1.

ANNEXURE C 2.
3.
BOND OF INDEMNITY/SURETY" 4.
The sum of Rupees. Standing at the। **credit of
(To be duly stamped as per the Stamp following deposit accounts with your bank in the
Act applicable to the State) name of Shri/ Smt/ Kum.
Since deceased, without production of Probate of Will
(For Settlement of Claim in Deposit or Letter of Administration Succession Certificate to
Accounts of Deceased Customer his/her estate
without production of Legal
Documents)

The Branch Manager

Indian Bank

Date:

Name of Branch We______________________________________________________________________

_________________________________________________________________________
___________________________________________Mention here the Name of
IN CONSIDERATION of your paying claimants /sureties) do hereby for ourselves and our heirs, legal
or agreeing to pay us, (Mention here representatives, executors and administrators, jointly and successors
and assign against all claims, demands, proceedings, losses, severally
the name of the claimant/s) UNDERTAKE AND AGREE indemnify you and 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 the said sum to
the claimants as aforesaid.

SIGNED AND DELIVERED by the above named

1._________________________________________
2_______________________________________
3.________________________________________
4.________________________________________
(Heirs/claimants of the deceased customer)

Signed and delivered by the above named on this________ day of two thousand,_____________

SIGNED AND DELIVERED by the above named Suretles

1._________________________________________

2_______________________________________

Signed and delivered by the above named on this ________day of two thousand_________________

*Surety is applicable only in case of claims above the threshold limit of .15 Lakhs
 Signed and delivered by the above named on this day of two thousand. _

•SIGNED ANO DELIVERED by the above named �uretles

!.. _

2.

Signed and delivered by the above named on this day of two thousand _

• svrety Is applicable only In case of claims above the threshold limit of \',15 Lakhs.

Pase I 22
 .

...
rY/
,•{Delete whichever ls not applicable)

·./

OQlnl�n ReQ�d on�yreh'..

A. Details to be furnished by the surety,

Name In Full

Address

Academic Qualiflcatlon

Age

Occupation (If employed, please state the name of the employer

and since when employed).

Present Monthly Income/ Salary

earl Income from all sources

Total .
of dependents
No. .
Personal Assets ..

a. Immoveable Property, viz., land/ Building, etc; (please give details

of acquisition, present value, etc.)
Investments
b. (Term Deposits, Shares, etc., if any)

Life -
c. Insurance Policy

d. Other Assets
Details of Bank Accounts, If any (Name and address of Bank
with Account No. (Savings bank/ Current) to be furnished.

Liability, if any
Personal '

Please Indicate whether surety is related to claimants Yes/No

Period for which claimants are known Years.
J confirm that all the statements made by me In this application are true and correct to the best of my knowledge and belief.
..
Place:

Date: Signature of Surety

B. Remarks of the Bank Offlclal

" -
......

Paa•I u
 A�NEXURE D
LETTER OF DISCLAIMER
(To be duly stamped as per the Stamp Act applicable to the State)

The Branch Manager

lndlan Bank
Name of Branch:---------

Madam/ Dear Sir,

1. Details of deposit account(s)/ safe

custOdY artIcIes/ safe deposit locker In the name of Shrl/ Smt/
Kum.................................................................,. slnce deceased are as follows:
a. Oeposlt Accounts
Sr Nature of Deposits (SB / CA/ Account No. Amount Date of Maturity
TD, etc.) (In case of TD)

,
No.
1.

2.
\ 3.

4.

b. Safe Deposit Locker No. Mode of Holding:.

