LETTER OF DISCLAIMER (To be stamped as per the Stamp Act applicable to the State)
The Branch Manager
_________________
----------------------------
Dear Sir,
___________________________________*Account No _______________________in the
name of Shri/Smt./Kum._________________________________________________________ Balance ₹____________________________________________________________
With reference to the above account, I/We, the following legal heirs of the late Shri/Smt./Kum._____________________________________________________________ ___ (Name of the deceased account holder), have to advise that we have no interest in the above assets and as such we have no objection to your paying the balance amount lying in the above account(s) with you in the name of the aforesaid Shri/Smt./Kum __________________________ ____________________________(Name of the deceased account holder) to Shri/Smt./Kum.
Such delivery of the payment of the balance in the above account(s) would be completely binding on us and we will not question the Bank’s action in so doing if any proceedings. I/We undertake to bind ourselves, our heirs and legal representatives not to revoke the declaration made herein.
Name(s) of the Claimants
Sr. No (who relinquish their rights) Age(yrs) Signature
Signed before me this ______day of _______________20____
Notary Public/Magistrate) *fill in here the type of account viz. SB/R.D/Term Deposit, Current etc. Annexure B AFFIDAVIT (To be stamped as per the Stamp Act applicable to the State)
I/We_____________________________________S/D/O______________________ residing at _________________________________________________ and _______________________ __________________________S/D/O_______________________________________resi ding at ___________________________________________________________do hereby make oath*/solemnly affirm and say as follows: That Shri/Smt./Kum. _________________________________ (Name of the deceased) hereinafter, referred to as “the deceased” died intestate on ____________at _______________
2. That we know the deceased and his/her family since the last_ _________ years.
3. That at the time of his death the deceased left surviving him/her the following persons who according to the law by which they are governed, are the only legal heirs of the deceased entitled to succeed to the estate of the deceased on an intestate succession:
SNO. Name Age(yrs.) Relationship with the deceased
4. That I am not related in any manner whatsoever to the deceased or any of the above- mentioned persons nor have we any claim or interest of whatsoever nature in the estate of the deceased.
5. That we are informed, and we verily believe that the deceased has left certain deposits*/ assets with the ________________Bank ________________________________branch, to which the above-mentioned persons are entitled to claim.
6. That we are making this solemn declaration sincerely and conscientiously believing the same to be true and with full knowledge that it is on the strength of this declaration that the _____________________Bank _____________________________branch, has agreed at our request to make payment of the amount of the deposits/ to deliver the assets to the above mentioned persons without insisting on production by them of a grant of legal representation to the estate of the deceased from a competent Court. Sworn*/ solemnly affirmed at this ________ day of _________________ 1. ___________________________
2.___________________________
in the presence of ___________________ before me
*(Delete whichever is inapplicable) Judge / Magistrate / Notary Annexure C
LETTER OF INDEMNITY (To be duly stamped as per the Stamp Act applicable to the State) (Letter of Indemnity with respect to payment of Balance in the Deceased Constituents Account without production of Legal representation) To, The Branch Manager _______________ __________________
IN CONSIDERATION of your paying or agreeing to pay us,
Insert here the names of the claimants 1 ___________________________________________ 2. ___________________________________________ 3. ___________________________________________ 4. ___________________________________________ 5. ___________________________________________
The sum of Rupees__________________________________________standing at the
credit of Saving Bank / Current / R.D Account No. etc. with your Bank in the name of Shri/Smt./Kum. __________________________________since deceased, without production of Letter of Administration or a Succession Certificate to his/her estate, we
Insert here the 1
Names of the 2 suret(y/ies 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 assign against all claims, demands, proceedings, losses, damages, charges and expenses which may be raised against or incurred by you by reasons or in consequence of your having agreed to pay / or paying me / us the said sum as aforesaid.
Signed, Sealed and delivered by the above named on this ________day of
4._____________________5. ____________________ (Heirs/claimants of the deceased) SIGNED AND DELIVERED by the above named
1._________________________________ 2. _______________________________ (Sureties) Annexure D Opinion Report on Surety
1. Name in Full 2. Address
3. Academic Qualification 4. Age 5. Occupation
(If employed, please state the
name of the employer and since when Employed). 6. Present Monthly Income / Salary (Attach a Salary Certificate, if income is by way of salary) 7. Total yearly income from all sources 8 No. of dependents 9 Personal Assets a. Immoveable Property viz. land / Building / flat etc. give details acquisitions, present value etc. b. Investments (Fixed Deposits, Shares etc. if any) c. Life Insurance Policy d. Other Assets e. Details of Bank Accounts, if any (Name and address of Bankers with Account No (Current / Savings) to be furnished). 10 Personal Liability if any 11 Please indicate whether surety is related to claimants Yes/No 12 Period for which claimants are known Yrs. I confirm that all the statements made by me in this application are true and correct and have been made by me.
Place:
Date: Signature (Surety) Remarks of the Divisional Manager/ Branch Manager Divisional Manager/ Branch Manager Annexure – E
Form of Inventory of Contents of Safe Deposit Locker
(To be used where there is no nomination or survivorship clause)
The following inventory of contents of Safe Deposit Locker No. ___________ located at _____________________________ Branch of ___________________________ Bank. * hired by Shri/Smt. _________________________________ (deceased) in his/her sole name. *hired by Shri/Smt. (i) ___________________________________ (deceased) (ii) ___________________________________ jointly (iii)____________________________________ was taken on this ______________ day of _________________ 20______.
