(1)
FORM FOR CLAIM OF BALANCE IN THE SAVINGS ACCOUNT
OF DECEASED DEPOSITOR
(Application
for closure of Savings/RD/TD/MIS/NSS
Account by Nominee/Legal Heirs)
To,
The Sr PM/PM/SPM
____________________________________________________________
Subject- Application for Withdrawal/ Closure of
Account
Sir,
I/We___________________________________________________________________________________________________________________________________________________________________________________ the
Nominee(s)/Legal Heir(s) of Late Shri/Smt _____________________
__________________________________, the Depositor of the Savings/ RD/TD/MIS/NSS Account No- __________________________________
_____________________________________________________________
_____________________________________________________________ standing at PO
________________ _______________________________ wish to Withdraw the entire
amount standing to the credit of the deceased in the said account including
interest admissible as per rules.
Please find
enclosed:-
I. Certificate to the death of the Depositor.
II. Pass Book of the Depositor.
*III. Certificate in regard to the Death of the
Nominee/Nominees appointed by the Depositor.
**IV. Succession Certificate / Letter of
Administration / Probate of Will of the
Deceased Depositor under the Provisions of the Indian Succession Certificate
Act, 1925
@V. Letter of Indemnity
@VI. Affidavit
@VII. Letter of Disclaimer on
Affidavit
_______________________________________________
Signature or Thumb Impression of
Claimant / Legal Heirs
Date______________________
Place_____________________
(2)
Witness:
(1)______________________________(Signature)__________________________________________________________________________________________________________________(Name
and Address)
(2)______________________________(Signature)__________________________________________________________________________________________________________________(Name
and Address)
(FOR USE OF POST OFFICE)
Witness Accepted
Signature of Sr PM/PM/SPM/BPM
(With Designation Stamp)
Withdrawal of Rs__________________________________________
only (Rs_____________________________________________________ only) is
sanctioned which pertains to balance in the account of deceased inclusive of
interest admissible as per rules.
Signature
of Sr PM/PM/SPM/BPM
(With Designation Stamp)
Received Cheque No ______________________
__________________ dated_______________________
for the sum of Rs______________only
Rs_____________________________________________ _________only )
From _________________________________(Name of Post
Office) as per details furnished above in the settlement of our claims.
Date__________________
Place_________________
________________________________________
Signature /Thumb
Impression of the claimant(s)
*Delete wherever is
not applicable.
**Strike off if
there is valid nomination.
@To be produced by
legal heirs, in absence of nomination(s) for claims exceeding prescribed limit
of Rs 1 lac.
(1)
ANNEXURE-I
(LETTER OF INDEMNITY)
To,
The Postmaster
__________________________________________________(Name
of the Post Office)
In consideration
of your payment or agreeing to pay me/us
________________________________________________________ __________________________________________________________________________________________________________________________
[name(s) of the legal
heir(s)], the sum of Rs_______________________only (Rupees__________________________________________________only)
Standing in the account
No________________________ ___________ ___ under__________________________________________(name
of scheme) with your Post Office in the name of _______________________________
without production of Letter
of Administration 0r a Succesion
Certificate to the estate of the deceased ________________________________________
(name of the depositor), I/we and we _______________________________ __________________________________________________________________________________________________________________________
_____________________________________________________
(sureties) 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 assigns
against all claims, demands proceedings , loss damage, charges and expenses
which may be raised against or incurred by you by reason or in consequence of
having agreed to pay / or paying me /us the sum as aforesaid.
In witness
whereof we have hereunto set my/our hands at this ______ __________________ day
of ________________________ in presence of witnesses.
___________________________________________
Signed and delivered by the above named heirs of the deceased.
