Claim Case Forms
Claim Case Forms
Claim Case Forms
Sr. No.
Prescribed forms ANNEXURE
3. Inventory for articles left in safe custody (With III & III A
Nomination & without Nomination )
CLAIM FORM
(For Establishing the Identity of the Nominee)
(PNB 831)
Shri/Smt./Kum.___________________________
Signature____________________
(Nominee/appointed on behalf of minor nominee).
Address __________________________
__________________________
__________________________
Witness*:
********
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ANNEXURE-II
1.
2.
for the purpose of inventory access to the locker was given to the Nominee/
and the surviving hirers.
AND
Shri/Smt.______________________
{ Survivors of joint hirers.} Shri/Smt. { Survivors of joint hirers.}
Address ___________________ }
Address (Signature) _________________ }
_______________________
(Signature) ____________
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2. Witness(es) with name, address and signatures.
Note:
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ANNEXURE-II A
1.
2.
For the purpose of inventory, access to the locker was given to the legal
heir(s)/a person mandated by the legal heir(s) and surviving hirers
*By breaking open the locker under his/her/their instructions.
*Who produced the key to the locker. (Delete whichever is not
applicable).
1. __________________ (Signature)
Shri/Smt.______________________________
Address . _________________________
__________________(Signature)
Shri/Smt.______________________________
Address .____________________________________
And
__________________(Signature)
Shri/Smt. _______________________{Survivors of Joint hirers}
Address _____________________________________
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____________________(Signature)
Shri/Smt. ________________________
Address. _____________________________________
__________________(Signature)
Shri/Smt. ________________________
Address . __________________________________
__________________(Signature)
Shri/Smt.______________________________
Address .____________________________________
******************
ACKNOWLEDGEMENT
* I, Shri/Smt. __________________________________ legal heir/mandate holder
* We, Shri/Smt. _________________________________________________________
____________________________________ legal heirs and Shri/Smt.
____________________________________________________________ surviving
hirers hereby acknowledge the receipt of the contents of the safety locker
comprised in ad set out in the above inventory together with a copy of the
said inventory.
Shri/Smt. ____________________________
(Legal Heir/Mandate Holder)
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ANNEXURE-III
The following inventory of articles left in safe custody of Punjab National Bank
with________ branch, by Shri/Smt.________________
(Deceased) under an agreement/ receipt dated_____________ was taken on this
________day of _____________200 :-
2.
1. Shri/Smt._____________(Nominee) OR 1. Shri/Smt._______________
Address ______________ (Appointed on behalf of minor
________________________ Nominee)
Address __________________
____________________________
Signature ______________
Signature _________________
Shri/Smt._____________(Nominee) OR Shri/Smt._______________
(Appointed on behalf of minor
Nominee)
Signature _________________ Signature _________________
Date_______________________ Date_______________________
Place___________________ Place___________________
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ANNEXURE-III A.
Form of Inventory of articles left in
Safe Custody with banking company
(To be used where there is no nomination or survivorship clause )
1.
2.
The above inventory was taken in the presence of, Legal heirs or a person
mandated by legal heirs
1. Shri/Smt. __________________
(
Signature)
Address . __________________________________
2. Shri/Smt. ________________________________ __________________
(Signature)
Address .____________________________________
ACKNOWLEDGEMENT
Shri/Smt. ____________________________
(Legal Heir/Mandate Holder)
Shri/Smt. _________________________________ Signature __________________
Shri/Smt. _________________________________ Signature __________________
Shri/Smt. .______________________________ Signature __________________
Date & Place ________________________
(* Delete whichever is not applicable)
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Annexure-IV -1
I hereby confirm that the payment has been received as trustee (s) of the
legal heirs of the deceased.
Place: Revenue
stamp
Date:
(Signature of Nominee)
*********
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Annexure-IV-2
I /we hereby confirm that the payment has been received for self and for
and on behalf of other legal heirs of the deceased.
Place: Revenue
stamp
Date:
(Signature of the legal heirs)
DECLARATION
(In case funds are settled in favour of a Minor)
Signature
Date :
Place:
***********
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ANNEXURE -V
(PNB – 1141)
POWER OF ATTORNEY
(For deposit accounts)
2.