SNO. Description of Articles in Safe Deposit Lockers Other identifying particulars
if any
For the purpose of inventory, access to the locker was given to the legal heir(s)/a person mandated by the legal heir(s) and surviving hirers
By breaking open the locker under his/her/their instructions.
Who produced the key to the locker (Delete whichever is not applicable)
The above inventory was taken in the presence of:
Legal heirs of deceased joint hirer(s)/person mandated by legal heirs
Hereby acknowledge the receipt of the contents of the safe Deposit locker comprised in as set out in the above inventory together with a copy of the said inventory.
(* Delete whichever is not applicable) Annexure – F
Form of Inventory of articles left in Safe Custody
(To be used where there is no nomination or survivorship clause)
The following inventory of articles left in safe custody with
_______________________branch of _______________ Bank by Shri/Smt. __________________ (deceased) under an agreement/receipt dated _____ was taken on this, ______ day of _____20 ____.
SNO. Description of Articles in Safe Custody Other identifying particulars, if
________________________________________________ ________________________________________________Legal heirs and Shri/Smt. _______________________________________________ _______________________________________________ ________________________________________________ Surviving hirers Hereby, acknowledge the receipt of the contents of the safe Deposit locker comprised in as set out in the above inventory together with a copy of the said inventory.
Shri/Smt._________________________Signature __________________ Shri/Smt. ._______________________ Signature ___________________ Date & Place ________________________ (* Delete whichever is not applicable) Annexure – G
LETTER OF INDEMNITY WITH RESPECT TO DELIVERY OF ARTICLES KEPT IN
BANK’S SAFE DEPOSIT VAULT / SEALED BOXES ETC. OF THE DECEASED WITHOUT PRODUCTION OF LEGAL REPRESENTATION (To be stamped as an agreement) To, ________________________ ________________________
In consideration of your delivering or agreeing to deliver to me/us
_______________________________ _______________________________ (Insert here the names of the heir(s) of the deceased) The articles/properties mentioned hereunder - Safe Deposit Details of the Weight Value Locker articles/proper Description No./Sealed Box in Safe Deposit Account No.
and held in the name(s) of ___________________________ since deceased, without
production of any succession certificate/ letters of administration to his / her / their estate or a certificate from the Controller of Estate Duty to the effect that the estate duty has been paid or will be paid or none is due,
(State here the names of the heir(s) of the deceased).
and we ____________________________and________________________________ (State here the name of the sureties) do hereby for ourselves and our heirs, legal representatives, executors and administrators, jointly and severally undertake and agree to indemnify you, the Bank, and its successors and assigns against all claims, demands, proceedings, losses, damages, charges and expenses which may be raised against you or incurred by you by reason or in consequence of having delivered or agreed to have deliver to me/us the above mentioned articles/property of the deceased from the safe deposit locker/sealed boxes in safe deposit. Signed sealed and delivered by the above named on this ______ day of ________ Two thousand and ______.
SIGNED AND DELIVERED by the above named
(1)____________________________________ (2)____________________________________ (Heirs of the deceased)
Received from _____________________ Bank _______________________ Branch
Rs._______ (Rupees ____________________________________ only) by Banker’s Cheque No. _____________________ dated ________________ in favour of _____________________________________________being the balance standing at the credit of Saving Bank Account/ Current Account/ TDR/ STDR No. _________________ in the name of ____________________________________. The balance has been paid to me as per Bank rules.
Date : Signature of Claimant
Place: Name:
Declaration in case funds are settled in favour of Minor
I, ____________________________________________, father/mother and natural
guardian of ______________________________________________ hereby certify that the proceeds of your Banker’s cheque No. _____________ dated _______________ favouring ___________________________ issued by you in full and final settlement of the balance in Account No. _________________ of Late ____________________________________ will be utilized for the benefit of the minor only.
Place: Date: ___________________ (Signature of Guardian) Annexure H
LETTER OF INDEMNITY In respect of payment of balance in deposit accounts of Missing person presumed to be dead (To be stamped as an agreement)
The Branch Manager Place: ____________
Bank of Baroda Date: ____________ __________________
WHEREAS Mr/Mrs/Miss _______________ (name of the Missing person presumed
to be dead) of _________________ (address of the Missing person presumed to be dead) had at the time of his/ her missing to his/her credit a sum of Rupees _______________ (balance in the account as on the date of missing) which including interest upto __________ (date of repayment) amounts to ` __________ (amount now being repaid) in__________ (nature of account) account/s with the Bank of Baroda, _____________ Branch, (hereinafter referred to as "the said Bank").
AND WHEREAS ____________________ (names of the persons claiming
repayment) _____________________ of _______ (address) _________________ (hereinafter referred to as "the said claimant/s") and _____________ have represented to the said Bank that the said claimant/s is/are entitled to have the said sum paid to the said claimant/s and have accordingly requested the said Bank to pay the said sum to the said claimant/s.
AND WHEREAS the said claimant/s and Mr/Mrs/Miss __________ (names of the surety/ies) ________________ of _____________ (address of surety/ies) ___________ have agreed to indemnify the said Bank in respect of such payment. NOW IN CONSIDERATION of the premises we, __________ (name/s of claimant/s) __________________ and _________________ (name/s of surety/ies) _________ for ourselves and our respective heirs, executors and administrators jointly and severally agree and undertake that the said 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, costs, charges, expenses and demands whatsoever in respect of the said payment.