(2)
Signed
and delivered by the above named sureties,
(Signatures, names and addresses)
1._________________________________________________________________________________________________________________________
2._________________________________________________________________________________________________________________________
Signatures, names and addresses of witnesses,
1._________________________________________________________________________________________________________________________
2._________________________________________________________________________________________________________________________
ATTESTED
NOTARY PUBLIC
(1)
ANNEXURE-II
(Affidavit)
To,
The Postmaster,
________________________________________(Name
of the Post Office)
I/we__________________________________________________________
__________________________________________________________________________________________________________________________
Husband/ wife of Late
___________________________________________ aged__________,aged____________,aged___________,aged____________
aged_____________ and aged
_______________ sons/daughters of said Late ________
_______________________________________ ,resident of _____________________________________________________________
_____________________________________________________ do hereby declare and
solemny affirm as under :
(1) That I/we am/are the only heir(s) of the deceased
________________ __________________________
who died at ____________________ on______________________ I/we alone represent
the estate of Shri/Smt_________________________________________________
(2) That the deceased ______________________________________
did not leave any will and therefore I/we are the only successor(s) to the
estate of the said deceased.
DEPONENTS
1.__________________________________________________
2.__________________________________________________
3.__________________________________________________
4.__________________________________________________
5.__________________________________________________
6.__________________________________________________
DEPONENTS
(2)
Verification: I/we ,the above named deponents do hereby on solemn affirmation in
_____________________________( name of place ) that the contents of this
affidavit are true to the best of my/
our knowledge and nothing materials have been concealed.
Date_______________________
1.__________________________________________________
2.__________________________________________________
3.__________________________________________________
4.__________________________________________________
5.__________________________________________________
6.__________________________________________________
DEPONENT
ATTESTED
OATH COMMISSIONER
(1)
ANNEXURE III
(LETTER OF DISCLAIMER ON AFFIDAVIT)
To,
The Postmaster,
_________________________________________(name of the Post Office)
I/we
(i)___________________________________________________ Husband/wife of
_______________________________________,Resident of ___________________________________________________________
_____________________________________________________________
(ii) _______________________son/daughter of ______________________ (iii)
_______________________son/daughter of _____________________ (iv)
_______________________son/daughter of ______________________ (v) ___________
____________son/daughter of ______________________ (vi)
_______________________son/daughter of ______________________
do hereby declare and solemnly affirm as
follow:
(1) That Shri/Smt ___________________________________ in estate
on leaving behind us _________________________________his/her only heirs.
(2) That I/we _________________________________heir(s) of
our Late father/mother for my/ourselves and on behalf of my/our heir(s),
executors, representatives and assigns to hereby relinquish our claims to the
balance of Rs________________________________________
in
account No ____________________________________________
________________________________________________________ of ________________________________________(name
of scheme)
at
____________________________________( name of Post Office) in the name of the
estate of the objection whatsoever in the balance in the above referred
account(s) together with interest, if any, accrued thereon being paid by the
Post Office to Shri/Smt:
1.______________________________________________
2.______________________________________________
3.______________________________________________
4.______________________________________________
5.______________________________________________
6.______________________________________________
(2)
DEPONENT VERIFICATION: I/we the above named deponents do hereby verify on solemn
affirmation that the contents of this affidavit are true to the best of my
knowledge and nothing material has been concealed .
Dated _____________________
1.______________________________________________
2.______________________________________________
3.______________________________________________
4.______________________________________________
5.______________________________________________
6.______________________________________________
DEPONENT
I identify the deponent(s) who is/are personally known
to me and who has /have signed in my presence
Dated______________________
OATH COMMISSIONER
(1)
Claim Application Form for Settlement of Savings Cerertificates of Deceased
Holder who died on
___________________________________
( Where Nomination has been
Registered with Post Office)
To,
The
Post Master,
_________________________________________
Sir,
In connection with the settlement of claim of Post Office Certificates
standing in the name of deceased
___________ ________________________________________ in the books of
________________________________( name of Post Office ), I hereby claim the
payment of the value of the Post Office Certificate(s) No
_____________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________________
In support of the claim, I hereby submit :
(i)
Proof of Death of
the deceased issued by appropriate authority in original.
(ii)
Proof of Death of
other nominee(s), if any issued by appropriate authority in original.
