)
Brothers (vii) Sisters (viii)Grand children. If Hindu Joint Family, the name and
address of the Kart and Co-parceners with their respective ages.
Full Name/Address Occupation Relationship with Deceased Age
1. _______________ ___________ _________________ ______
2. _______________ ___________ _________________ ______
3. _______________ ___________ _________________ ______
4. _______________ ___________ _________________ ______
5. _______________ ___________ _________________ ______
6. _______________ ___________ _________________ ______
4. Name or names of the Guardian/s
Of the minor, Children of the depositors _____________________________
(a) Whether Natural Guardian
(b) Whether Guardian appointed by
Court of Law in India. If so, attach a
Certified copy or duly attested copy
Of such order ______________________________
( c) In whose custody the
Minor/Minors is/are?
5. Claimant/s name/s and address in full
(i) _________________________________________________________________
(ii) _________________________________________________________________
(iii) _________________________________________________________________
I/We submit the following documents. Please return the original death certificate to us
after verification.
1. Death Certificate (Original + 1 photocopy) issued by
2. Letter of indemnity
We request you to pay the balance amount lying to the credit of the above named
deceased to ……………………………………………………………………. On my/our
behalf.
I/We hereby solemnly affirm that the above statements are true and correct to the best of
my/our knowledge and belief.
Place : Yours faithfully,
Date : Signature of Claimant (s)

Name of Claimant Address Signature

 Annexure - 5
Affidavit cum Indemnity Letter
In respect of payment of balance in deposit accounts / contents of safe deposit
locker/ safe custody articles of deceased person;
(To be stamped with the duty payable for affidavit & Indemnity bond)
I/We Mr/Ms/Miss
(name/names of the claimants),
(s/o, w/o, d/o), aged,
address,
do hereby solemnly affirm and state as follows.
1. I/We am/are the legal heirs of Mr/Ms/Miss
(name of deceased account holder) and the deceased is my/our
(father/mother/wife/husband/son/daughter etc.)
2. I/We further state that I/We the following legal heirs are the only legal heirs
entitled to claim the balance deposit/amount /jewels/ ornaments and other
valuables the contents held in the locker/safe custody:-

No. Name Age Relationship to the deceased

1.
2.
3.
4.
5.

3. I/We further state that the deceased was holding an account (hereinafter
referred to as “the account”) (specify the account details) _____________ in
_______________ branch of ______________ bank (herein after referred to as
“the Bank”). At the time of the death of the deceased the account was having a
credit of Rs_________ (balance amount in the account) which includes interest
upto __________ (date of payment) amount to Rs.__________ (amount being
now paid).
35
4. I/We affirm that I/We am/are the sole legal heirs of the deceases who are
entitled to receive the amount standing in the credit of the account belonging to
the deceased.
5. I/We have requested the bank to make the payment of the amount standing in
the credit of the account belonging to the deceased together with interest thereon
as applicable to shri/smt _______________ being one of the legal heirs for and on
behalf of all the legal heirs.
OR
I/We have requested the bank to hand-over contents of the safe deposit
locker/items held in safe custody to Shri/Smt. ____________________ being one
of the legal heirs for and on behalf of all the legal heirs.
6. I/We are aware that the Bank has agreed to settle our claims relying on this
affidavit and I/We agree to indemnify the bank in respect of such payment or
delivery of the contents of items in safe deposit locker or held in safe custody
against any claim made by any person for the amount standing to the credit of the
account of the deceased.
7. I/We for ourselves and my/our respective heirs, executors and administrators
jointly and severally agree, affirm and undertake that the bank, its successors and
assigns and its managers, agents, officers and servants and their respective
estates and effects are and shall from time to time and at all times hereafter be
kept safe and saved harmless and indemnified for and in respect of such payment
and against all actions, losses, cost, charges, expenses and demands whatsoever
in respect of the said payment or delivery of the contents of items in safe deposit
locker or held in safe custody.
All the averments made herein before are true and correct and I/We put my/our
signature/mark on this __________ Day of __________ 200___ at ______ in the
presence of ____________.
Signatures(s) of deponents. (claimants)
Signature of Witness

Affidavit to be attested by Notary Public.

 Annexure – 6
RECEIPT
Received with thanks from XXX Bank, ____________________________branch,
a sum of Rs._______________
(Rupees__________________________________ only) by Banker’s Cheque No.
_____________________ dated ________________ in favour of
_______________________________________________________________in
full and final settlement of my/our claim as successor on the balance in
________________ Account(s) No(s) ______________________ standing in the
name of the deceased Shri/Smt/Kum.
_______________________________________________________ I/We do not
have any other claim from the Bank henceforth.
Place :
Date :

(Signature of all the legal heirs

over a revenue stamp)

Declaration in case funds are settled in favour of a Minor

I, ________________________ father and natural guardian of
___________________ hereby certify that the proceeds of your Banker’s Cheque
No. _________________ dated ______________ favouring
_________________ issued by you in settlement of the balance in account
number ___________________ of Late _____________________ will be utilized
for the benefit of the minor only.