ADARSH CO-OPERATIVE BANK LTD, SIROHI
Annexure-I
Claim from nominee to recognize his claim to the
deposit*/safety locker*
Shri/Smt/Kum________________________________________Nominee/appointed on behalf of
the minor nominee hereby declare that I am the nominee/appointed on behalf of the minor nominee
of the deceased Shri/Smt._________________________________ further declare that I am
nominated to claim the deposit monies /articles held
in safe custody/safety locker
with______________________________Branch
by
Shri/Smt_____________________________________
deceased.
The
deposit
monies/
articles held in safe custody/safety locker are held in Account/Locker No._________________
Safe
custody
receipt
No.___________________________of
Shri/Smt.__________________________________________deceased.
Shri/Smt._____________________
Signature__________________
Nominee/appointed on behalf of minor nominee)
Date_____________________
Address:_____________________________
_____________________________
_____________________________
Witness:
1. Magistrate or Judicial Official
1. Name______________________________
Or
Address_____________________________
2. An officer of the Central or
___________________________________
Sate Government
Or
3. An Officer of a Bank
Or
4. Twp persons acceptable to the bank
___________________________________
Signature____________________________
1. Name______________________________
Address_____________________________
___________________________________
___________________________________
Signature____________________________
(Strike out whichever is not applicable)
Annexure- II
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Annexure-III
No Objection Letter
To,
The Adarsh Co-operative Bank Ltd.
____________________Branch.
Dear Sir,
I/We
understand
that
Mr./Mrs./Miss________________________________(Claimant)
son/wife/daughter/husband of the late Mr./Mrs._______________________________ resident
of __________________ has claimed as a legal heir of the deceased, the following amounts lying to
the credit of the deceased and/or the contents of the locker No.____________ lying with the
Adarsh Co-operative Bank Ltd._____________Branch:1. T.D.R. No(s)_______________ for Rs.________________due on______________
2. S.B. A/c No.________________ having credit balance of Rs.__________________
3. C.D. A/c No.________________ having credit balance of Rs.__________________
4. R.S.D. A/c No._______________ having credit balance of Rs.___________ _______
5. Contents of locker No._________ having value Rs.____________ as on date_______
6. _________________________________________________________________
7. _________________________________________________________________
In
respect
of
the
above,
I/We_________________________________________
___________________________________________________________________
son/wife/daughter/brother/mother/husband of the late Mr./Mrs./Miss______________
____________________________________________
hereby
declare
that
I/We
have
renounced all interest or share in the proceeds of the aforementioned accounts and/or contents of
locker No.____________ and have no objection to the refund by the Bank of the proceeds of the
aforesaid accounts and/or release of contents of locker to the aforesaid claimant without insisting
of Succession Certificate or other legal representation.
Yours Faithfully,
Date____________
_________
_________
Full Adreess:____________________________
_________
_________
_____________________________________
_________
_________
_____________________________________
_________
_________
(Signature)
(Relation with
deceased)
(The signatures of declarer/s should be attested by Ist class Magistrate /Notary Public /Branch Manager if
personally known to him. However, Sarpanch/Tehsildar may attest the signatures of the executants on the
presence of the Branch Manager who will attest his signature)
Annexure- IV
Letter be completed and signed by the surety
Branch Manager
Adarsh Co-operative Bank Ltd.
Branch……………………….
I beg to inform you that I am prepared to execute an Indemnity bond in favour of the Adarsh
Co-operative
Bank
Ltd.
By
Shri/Shrimati………………………………………………………………………..
Resident
of……………………………………………………… or the claim under its share money opposites of late
Shri/Shrimati………………………………..(Membership No…………) /(account No………….) without
insisting on legal evidence of title.
Consequently I have filled in the questionnaire from given below:Question
Answer
1. Are you related to the member/Account holder ?
2. What is your present occupation and permanent Address?
3. What is your approximate monthly income and What are
its sources?
4. What property movable or immovable do you process
And what is the present value thereof?
5. Is the property free from encumbrance?
I do here be solemnly assure the Adarsh Co-operative Bank Ltd. Branch……………………
that I have thoroughly understood and correctly answered the above question
Declared at…………………..……….the ………..…….………….day of…………………..19…………….
Witness & counter signed
Signature…………………………..
Signature of the declarent
Name………………………………
Full Name……………………………………………
Address & Seal……………………
Father's name of the declarant…………….……..…..
Present Address…………………………………….
Annexure-V
ADARSH CO-OPERATIVE BANK LTD.
In
consideration of the Adarsh Co-operative Bank Ltd.,
under the Multistate Co-operative societies Act, 2002 having agreed to
______________________________________________________________________________
registered
pay to
(Name of all Payees)
________________________________ of____________________________________________
(Relationship)
(Name of Deceased member/Account holder)
the
sum
of
Rupees_________________________
due
under
Shares
Money/Deposits
______________________on the Name of _________________________________ deceased without
recurring production of Probate or letters of Administration or Succession Certificate granted to the estate
of_______________________________________________________________________________________
(Name of deceased member/depositor)
We______________________________________________________________________________________
(Name of all payees)
and________________________________________________________________ our Heirs, Executors and
(Name of Surety)
Administrators do hereby agree to keep the said Adarsh Co-operative Bank Ltd,
(Branch)________________harmless and indemnified from and against all claims against it on the part of any
person or person whomsoever all damages, costs and expenses which the said Adarsh Co-operative Bank Ltd,
may sustain or incur in consequence of any such claim or claims.
In witness whereof we the said_______________________________________________
(Name of Payees)
_____________________________________and_____________________________________________have
(Name of Surety)
set
our
hands
at________________(Place)
__________________(Months) 19_______(Year)
this_________________(date)
day
(Name of all payees in the presence of)
Signed and delivered by the said__________________________________
(Name of all payees in the presence of)
_______________________________________and____________________________________
(Name of Surety)
(1)_________________________
(2)_________________________
(Signature)
1- Full Signature
Of witness______________________
Designation_____________________
Address________________________
2- Full Signature
Of witness______________________
Designation_____________________
Address________________________
Note:- (1) If this bond is signed in Vernacular one of the attesting witness should be requested to certify
that the contents of this Bond were explained to the party in vernacular before execution.
(2) Thumb impressions should be attested by a Magistrate or a Gazetted Officer or close Ist Officer
or Manager of Adarsh Co-operative Bank Ltd. Provided, he is fully satisfied about the identity of
the Party.
(3) To be stamped @0.05% & deposit or Rs. 200 whichever is lower with non judicial revenue
stamp.
of