Da Forms: Da-1 To Annexure-15 Page 17
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35ANNEXURE-3
Indemnity format
(To be duly stamped as per the Stamp
(from legal heirs only)
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
The South Indian Bank Ltd.,
________________ Branch.
IN CONSIDERATION of your paying or agreeing to pay me/us,
Insert here the
1) __________________________________________
Name(s) of
2) __________________________________________
Claimants
3) __________________________________________
4) __________________________________________
The sum of Rupees______________________________________________
standing at the credit of Savings Bank/Current/R.D. Account No. 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 Duly to the effect that estate duly 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)
17
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