C. Safe Custody Article Receipt No.. _
Details of Articles (If known):--.-------------------

2. With reference to the above account(s)/ safe deposit locker/ safe custody articles, I/ We, the legal heirs of Shri/ Smt./
Kum.. (Name of deceased customer), have to advise that we have no Interest In the
above
deposits/ assets and as such we have no objection to your paying the •balance amount In the above account(s)/ releasing the contents
in safe deposit locker/ returning the safe custody articles lying with you in the name of the aforesaid deceased customer to Shri/Smt/
Kum.:
1.
2.
3.
4.
Such payment of the •balance in the above account(s)/ release of the contents In safe deposit locker/ return of the safe custody articles
would be completely binding on µsand we wlll not question the bank's action In doing so. I/ We undertake to bind ourselves, our heirs
and
legal representatives not to revoke the declaration made herein.

[Link] of the [Link] Legal Helr(s) (who Age (yrs) Signature

[Link]. relinquish their rights
1
'
2
3
4

Signed on this day of two thousand, _

• (Delete whichever Is not applicable

Paee I 24
 ...

ANNEXURE E
DECLARATION/ AFFIDAVIT
(To be duly stamped as per the Stamp Act appllca8'te�o the State)

(I/the claim amount ls more than threshold llmlt of r.1s Lakhs, the Declaration to be sworn as an Affidavit before a Notary
Pub/le I Judge/Magistrate)

l•------�---,---,-----------------S/0/O _

residing at ; do hereby make oath•/sofemnly affirmand

say as follows:

1. That Shrl/ Smt /Kum. ....,. (Name of the deceased

customer) hereinafter, referred to as "the deceased" died Intestate on at

2. That I know the deceased and his/ her family since the last years.
3. That at the time of his/ her 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:
7 [Link] Name �e (yrs.) Relationship with the deceased
\l I
� I
� -
� I

4. That I am not related in any manner whatsoever to the deceased or any of the above-mentioned persons nor have I any
claim or interest of whatsoever nat11re in the estate of the deceased.
S. That I am informed, and I verily believe that the deceased has left certain *deposits/safe deposit locker/ articles In safe custody with
the Indian Bank, branch, to which the above-mentioned persons are entitled to claim.
6. That I am 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 Indian Bank---------------------------------------branch, has agreed at my request to
make
payment of the amount of the deposits arid •deliver the articies in safe deposit locker/ safe custody to the above mentioned persons
without requiringproduction of a grant of legal document to the estate of the deceased from a competent Court by them.
• sworn/ solemnly affirmed at this day of two thousand, _

(Signature of Declarant) in the presence of _ before me

Notary Public/ Judge/ Magistrate

• (Delete whichever isnot applicable)
.. The declaration Is required to be sworn as an affidavit before a Notary Public/Judge/Magistrate only If the claim amountis above
the threshold limit of t.15 Lakhs.
 ANNEXURE C

BOND OF INDEMNITY/SURETY”

(To be duly stamped as per the Stamp Act applicable to the State)

(For Settlement of Claim in Deposit Accounts of Deceased Customer without production of Legal Documents)

The Branch Manager

Indian Bank

Date:

Name of Branch

IN CONSIDERATION of your paying or agreeing to pay us, (Mention here the name of the claimant/s)

1.
3.
2
3.

4.

The sum of Rupees. Standing at the। **credit of following deposit accounts with your bank in the name of Shri/ Smt/ Kum.

Since deceased, without production of Probate of Will or Letter of Administration Succession Certificate to his/her estate

We______________________________________________________________________________________________________________________________________________________
____________________________________Mention here the Name of claimants /sureties) do hereby for ourselves and our heirs, legal representatives,
executors and administrators, jointly and successors and assign against all claims, demands, proceedings, losses, severally UNDERTAKE AND AGREE
indemnify you and 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 the said sum to the claimants as aforesaid.

SIGNED AND DELIVERED by the above named

1._________________________________________

2_______________________________________

3.________________________________________

4.________________________________________

(Heirs/claimants of the deceased customer)

Signed and delivered by the above named on this________ day of two thousand,_____________
SIGNED AND DELIVERED by the above named Suretles

1._________________________________________

2_______________________________________

Signed and delivered by the above named on this ________day of two thousand_________________

*Surety is applicable only in case of claims above the threshold limit of .15 Lakhs