Bank Deceased Claim Settlement Affidavit by Legal Heirs (Annexure-10)

Before the Ld. Concerned Authority / Notary Public At Ghatal, Dist.- Paschim Medinipur, West Bengal AFFIDAVIT (On Non-Judicial Stamp Paper of ₹100 Non-Judicial Stamp Paper) In the matter of: Bank Deceased Claim Settlement Affidavit by Legal Heirs (Annexure-10) I, [Deponent Name], [S/O / D/O / W/O] [Father / Husband Name], aged about [Age] years, by faith [Religion], by occupation [Occupation], residing at Vill.- [Village / Ward No.], P.O.- [Post Office], P.S.- [Police Station], Sub-Division- Ghatal, Dist.- Paschim Medinipur, Pin- [Pin Code], West Bengal, do hereby solemnly declare, affirm and state on oath as under:- 1. That the deceased account holder late [Predecessor / Family Member Name] maintained a Savings Bank / Term Deposit Account No. [Account No. XXXXXXXXXX] with the bank. 2. That the said depositor expired intestate on [Date of Death] without leaving any Will or testamentary instrument. 3. That the deceased was survived by the following lawful legal heirs: [Names, Ages, and Relationships of Heirs]. 4. That all legal heirs have unanimously agreed that the net balance standing to the credit of the account be released to claimant [Deponent Name]. 5. That we jointly and severally agree to indemnify the Concerned Authority against any future rival claim or litigation. Verification:- I, the above-named deponent, do hereby verify and declare that the statements made in paragraphs 1 to 5 above are true and correct to the best of my personal knowledge, belief and derived from authentic records. No material facts have been suppressed, concealed or misstated herein. If any statement is subsequently found to be false or incorrect, I shall be liable to face statutory legal prosecution under the Indian Penal Code / Bharatiya Nyaya Sanhita and relevant provisions of RBI Guidelines on Settlement of Claims of Deceased Depositors & Indian Succession Act 1925. Solemnly affirmed and signed on this [Date] day of [Month], [Year] at Ghatal. ___________________________ Deponent Signature / LTI Identified by me and signed in my presence: ___________________________ Advocate, Ghatal Dewani Court Dist.- Paschim Medinipur, West Bengal