2) To give receipt and proper discharge to the bank in connection with the
above amounts received on my/our behalf
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AND I / We hereby agree that all acts, deeds and things lawfully done by
my/ our said attorney shall be deemed as acts, deeds and things done by
me/ us personally and I / we undertake to ratify and confirm all and
whatsoever that my /our said attorney shall lawfully do or cause to be done
for me/ us by virtue of powers hereby given.
IN WITNESS WHEREOF I/We have signed this deed on this ...... day of...
……………..200 ..
EXECUTANT(S)
1) Witness
2) Witness
(If different persons execute at different places / difference dates, the place/
date be not filled up. The place / date be indicated against their respective
signatures)
********
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ANNEXURE-VI
(PNB – 1142)
POWER OF ATTORNEY
(For Lockers)
1) To have access, to open the said locker and to receive contents thereof
2) To sign the inventory of the contents of locker and receive copy thereof,
give receipt and proper discharge to the bank in connection with the
receipt of contents of locker.
4) Generally to do all lawful acts necessary for receipt of the contents of the
said locker.
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AND I/We hereby agree that all acts, deeds and things lawfully done by
my/ our said attorney shall be deemed as acts, deeds and things done by
me/ us personally and I / we undertake to ratify and confirm all and
whatsoever that my /our said attorney shall lawfully do or cause to be done
for me/ us by virtue of powers hereby given.
1) Witness
EXECUTANT(S)
2) Witness
(If different persons execute at different places / difference dates, the place/
date be not filled up. The place / date be indicated against their respective
signatures)
********
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ANNEXURE- VII
(PNB – 1143)
AGREEMENT OF INDEMNITY
( For deposits /lockers)
The said principal party has/have accordingly signed this agreement on the
day, month and year mentioned above.
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ANNEXURE-VIII
(PNB 346)
1.
2.
AND WHEREAS the said principal party .............. claim (s) to be the sole
heir/heirs of the said deceased and entitled to the above mentioned
property of the deceased and also claim(s) the payment of the balance (s)
standing to the credit of the deceased in the books of the bank.
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said principal party by the said bank, the principal party and the surety
both undertake for themselves their heirs, executors and administrators to
hold the bank, its agents etc. harmless and indemnified in respect of all
claims to the aforesaid money(s).
IN WITNESS whereof the principal party, and the surety have put their
signatures
1) WITNESS ....………….
OCCUPATION…………. PRINCIPAL PARTY
ADDRESS ....…………..
2) WITNESS……………… SURETY
OCCUPATION…………
ADDRESS ...……………
(EXECUTANT(S)
************
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ANNEXURE-IX
(PNB – 1144)
INDEMNITY BOND WITH SURETY
(for locker)
IN WITNESS whereof the principal party and the surety have put their
signatures
1) WITNESS ....………….
OCCUPATION…………. PRINCIPAL PARTY
ADDRESS ....…………..
2) WITNESS……………… SURETY
OCCUPATION…………
ADDRESS ...……………
FOR PUNJAB NATIONAL BANK
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(EXECUTANT(S)
ANNEXURE-X
LETTER OF CONSENT-CUM-RELINQUISHMENT
Dear Sir,
With reference to the above I / we inform you that Shri / Smt. / Kum.
___________________________, who has been your customer, expired on
______________________ leaving behind him/her the following legal heirs,
who are entitled to receive the amount / contents of the Locker lying with
you in the above account / locker:
1.
2.
3.
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We hereby declare that the payment / delivery so made to the above Shri /
Smt. / Kum. _________________________ shall validly discharge the bank and
none of us will have any claim against the bank in whatsoever manner in
this regard.
_____________________________ 1.
(Signature of the Authorized Person) 2.
3.
Name:
Address__________ *EXECUTANTS
(*To be signed with name and full address by the persons except the
person in whose favour the relinquishment and consent is given)
Seal
Notary Public / Gazetted Officer / Officer of Public Sector
Undertaking
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ANNEXURE- XI
And
WHEREAS
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c) The principal parties further affirm that Mr./Ms.
____________________________________ is a coparcener of the HUF and
he/she has been unanimously appointed as the new Karta of the
HUF;
IN WITNESS whereof the principal parties, and the sureties have put their
signatures
1) WITNESS ....………….
OCCUPATION…………. PRINCIPAL PARTIES
ADDRESS ....…………..
SURETIES
2) WITNESS………………
OCCUPATION…………
ADDRESS ...………… …
FOR PUNJAB NATIONAL BANK
{EXECUTANT(S)}
************
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