APPENDIX-9 (To be stamped as per
local Stamp Act)
AFFIDAVIT
I/We ……………… S/o / D/o / W/o ……………… aged about ……. Years, residing at
……….. do hereby solemnly affirm and sincerely state as follows: I/We are the deponent herein.
I/We submit that Sri/Smt……………… (name of the missing person) residing at………. is my/our
…………… (relationship with the missing person), has been missing from …………..(date).
AM
I/We submit that Sri/Smt………….. (name of the missing person) is holding a deposit with
Canara Bank…………………… (Name of the branch) in his/her name.
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I/We submit that all efforts were taken by me/us to trace him/her and a paper publication was made
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in…………….. (Name of the newspaper) on ……….. (Date of publication) regarding the fact of
his/her missing but in vain. In addition to that a police complaint was filed with……………….
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(Police station) on ……….. (Date) regarding his/her missing.
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I/We submit that police authorities have reported that Sri/Smt………………….. (Name of the
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missing person) could not be traced and has submitted a non-traceable report to that effect. Further
no person has seen or has reported having seen Sri/Smt…………………… (Name of the missing
person) after………….. (Date of missing).
I/We submit that, I/We are the only legal heirs/nominee entitled to the deposits standing in the
name of Sri/Smt…………….. (Name of the missing person).
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I/We submit that, the copy of the police complaint, non-traceable report copy, copy of newspaper
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publication, other documents required by bank for settling the claim as death claim etc. are already
submitted to The Manager, Canara Bank ……………. (Name of the branch).
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I/We submit that the above said facts are true and correct.
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I/We state that, this affidavit is executed for the purpose of settlement of the said deposit.
Solemnly affirmed and signed
Before me at ........................... …………….. on … ................... ……
DEPONENT/S
NOTARY PUBLIC
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