1. LETTER OF DISCLAIMER Annexure-A
(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 Rupees.
________________________
Withreference tothe above account,I/We,the followinglegal heirsof the late Shri/Smt./Kum.
_______________________________________________________________________________
(Name of the deceasedaccountholder),have toadvise thatwe have nointerestinthe above assets
and as such we have noobjectiontoyourpayingbalance amountlyinginthe above account(s) with
youin the name of the aforesaidShri/Smt./Kum_________________________
______________________________ (Name of the deceasedaccountholder) toShri/Smt./Kum.
1. ___________________________________________________________________________
2. ___________________________________________________________________________
3. ___________________________________________________________________________
4. ___________________________________________________________________________
5. ___________________________________________________________________________
Such deliveryof the paymentof the balance inthe above account(s) wouldbe completelybindingon
us and we will notquestionthe Bank’sactioninsodoingif anyproceedings.I/We undertake tobind
ourselves,ourheirsandlegal representatives nottorevoke the declarationmade herein.
Sr. No Name(s) of the Claimants(whorelinquishtheirrights) Age(yrs.) Signature
Signedbefore me this________________ dayof _____________20___________
Notary
Public/Magistrate)
2. AFFIDAVIT
(To be stamped as per the Stamp Act Applicable to the State)
I/We ________________________________________________S/D/O ________________________ residing at
_____________________________________ and________________________________
S/D/O _______________________________ residing at _________________________________ do
herebymake oath*/solemnlyaffirm and sayas follows:
1. That Shri/Smt./Kum. _____________________________ (Name ofthe deceased) hereinafter, referred to as “the
deceased” diedintestate on _________________ at _______________
2. That we know the deceasedandhis/her familysince the last _________ years.
3. That at the time of his death the deceased left surviving him/her the followingpersons whoaccording to the law
bywhich theyare governed, are the onlylegal heirs of the deceasedentitledto succeedto the estate ofthe
deceasedonanintestate succession:
Sr. No Name Age(yrs.) Relationshipwiththe
deceased
4. That I am not related in anymanner whatsoever to the deceasedor anyof the above- mentionedpersons nor
have we anyclaim or interest of whatsoever nature inthe estate of the deceased.
5. That we are informed, and we verifybelieve that the deceased has left certaindeposits*/assets withthe
_____________ Bank ___________________________ branch, to whichthe above-mentionedpersons are
entitledto claim.
6. That we are making this solemndeclarationsincerelyand consistentlybelieving the same to be true and withfull
knowledge that it is onthe strength of thisdeclarationthat the ________________
Bank_______________________ branch, has agreedat the request to make payment ofthe amount of the
deposits/todeliver the assets to the above mentioned persons without insisting onproduction bythem ofa
grant of legal representative to the estate ofthe deceased from a competent Court.
Sworn*/Solemnlyaffirmedat this _______ 1. _____________________
dayof _______________ 2. _____________________
In the presence of_________________ before me
*(Delete whichever is inapplicable) Judge/Magistrate/Notary
3. 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 BranchManager
_________________
_________________
IN CONSIDERATION of your paying or agreeing to payus,
Insert here the names
of the claimants
1.___________________________________________
2.___________________________________________
3.___________________________________________
4.___________________________________________
5.___________________________________________
The sumof Rupees ______________________________________________ standing at the credit of Saving
Bank/ Current/R.D Account No. etc. withyour name inthe name of Shri/Smt./Kum.
___________________________________ since deceased, without productionof Letter of Administrationor a
Succession Certificate to his/her estate, we
Insert here the Names of the sureties __________________________________________________________
do herebyfor ourselves and our heirs, legalrepresentatives, executors andadministrators, jointlyandseverally
UNDERTAKE AND AGREE to indemnifyyou and your successors andassign against all claims, demands,
proceedings, losses, damages, chargesandexpenses which maybe raised against or incurredbyyou byreasons
or in consequences of your having agreedto the pay/ or payingme/us the saidsum as aforesaid.
Signed, Sealedand deliveredbythe above named onthis___________ dayof _______________ two thousand
_________________________.
SIGNED AND DELIVERED bythe above named
1.____________________________ 2. _____________________________ 3. _____________________
4. ____________________________ 5. _____________________________
(Heirs/claimants of the deceased)
SIGNED AND DELIVERED bythe above named
1. _______________________________ 2. _______________________________
(Sureties)
