Da Forms: Da-1 To Annexure-15 Page 29
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35ANNEXURE-12
RECEIPT
(TO BE OBTAINED FROM THE NOMINEE)
I, Sri/Smt. ____________________, S/o. / D/o. ______________________ aged
________ years, the nominee/guardian of the minor nominee ___________________
hereby
acknowledge
receipt
of
a
sum
of
Rs.____________
(Rupees
________________________________ only) from The South Indian Bank Ltd.,
_______________________ Branch, being the amount payable in the accounts
mentioned hereunder of the late ____________________________ as his/her
nominee in full and final settlement of the claims * by substitution of my name to the
deposit account.
Deposit A/c.No. / Assets.
Amount / Value in Rs.
I hereby confirm that I have no further claim against the Bank in respect of
accounts/assets of the said deceased as nominee and the Bank is fully discharged from
all liability and obligation to me or to any person claiming for or through me
including the legal heirs of the deceased depositor(s).
Date:
Revenue Stamp
WITNESSES: (If nominee affixes
(Signature with name and
Thump impression)
address of the nominee /
Guardian of the minor nominee)
1.
2.
* Strike out if not applicable.
29
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