The nomination was registered at ________ ________________ ___ _______________________________ Post Office under
Registration No(s)_________________________________________
_____________________________________________________________
Dated
________________________________________________________
Yours Faithfully,
_______________________________________________________________________________________________________________________________________________________________________________________
Signature or Thumb Impression
of the Claimants if illiterate
Witness (1)_____________________(
Signature)
Address
_________________________________
________________________________________
Witness
(2)______________________( Signature)
Address
_________________________________
________________________________________
(2)
Witnesses accepted,
____________________
__________________________
Signature of Sr
PM/PM/SPM Signature of the
Claimant/ Guardian appointed
to receive the amount on behalf of
minor nominee(s)
Address of the Claimant/Guardian
____________________________
____________________________
(1)
Claim Application Form for Settlement of Savings
Certificate(s) of the
Deseased
Holder
(Where
the Claim is preferred on Legal Evidence of Heirship)
To,
The Postmaster,
_____________________________
Sir,
In connection with
the settlement of claim of Post Office Certificate(s) standing in the name (
deceased )______________________ ____________________________________________________________
in the books of _________________________________________(
name of Post Office), I/We______________________________________________
_______________________________________________________________________________________________________________________________________________________________________________________
( state full relationship ) of the
deceased , who died on_________________, hereby claim the payment of the value of the
Post Office NSCs/KVPs Certificate no(s)
________________________________________________
_______________________________________________________________________
. In support of the claim, I hereby, submit the original/ certified / attested
copy of the followings:
(i)
A succession
Certificate granted by____________________________________________________ under No ________________________ dated________________
(ii)
Probate of will
granted by ________________________________ _____________________________________________________
(iii)
Letter of
Administration the Estate of the deceased granted by _____________________________________________________
under No ___________________dated_____________________
Yours Faithfully,
_____________________________
_____________________________
_____________________________
_____________________________
Signatures
or thumb impressions
of the claimant if illiterate
Witness (1)
___________________________________(Signature)
Address
______________________________________
_____________________________________________
Witness (2)
___________________________________(Signature)
Address ______________________________________
_____________________________________________
(2)
Witnesses accepted,
____________________
Signature of Sr PM/PM/SPM
_____________________________
_____________________________
_____________________________
_____________________________
Signature of the
Claimants/Guardian
appointed to
receive the
amount on behalf
of minor
Nominee(s)
Address of the
Claimants/Guardian
______________________________
_______________________________
_______________________________
_______________________________
NOTE-
Whenever copies of the original documents are produced , the claimants should
get them attested by a Gazetted Officer / Sarpanch Gram Panchayat.
(1)
Claim
Application for Settlement of Saving
Certificate(s) of the
deceased
holder who died on ____________________ (Where there is No
Nomination or Legal Evidence and Total Amount of
all certificates in the name of the dceased holder
does not exceed Rs 1,00,000/-)
To,
The Postmaster,
______________________________
Sir,
In
connection with the settlement of the claim of Post Office NSCs/KVPs
Certificate(s) standing in the name of the deceased ____________________________________________________________
,
I hereby claim the payment of
the value of the Post Office Certificate(s) detail of which is given below:
|
SL No
|
Scheme
|
Registration numbers and
date of issue
|
Office of issue
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Amount
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1
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2
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3
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4
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5
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6
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7
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8
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9
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10
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In support of the claim, I
hereby submit:
(i)
Proof of Death of
the deceased issued by appropriate authority in original.
(ii)
Letter of
Indemnity in original duly attested by Notary Public.
(iii)
Affidavit and
Letter of Disclaimer on Affidavit duly attested by Oath Commissioner.
