Revised
deceased claim forms for PO Savings Schemes
(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.
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