Da Forms: Da-1 To Annexure-15 Page 14
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35ANNEXURE-1
Application for Deceased claim
other than Nomination
(To be used for cases
/ joint account with survivor
clause)
From
___________________
___________________
___________________
To
The Branch Manager
The South Indian Bank Ltd.,
___________________ Branch
Dear Sir,
Re: Deceased Account
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(s)
is/are
in
the
name
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) Grand Children. If Hindu
Joint Family, the name and address of the Karta and Co-
parceners with their respective ages.
Contd…2
14
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