FORM F
(See sub-rules (3) and (4) of Rule 8)
Serial No……………………..
APPLICATION FOR CLOSURE OF ACCOUNT UNDER SENIOR CITIZENS SAVINGS
SCHEME, 2004 BY SPOUSE (JOINT HOLDER)/NOMINEE(S)/LEGAL HEIRS
To
The Postmaster/Incharge
…………………………………. (name of the Deposit Office)
………………………………….
Sub : Application for withdrawal/closure of account
Sir
I/We ………………………………………………. the spouse (Joint holder/nominee(s)/legal heirs of late ………………………………….., the depositor to the Senior Citizen's Savings Scheme, 2004 account No………………………………. wish to withdraw the entire amount standing to the credit of the deceased in the said account.
Please find enclosed :-
(i) A certificate in regard to the death of the Depositor
(ii) A certificate in regard to the death of Sri/Smt ……………………………………………
Sri/Smt ………………………………………… also the nominee(s) appointed by the Depositor
(iii) Succession Certificate/Letter of Administration with attested copy of probated 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
Signature or thumb impression of claimant(s)
Witness ……………………………. (Signature, name and address)
Date ………………………………
Place ………………………………
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FOR USE BY THE DEPOSIT OFFICE
Withdrawal of Rs………….. (Rupees ………………………...……………………………) is sanctioned
Adjustments made (to be specified) Rs……………., (Rupees…………………………………………)
Net amount payable Rs…………………. (Rupees ……………………………………………………..)
RECEIPT TO BE SIGNED BY THE CLAIMANT(S)
Received a sum of Rs……………… (Rupees …………………………………………………....) from
…………………………………………… (name of deposit office) as per details above in full settlement of our claim
Signature or thumb impression of 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 Rs.1 lakh
ANNEXURE I TO FORM F
(Letter of indemnity)
To
The Postmaster/Incharge
…………………………………. (name of the Deposit 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 SENIOR CITIZENS SAVINGS SCHEME, 2004 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 ……………………………..…………………………………………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 Signed and delivered by the above named sureties (Signature, names and address)
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Signature, names and address of witnesses
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ATTESTED
NOTARY PUBLIC
ANNEXURE II TO FORM F
(Affidavit)
To
The Postmaster/Incharge
……………………………… (Name of the Deposit Office)
I/We …………………………… husband of/wife of late ………………………………………. aged
………………….. aged ………………… aged ………………… sons/daughters of the said late
………………………………………… resident of ……………………………………. do hereby declare and solemnly 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 Sri/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.
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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 ……………………
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ATTESTED DEPONENTS
OATH COMMISSIONER
ANNEXURE III TO FORM F
(Letter of disclaimer on Affidavit)
To
The Postmaster/Incharge
…………………………………. (name of the Deposit Office)
………………………………….
I/We (i) …………………………………………….. Husband of/wife of ………………………... Resident of …………………………………………………………………………………………………(ii) …….…………………….. son/daughter of …………………………………… (iii) ………………………………………………….. son/daughter of …………………………………… do hereby declare and solemnly affirm as follows :-
(1) That Sri/Smt ……………………………………………. died intestate on ………………….. leaving behind us ………………………………………………….………… his/her only heirs.
(2) That we ……………………………………………………. Heirs of our late father/mother ourselves and on behalf of our heirs, executors, representatives and assigns to hereby relinquish our claims to the balance of Rs……………………………. which may be
credited to the account sought by our mother/father to be opened in the deposit office in the name of the estate of the said ……………….. …………………………………………………… deceased father/mother after the realization of Draft No……………………………… on ……………………………. issued by ……………………………
………………………………………………………………. (name of the deposit office) and have no objection whatsoever in the balance in the above referred account no…………………… together with interest if any, accrued thereon being paid by the Deposit office to our mother/father Mrs/Mr ………………………………..
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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 ……………………
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DEPONENTS
I identify the deponent(s) who is/are personally
known to me and who has/have signed in my presence
Dated …………………………
OATH COMMISSIONER
FORM G
(See rule 11)
Serial No…………..
To
The Postmaster/Incharge
…………………………………. (name of the Deposit Office)
………………………………….
Sir,
Sub : Application for Transfer of account to another Deposit office
I ………………………………………………… son/daughter/wife of ………………………… resident
of ………………………………………………………………………………………………….. depositor of
account no………………………………. hereby apply for TRANSFER OF MY ACCOUNT No……………. with deposit of Rs…………… (Rupees ……………………………………
…………………………………………………………..) under the Senior Citizen's Savings Scheme, 2004 to ……………………………………………………………………………………………………..
……………………………………………………………… (name and full address of the transferee deposit office)
The Passbook is enclosed
Signature or thumb impression of the Depositor
Witness ………………………………….
(Signature, name and address)………………….
My specimen signature/thumb impressions, as available in the record of transferer deposit office are as below :-
1 1st Depositor
1 2 3
Witness …………………….. Witness …………………….. Witness ……………………..
2 Joint Depositor
1 2 3
Countersigned Postmaster/ Countersigned Postmaster/ Counter Postmaster/
Incharge of Transferer Office Incharge of Transferer Office Incharge of Transferer Office
Date …….. & office seal Date …….. & office seal Date …….. & office seal
Forwarded to ……………………………… (Transferee Deposit Office) and necessary entries passed in the office records.
Signature & Office Seal (Transferer Deposit Office)
Date …………………..
FOR USE BY THE TRANSFEREE DEPOSIT OFFICE
A Received application for transfer of account no…………………. opened on …………….. under SENIOR CITIZENS SAVINGS SCHEME, 2004 in the name of ……………………………………….. and …………………………………………. (joint holder, if any) standing on the books of the ………………………………………………..…………………………………………………………………………………… (name and address of the transferer deposit office) showing deposit of Rs………… (Rupees …………………………………………………………) due to mature on …………………….
B The entries in the passbook have been checked, necessary entries indicating transfer, have been made and passbook has been returned to the depositor.
Passbook received in original Signature of Postmaster/Incharge
(with office seal) Transferee Deposit
…………………………………………
(Signature/thumb impression of the depositor)
Date ………………………
Date ………………….
In case of thumb impression
to be signed on receipt of the passbook at the transferee deposit office