Yours Faithfully,
____________________________
____________________________
___________________________
____________________________
Signature or thumb impression of
the claimant if
illiterate
Address_____________________
____________________________
____________________________
(2)
Witness (1)
____________________________(Signature)
Address________________________________________
_______________________________________________
Witness (2)
____________________________(Signature)
Address________________________________________
_______________________________________________
(1)
ANNEXURE-I
(LETTER OF INDEMNITY)
To,
The Postmaster
________________________________________(Name
of the Post Office)
In consideration
of your payment or agreeing to pay me/us________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________________
name(s) of the legal
heir(s)], the sum of Rs______________________only (Rupees_____________
____________________________________only)
Pertaining to NSC/KVP
certificate registered under Nos__________________________ ___________
____________________ _____________________________________________________________
_____________________________________________________________
with your Post Office in the
name of ___________________________
____________________________________________without
production of Letter of Administration
0r a Succesion Certificate to the estate of the deceased __________________________________(name
of the depositor), I/we and we___________________________________________________
_____________________________________________________________ (sureties) 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 assigns
against all claims, demands proceedings , loss damage, charges and expenses
which may be raised against or incurred by you by reason or in consequence of
having agreed to pay / or paying me /us the sum as aforesaid.
In witness
whereof we have hereunto set my/our hands at this ______ __________________ day
of ________________________ in presence of witnesses.
____________________________________________
___________________________________________
Signed
and delivered by the above named heirs of the deceased.
(2)
Signed and delivered by the above named sureties,
(Signatures, names and
addresses)
1.___________________________________________________________
____________________________________________________________
2.____________________________________________________________
____________________________________________________________
Signatures, names and addresses of
witnesses,
1._________________________________________________________________________________________________________________________
2.____________________________________________________________
____________________________________________________________
ATTESTED
NOTARY PUBLIC
(1)
ANNEXURE-II
(Affidavit)
To,
The Postmaster,
________________________________________(Name
of the Post Office)
I/we_________________________________________________________
_______________________________________________________________________ ___________________________________________________
Husband/ wife of Late
____________________________________________________
aged_____________,aged_______________,aged______________,aged____________
aged_____________ and aged
_______________ sons/daughters of said Late ________ ________________________
,resident of_______________ _____________________________________________________________
_____________________________________________________________ do hereby declare
and solemnly affirm as under :
(3) That I/we am/are the only heir(s) of the
deceased__________________________ who died at_____________
____________________ on______________________ I/we alone represent the estate
of Shri/Smt ______________________________
(4) That the deceased________________________________________
did not leave any will and therefore I/we are the only successor(s) to the
estate of the said deceased.
DEPONENTS 1.__________________________________________________
2.__________________________________________________
3.__________________________________________________
4.__________________________________________________
5.__________________________________________________
6.__________________________________________________
DEPONENTS
(2)
Verification: I/we ,the above named deponents do hereby on solemn affirmation in
_____________________________( name of place ) that the contents of this
affidavit are true to the best of my/
our knowledge and nothing materials have been concealed.
Date_______________________
1.__________________________________________________
2.__________________________________________________
3.__________________________________________________
4.__________________________________________________
5.__________________________________________________
6.__________________________________________________
DEPONENT
ATTESTED
OATH COMMISSIONER
(1)
ANNEXURE
III
(LETTER
OF DISCLAIMER ON AFFIDAVIT)
To,
The Postmaster,
__________________________________________________(name of the Post Office)
I/we:
(i)___________________________________________________ Husband/wife of
_____________________________________,Resident of _____________________________________________________________
_____________________________________________________________ (ii)
_______________________son/daughter of ______________________ (iii) _______________________son/daughter of
______________________
(iv) _______________________son/daughter
of ______________________
(v) ___________
____________son/daughter of __________________ ___ (vi)
_______________________son/daughter of ______________________
do hereby
declare and solemnly affirm as follow:
(3) That Shri/Smt _______________________________________died
in estate on leaving behind us__________________________________
__________________________________________his/her only heirs.
(4) That I/we _________________________________heir(s) of
our Late father/mother for my/ourselves and on behalf of my/our heir(s),
executors, representatives and assigns to hereby relinquish our claims to the
NSCs/KVPs with maturity value of Rs___________________________________________
_______only
Is
issued by _________________________(name
of the Post Office)
in
the name of the estate of the objection whatsoever in the balance in the above
referred account(s) together with interest, if any, accrued thereon being paid
by the Post Office to Shri/Smt::
DEPONENTS 1.______________________________________________
2.______________________________________________
3.______________________________________________
4.______________________________________________
5.______________________________________________
6.______________________________________________
(2)
DEPONENTS VERIFICATION: I/we the above named deponents do hereby verify on
solemn affirmation that the contents of this affidavit are true to the best of
my knowledge and nothing material has been concealed .
