Deceased Estate Declaration And Claim printable pdf download

Deceased Estate Declaration and Claim/Indemnity Form

This form applies when Probate/Letters of Administration are not being applied for. It may be used for claims up to

but not exceeding the value of $15,000.

Section A: Deceased’s Details and Checklist

Documentation checklist:

(please tick)

Full name

Certified copy of the Death Certificate or

Medical Cause of Death Certificate

Certified copy of valid photo ID for the

Date of death

Declarant

Section B: Declarant’s Details

Name

Date of Birth

Contact phone number

(In accordance with ID)

Home Address

Relationship to deceased:

(choose one)

Husband or wife of the deceased

Defacto partner of the deceased

A child of the deceased

Person entitled to the estate under the will of the deceased

Person appearing to be entitled to obtain administration of the estate of the deceased in New Zealand

Person who has custody and control of the infant children of the deceased

Brother or sister of the deceased

Parent or legal guardian of the deceased

Section C: Payment Details

___________________________________

I request Westpac NZ to close the accounts of the deceased and pay the funds to the account of

Bank

Branch

Account Number

Suffix

Section D: Declaration & Indemnity

I ________________________________________________________ solemnly and sincerely declare that;

•

I confirm that I am acting as the Administrator or Executor of the above named estate. I am either named as Executor in the will or

confirm that the deceased died without leaving a will.

•

All the information provided above is true and correct and forms part of this declaration.

•

To the best of my knowledge Probate or Letters of Administration have not been applied for or obtained in New Zealand and I do not

intend to nor will I apply for grant of Probate or Letters of Administration of the Estate of the said deceased and to the best of my

knowledge no other person intends to apply for Probate or Letters of Administration of the Estate of the deceased.

•

I will pay and discharge any debts that may be proved in the estate of the deceased

•

I claim payment of the moneys to which the deceased was entitled upon the grounds of my relationship to the deceased as detailed

above.

•

I shall apply the said moneys in due course of administration as the law requires. In consideration of Westpac New Zealand Limited

(Westpac NZ) releasing the funds in the deceased’s account(s) I hereby agree to indemnify Westpac NZ against any claims, losses,

damages, costs and/or expenses whatsoever (including its own legal costs on a solicitor/client basis,) which may arise in connection with

the said account(s) or the payment of the balance(s) therefore and also against all amounts Westpac NZ maybe called upon to pay and

all costs (including its own legal costs on a solicitor/client basis) charges and expenses which Westpac NZ may incur in connection

therewith.

I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act 1957.

Declared at ______________________________________________on this day ______________________________

Signature of Declarant

Full Name

Witnessed by: (Must be a Solicitor of the High Court of New Zealand/Justice of the Peace in New Zealand)

Signature

Justice of the Peace/Solicitor’s Stamp

Deceased Estate Declaration And Claim

Related Articles

Related forms

Related Categories