FORM FOR CLAIM OF BALANCE IN THE SAVINGS BANK ACCOUNT OF

DECEASED DEPOSITOR
Application for closure of Savings/RD/CTD/TD/MIS/NSS Account by Nominee(s)/Legal heirs

To MARGINAL REMARKS
The Sr.Postmaster/Postmaster/Sub Postmaster 1. No nomination has
…………………………….. (Name of Post Office) been registered.
2. Balance verified and
Subject: - Application for withdrawal /closure of account. Rs………………
(Rupees
……………………………………
……….
Sir, only) & found
I/We* correct
3. No court attachment
4. No OM pending
5. Required entries made
in the relevant records
6. No counter Claim

Date: APM/SPM
………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………. the
Nominee(s)/legal heirs of late………………………………………………………………………..the
depositor of the
Savings/RD/CTD/TD/MIS/NSS Account
No……………………………………………………………………..standing
at………………………………………..Post Office 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) An original certificate to the death of the Depositor.
*(ii) An original Certificate in regard to the death of
Shri/Shrimati……………………………………
and Shri/Shrimati………………………………………………………………………also the
nominee(s) appointed
by the Depositor.
*(iii) Succession Certificate/Letter of Administration/ Probate of will of the deceased
depositor issued under the provisions of the Indian Succession Act, 1925.
(iv) Pass Book of the Depositor.
@(v) Letter of Indemnity.
@(vi) Affidavit.
@(vii) Letter of disclaimer on affidavit
1)
2)
3)
4)
5)
Signature or thumb impression of claimant(s)/Legal heirs
Address:
………………………………………………………………………………………..

………………………………………………………………………………………….

……………………………………………………………………………………………
PIN:
………………………………………………………………………………….
Phone No:
……………………………………………………………………..
Date:-………………………………………..
Place:-…………………………………………
Witness:-

(1)……………………………………………………(Signature) 2)
…………………………………………………………(Signature)
……...……………………………………………………(Name)
………………………………………………………………….(Name)
Address………………………………………………………………
Address………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
PIN………………………………………………………………………
PIN………………………………………………………………………

-2-

FOR USE OF POST OFFICE

Witness Accepted.

Signature of Sr.PM/PM/SPM/BPM
With Designation Stamp

Withdrawal of Rs. ………………………….

(Rs……………………………………………………………………………………………..)
is sanctioned which pertains to balance in the account of deceased inclusive of
interest
admissible as per rules.

Signature of Sr.PM/PM/SPM
With Designation Stamp

RECEIPT TO BE SIGNED BY THE CLAIMANT (S) AT THE TIME OF PAYMENT

Received cheque No……………………………………………………………...dated………………..

…………………..for a sum of
Rs……………………………………...
(Rupees…………….........................................................................................) from
……………………………………... (name of Post office) as per details furnished above, in full
settlement of our claim.

Date:
Place:
Signature / Thumb impression of the claimant(s)]

* Delete whichever is not applicable.

** Strike off if there is a valid nomination.
@ To be produced by legal heirs, in the absence of nomination(s) for claims upto
prescribed limit of Rs. 1 lakh.
 (Letter of indemnity) ANNEXURE-I (Rs.80 Adhesive stamp)

To
The Postmaster,
………………………………… (Name of the Post office)

In consideration of your payment (or) agreeing to pay me /

us……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………...
[name(s) of legal heir(s)] the sum of
Rs………………………… (Rupees…………………………………………………………………………..)
Standing in the account No…………………………………under…………………………..(name of
scheme) with your office
in the name of ………………………………………………………………………………………..without
production of
letters of administration or a succession certificate to the estate of the deceased
……………………………………………………………(name of the depositor).

I/
We…………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………....
[name(s) of legal heir(s)] 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, losses, damages,
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 the presence of witnesses,

Signed and delivered by the above named

heir/heirs of the deceased.
1)
2)
3)
4)

Signed and delivered by the above named sureties

(Signature, names and address)

1)……………………………………………………(Signature) 2)
…………………………………………………………(Signature)
……...……………………………………………………(Name)
………………………………………………………………….(Name)
Address………………………………………………………………
Address………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
PIN………………………………………………………………………
PIN………………………………………………………………………

Signature, names and address of witnesses:

1)……………………………………………………(Signature) 2)
…………………………………………………………(Signature)
……...……………………………………………………(Name)
………………………………………………………………….(Name)
Address………………………………………………………………
Address………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
PIN………………………………………………………………………
PIN………………………………………………………………………

ATTESTED
NOTARY PUBLIC
 AFFIDAVIT ANNEXURE –II ( Rs. 20 Adhesive stamp)
To
The Postmaster,
………………………………………(Name of the Post office)

I/WE 1) ……………………………………………… aged……… wife/husband of deceased

2) ………………………………………………….aged…… son/daughter depositor
3) ……………………………………………… aged……… son/daughter
……………………………….
4) ……………………………………………… aged……… son/daughter
5) ……………………………………………… aged……… son/daughter
and resident of………………………………………………………………………………………(native).do
hereby declare and solemnly affirm as under :-

(1) That I / we am/are the only heir(s) of the

deceased……………………………………….who died at…………………………………………(place
of death) on……………………………………..(date of death) I / We alone represent the
estate of Shri/Smt…………………………………………………………………… (Deceased)

(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.

