Affidavit Format
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1
2ANNEXURE - 7
Affidavit format
(To be typed on ledger paper & duly stamped as per the
Stamp act applicable to the State)
AFFIDAVIT
I/We,Shri/Smt/Kum_____________________________________aged
adult,
residing
at
___________________________ and Shri/Smt/Kum _____________________________ aged adult,
residing at ___________________________________, Indian Inhabitants, do on solemn affirmation state
that my/our _______________________ (state relation) late Shri/Smt/Kum. ______________________
died intestate at _________________________ on ____________________. He/she has left behind
him/her surviving the following persons as his/her only heirs according to the law of Intestate Succession
applicable to _________law by which he/she was governed at the time of his/her death.
Sr.No.
Name
Age
Relationship with the deceased
1.
______________________
____________
_____________________________
2.
______________________
____________
_____________________________
3.
______________________
____________
_____________________________
4.
______________________
____________
_____________________________
(Being the mother/father I am the natural guardian of the said minor heirs). There are no other heirs than
those mentioned above.
Particulars of Accounts of the deceased left behind in his/her name in Dombivli Nagari Sahakari Bank Ltd.
are as follows :-
a)
Current A/c No. _________
_____________ Branch
Balance Rs. ______
b)
Saving A/c No.
__________ _____________ Branch
Balance Rs. ______
c)
Fixed Deposit A/c No. _________ _____________ Branch
Balance Rs. ______
d)
R/D A/c No.
_________ _____________ Branch
Balance Rs. ______
e)
Share Membership No. _________ No of shares __________ Rs. _____________
The said deceased has left no will nobody obtained any legal representation from any court regarding the
estate of the deceased nor has applied for or is required to apply for the same.
I/We, one of the Sole/heirs claiming the balance amount in the said accounts in the name of deceased
and all the other heirs mentioned above given their no. objection for the same by their consent vide letter
dated _____________ to that effect.
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