Dated _____________________
1.______________________________________________
2.______________________________________________
3.______________________________________________
4.______________________________________________
5.______________________________________________
6.______________________________________________
DEPONENTS
I identify the deponent(s) who is/are personally known
to me and who has /have signed in my presence.
Dated______________________
OATH COMMISSIONER
(1)
Reconciliation Certificate in case of
difference in name
Certified that the
real name of the deceased depositor of PO SB/TD/MIS/NSS/RD Account or NSC/KVP
Registration No _____________________________________________________________
__________________________________________________________________________________________________________________________
Was _____________________________________. He was also
called by __________________________________________ ( name) . The name as
mentioned in Pass Book/ NSCs/KVPs and death certificate is that of one and the
same person viz. the deceased depositor.
_____________________________
_____________________________
_____________________________
Signature of Claimants
____________________________
Name in block letters
Address- ____________________
___________________________
___________________________
Dated- ___________________
(1)
Sanction
Memo of Deceased Claim in respect of NSCs/KVPs
From: _________________________
_________________________(Name of PO)
Memo
No_______________________ dated____________________
To,
Sri/Smt
________________________
_______________________________
_______________________________
Dear
Sir /Madam,
Sanction of the
undersigned is hereby accorded to the payment to you of the amount due on the
Postal Savings Certificate(s) detailed below standing in the name of ___________________________
who is reported to have died on _______________________.
2.
The amount due
will be paid to you on your presenting the Savings Certificate(s) duly
receipted for payment at the __________________________ PO on surrendering the
original sanction order.
3.
You are however ,
at your liberty not to accept payment of the amount due on the Savings
Certificate(s) before the date of maturity entered therein, in which case the
savings certificate(s) in question shall be transferred to your name subject to
the condition laid down in the Rules governing the Savings Certificate(s) in
question.
4.
The sanction is
valid for accepting payment or for getting the certificate(s) transferred in
your name for a period of one year only from the date of its issue.
Yours Faithfully,
______________________
Sanctioning Authority
Stamps
(2)
Details of Savings Certificate(s)
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Certificate Nos
|
Denomination
|
Date of issue
|
Name of the office of
Registration
|
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Copy
forwarded to for information and necessary action—
1.
The
Postmaster/SPM _____________________________PO . The date of payment may be
communicated as soon as the payment is effected.
2.
The Director of
Postal Accounts ___________________________. The value of the Post Office
Certificate including interest accrued upto the last completed year, as the
case my be, prior to the death of the holder does not exceed Rs
1000/2000/5000/10000/20000/ 50000/ 75000/100000 as per claimant’s statement in
the claim application.
*Score out which is not applicable.
______________________
Sanctioning
Authority
Stamps
(1)
ACKNOWLEDGEMENT
OF CUSTMOR REQUEST
1.Name
of Post Office where request is received _______________________________________________________
2.Date
of receipt of request___________________________________
3.Time
of receipt of request-__________________________________
4Name
of Depositor/Holder __________________________________
5.SB/RD/TD/MIS/NSS/SCSS/PPF/NSC/KVP
Account/Registration Nos- ___________________________________________________________
______________________________________________________________________________________________________________________
___________________________________________________________
6.Name
of the Savings Schemes ________________________________ __________________________________________________________
7.Request
No- _____________________ ( Sl No of Register in case of non computerised
office )
Date
Stamp of the PO
__________________
________________________
Signature of the Postmaster/SPM
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