(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:
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SL No
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Scheme
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Registration numbers and date of
issue
|
Office of issue
|
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)
|
Certificate Nos
|
Denomination
|
Date of issue
|
Name of the office of Registration
|
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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