United Bank of India
Customer Service Department
Head Office : 11, Hemanta Basu Sarani,
Kolkata – 700 001.

SETTLEMENT OF CLAIMS IN RESPECT OF
DECEASED DEPOSITORS

Check-list of Documents
CLAIMS Documents Obtained : Yes/No
1.ACCOUNTS WITH NOMINATION CLAUSE :
(i) Application for Deceased Claim from
Nominee/Guardian of Nominee(Annex-3)
(ii) Copy of Death Certificate(Verified with
Original)
(iii) Identity Proof *
2.JOINT ACCOUNTS WITH EITHER OR SURVIVOR CLAUSE :
(i) Application for Deceased claim from
Survivor(s) (Annex-3)
(ii) Copy of Death Certificate(Verified with
Original)
3.FOR CASES OTHER THAN NOMINATION/JOINT ACCOUNTS
WITH SURVIVOR CLAUSE :
(FOR AMOUNTS UPTO THRESHOLD LIMIT i.e Rs 25000.00)
(i) Application for Deceased Claim(Annex-4)
(ii) Copy of Death Certificate(Verified with
Original)
(iii) Letter of Indemnity Signed by claimant(s)
(Annex-5)
(iv) Copy of Heirship Certificate in Bank’s
Format
Notes-
1) Death Certificate issued by Registrar of Birth and Death or any agency
authorized by them viz. Corporation, Municipality, Gram Panchayat etc will be
accepted.
2) Proof of identification such as Ration Cards, Election Card, PAN Card,
Passport or any other satisfactory proof of identification acceptable to Bank.
3) Name of Authority for issuing Heirship Certificate : Gazetted Officer,
Judicial Officer, Mayor or Councilor of a Corporation, Chairman or Councilor
of a Municipality, Chairman or Members of a Town Committee, Sabhadhipati of
a Gram Panchayat, Panchayat Pradhan/Head of Gram Panchayat, Notary Public
under Official Seal or by any valued constituent of the Branch in the format as
devised by Bank.
4.Heirship certificate should be issued in the following format :
“ This is to certify that Late ………………………son of / daughter of/ wife
of…………………………. left behind him/her the following legal heirs only :
Sl No. Name of Legal Heir Age Relationship with the deceased
5.For cases other than Nomination/Joint Accounts with survivor clause, where
claim amount is above Rs 25000.00, detailed guidelines laid down by Bank will
follow, including 2 surities.
Annexure-3
Application for Deceased Claim
(To be used when account has nomination or is a joint account with survivor clause)
From
……………………….
……………………….
To
The Branch Manager,
United Bank of India,
………………………Branch
Dear Sir,
Ref : Deceased account of Late Shri/Smt ………………………
Account No(s)……………………
I/We advise the demise of Shri/Smt……………………………….on ………….
He/She holds the above account(s) at your Branch.The account is in the name(s)
of :……………………………………………….
A. In case of Nomination
I, ………………………………son/daughter of Shri…………………………….
Residing
at………………………………………………………………………am
(i) the registered nominee in the above account(s).
(ii) the person authorized to receive payment on behalf of Master/Miss…..
…………………..who is the nominee in the above account(s) and is a
minor as on date of this claim.
Please settle the balance in the account in the name of the nominee. I/We receive
the payment as trustee(s) of the legal heirs of the deceased.
B.In case of Joint Account
I/We request you to delete the name of deceased person and continue the
account in my/our name(s) with same mode of operations.
I/We submit photocopy of the following document(s) together with
originals.Please return the original to us after verification.
Death certificate issued by ……………………………….
Identity proof(required in nomination cases)……….........
Place: Yours faithfully,
Date:
(Claimants)
Annexure-4
Application for Deceased Claim
(To be used for cases other than nomination / joint account with survivor clause)
From
……………………….
……………………….
To
The Branch Manager,
United Bank of India,
………………………Branch
Dear Sir,
Ref : Deceased account of Late Shri/Smt ………………………
Account No(s)……………………
I/We advise the demise of Shri/Smt……………………………….on ………….
He/She holds the above account(s) at your Branch.The account is in the name(s)
of :……………………………………………….
I/We lodge my/our claim for the balances with accrued interest lying to the
credit of the above named deceased who died intestate. I/We am/are the legal
heirs of the above named deceased and lodge my/our claim for payment as per
the bank’s rules and discretion.The relevant information about the deceased and
the legal heirs are as under.
1.Names in full of the parents of the deceased :
Father:…………………………………….
Mother:…………………………………...
2.Religion of the deceased:………………
3.Details of living (i)
Husband(ii)Wife(iii)Children(iv)Father(v)Mother(vi)Brothers(vii)Sisters(viii)Gr
and Children.If Hindu Joint Family,the name and address of the Karta and Coparceners
with their respective ages.
Full Name/address Occupation Relationship with deceased Age
(i)……………… ………….. …………………………… …..
(ii).…………… ………….. …………………………… …..
(iii)…………… ………….. …………………………… …..
(iv)…………… ………….. …………………………… …..
(v)…………… ………….. …………………………… …..
Cond-
4.Name or Names of the :…………………………………………….
Guardian/s of the minor
Children of the depositor
(a) Whether Natural Guardian :…………………………………………
(b) Whether guardian appointed :………………………………………
By court of Law in India.If so,
Attach a certified copy or duly
attested copy of such order
(c) In whose custody the Minor/ :………………………………………
Minors is/are ?
5.Claimant/s name/s and address in full :……………………………….
I/We submit the following documents. Please return the original death certificate
to us after verification:
1. Death Certificate(Original + 1 Photocopy) issued by : ……………………..
2. Letter of Indemnity
3. Heirship Certificate
We request you to pay the balance amount lying to the credit of the above
named deceased to …………………………..on my/our behalf.
I/We hereby solemnly affirm that the above statements are true and correct to
the best of my/our knowledge and belief.
Yours faithfully,
Place:
Date: Signature of Claimant(s)
(i) Name of Claimant Address Signature
Indemnity Format Annexure-5
(to be duly stamped as per the
Stamp Act applicable to the state)
LETTER OF INDEMNITY WITH RESPECT TO PAYMENT OF
BALANCE IN THE DECEASED CONSTITUENT’S ACCOUNT
WITHOUT PRODUCTION OF LEGAL REPRESENTATION
To
The Branch Manager,
United Bank of India,
…………………….Branch
IN CONSIDERATION of your paying or agreeing to pay me/us,
Insert here the 1)………………………………………….
Name(s) of 2)………………………………………….
Claimants 3)…………………………………………..
The sum of Rupees………………………………………………………………..
Standing at the credit of Savings Bank/Current/RD/TD Account etc…………….
With your bank in the name of Shri/Smt/Kum……………………………………
since deceased, without production of Letters of Administration or a Succession
Certificate to his/her estate or a Certificate from the Controller of Estate Duty to
the effect that estate duty has been paid or will be paid or none is due, I/we do
hereby for myself/ourselves and my/our heirs, legal representatives, executors
and administrators, jointly and severally UNDERTAKE AND AGREE to
indemnify you and your successors and assign against all claims, demands,
proceedings, losses, damages, charges and expenses which may be raised
against or incurred by you by reasons or in consequence of your having agreed
to pay/or paying me/us the said sum as aforesaid.
SIGNED AND DELIVERED
By the above named on this………………….
Day of …………………….Two thousand……………
…………………………………………………………
SIGNED AND DELIVERED
By the above named
1………………………..2………………………..3……………………….
4………………………. 5…………………………… 6……………………
(heirs/claimants of the deceased)