1.
2.
3.
4.
5.
DEPONENTS

VERIFICATION
I / We, the above-named deponents do hereby verify on solemn affirmation
in…………………………………… (Name of place) that the contents of this affidavit are
true to the best of my/our knowledge and nothing material has been concealed.

Dated………………….

1.
2.
3.
4.
5.
.
DEPONENTS
ATTESTED

(LETTER OF DISCLAIMER ON AFFIDAVIT) ANNEXURE –III Rs.20

To
The Postmaster,
………………………………………(Name of the Post office)

I/WE 1) ……………………………………………… aged……… wife/husband of

……………………………………………
2) ………………………………………………….aged……… son/daughter of
……………………………………………
3) ……………………………………………… aged……… son/daughter of
…………………………………………
4) ……………………………………………… aged……… son/daughter of
……………………………………………
5) ……………………………………………… aged……… son/daughter of
……………………………………………
do hereby declare and solemnly affirm as follows :-

(1) That Shri/Smt…………………………………………………………………………………….died

intestate on leaving
behind us………………………………..
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
his/her only heirs.

(2) That
we…………………………………………………………………………………………………………………………
…………………………

……………………………………………………………………………………………………………………………
heirs of our
late wife/husband /father/mother for ourselves and on behalf of our heirs,
executors, representatives and assigns to hereby relinquish our claims
to the balance of Rs………………………………………………………in Account
No…………………………………
of……………………………………(name of scheme) standing
at……………………………………………… (name
of post office) in the name of the estate of the
said…………………………………………………….
deceased and we have no objection whatsoever in the balance in the
above-referred account together with interest, if any, accrued thereon being paid
by the Post office to
Mrs./Mr…………………………………………………………………………………………….

1.
2.
3.
4.
5 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/our knowledge and nothing
material has been concealed.
Dated………………….

1.
2.
3.
4.
5. DEPONENTS

I identify the deponent(s) who is/are personally known to me and who has signed in
my presence.

Dated………………………………… Oath Commissioner

 CLAIM
TYPES

WITH NOMONATION WITH LEGAL EVIDENCE WITHOUT NOMINATION

& W/O LEAGAL EVIDENCE

WITH NOMINATION WITHOUT WITHOUT Nomination

NOMINATION and without legal
evidence
1. SB -30 (Claim form) 1. SB -30 (Claim form) 1. SB -30 (Claim
form)
2. Pass book 2. Pass book 2. Pass book
3. Copy of death 3. Copy of death 3. Copy of death
certificate certificate certificate
4. ID proof 4. ID proof 4. ID proof
5. Address Proof 5. Address Proof 5. Address Proof
6. Probate of will (Or) 7. Letter of
Succession indemnity
Certificate 8. Affidavit
(or) 9. Letter of
Letter of Disclaimer on
Administration affidavit

For SB

No separate SB 7-a For m for Claim

For
SB Form 30
SCSS Form F ( For SCSS /PPF for all cases SPM/Postmaster of the office is the
sanctioning Authority)
PPF form G
Sanctioning powers Schemes SB/RD / TD/ MIS
Savings Bank A/cs Without
With Nomination Nomination
Legal
Sl NO Authority & Without
Evidence
SB/ TD RD//MIS Legal
Evidence
Rs. Rs. Rs. Rs.
B & C Class –
Rs.1000
1. Time Scale SPM 1000 1000 1000
A-Class – No
limit
2. LSG SPM 2000 NO Limit 2000 2000
3. HSG - SPM 5000 NO Limit 5000 5000
HSG – PM
NO Limit NO Limit NO Limit 5000
MDG –PM
Senior Postmaster
4. Div .Supdt (Gr- No Limit No Limit No Limit 20000
B)
Chief Postmaster /
5. No Limit No Limit No Limit 50000
SSP (Gr-A)
6. DPS - - - 75000
7. PMG / CPMG - - - 100000
With out Nomination if exceeds 1 lac – legal evidence is Compulsory

For Certificates
Sl NO Authority With Legal Without
Nomination Evidence Nomination &
Without Legal
Evidence
Rs. Rs. Rs.
1. Time Scale SPM No Limit 1000 1000
2. LSG SPM No Limit No Limit 2000
3. HSG - SPM No Limit No Limit 5000
HSG – Postmaster
No Limit No Limit 5000
MDG – Postmaster
Senior Postmaster
4. No Limit No Limit 20000
Div .Supdt (Gr- B)
Chief Postmaster /
5. No Limit No Limit 50000
SSP (Gr-A)
6. DPS - - 75000

7. PMG / CPMG - - 100000

With out Nomination if exceeds 1 lac – legal evidence is Compulsory