Da Forms: Da-1 To Annexure-15 Page 21

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ANNEXURE-6
RECEIPT
Received with thanks from The South Indian Bank Ltd. _________________
branch,
a
sum
of
Rs.
_______________
(Rupees
_____________________________
only)
by
Banker’s
Cheque
No.________________
dated
____________
in
favour
of
____________________________________________________ in full and
final settlement of my/our claim as successor on the balance in ___________
Account(s) No(s).______________ standing in the name of the deceased
Shri/Smt/Kum. ________________________________. I/We do not have any
other claim from the Bank henceforth.
Place:
Date:
@
(Signature of all the legal heirs
Over a revenue stamp)
21

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