Exim Bank Claim Form

8/13/2019 Exim Bank Claim Form

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Exim Bank

TD- claims-1Application for Deceased claim (To be used when account has nomination clause)

Place:Date:

The General ManagerExport-Import Bank of India21stFloor, World Trade Centre,Cuffe Parade, Mumbai-400005

Dear Sir,Re: FD account of Deceased Late MR/Ms...

Account No(s)..

I/We advise the demise of Mr/Ms. _______________________ on __________________. He/She holds theabove FD account(s) in your Bank. The account/s is/are in the name(s) of:

i) ____________________________________ii) ____________________________________

iii) ___________________________________

I,son/daughter of Mr....

residing at .am

(i) the registered nominee in the above account(s).(ii) the person authorized to receive payment on behalf of Master / Miss

.. who is the nominee in the above account(s) and is a minor as on thedate of this claim.

Please settle the balance in the account in the name of the nominee. I/we receive the payment as trustee(s) of

the legal heirs of the deceased.

I/We submit photocopy of the following document(s) together with originals. Please return the original to usafter verification.

i)Death Certificate issued by.

ii) Identity proof . (enclose Election ID Card/ PAN Card / Passport)

iii)Address Proof.(attach ration card/electricity/telephone bill/municipal tax receipt)

iv) Photograph and signature of the claimant on the Annexure (duly attested by the Branch Manager of the

Bank where the claimant is maintaining the account along with details of account.)

Yours faithfully(Claimant(s)Name Signature

.

Address :..

Telephone/Mobile No.:..


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Exim Bank

Annexure-1

VERIFICATION OF SIGNATURE AND PHOTOGRAPH OF THE ACCOUNT HOLDER

This is to certify that Mr /Ms..Son/Daughter of

Mr

Residing at

..

is maintaining a Savings Bank/Current account No.

with our branch. The signature and photograph of the above account holder is attested here under:

Signature of above Account holderPhotograph of above Account holder

signed across by the Branch Manager

Signature of the Branch Manager:

Name of the Branch Manager:

Name of the Bank:

Name of Branch :.

Complete address:..

Telephone No:

Branch Seal


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Exim Bank

TD- claims-3Application for Deceased claim

(To be used for cases other than Nomination / joint account with survivor clause)

The General ManagerExport-Import Bank of India21stFloor, World Trade Centre,Cuffe Parade, Mumbai-400005

Dear Sir,

Re: FD Account of the Deceased Late Mr/Ms..

Account No(s)..

I/We advise the demise of Mr/Ms on ..

He/She holds the above account(s) at your branch. The account(s) is/are in the name of:

1

2

3

I/We lodge my/our claim for the balances with accrued interest lying to the credit of the above named

deceased who died intestate. I / we am / are the legal heirs of the above named deceased and lodge

my/our claim for payment as per the banks rules and discretion. The relevant information about the

deceased and the legal heirs are as under.

1. Names in full of the parents of the deceased:

Father: ..

Mother:

2. Religion of the deceased:..


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3. Details of living (i) Husband (ii) Wife (iii) Children (iv) Father (v) Mother (vi) Brothers (vii) Sisters

(viii) Grand Children. If Hindu Joint Family, the name and address of the Karta and Co-parceners

with their respective ages.

Full Name/Address Occupation Relationship with Deceased Age

1

2..

3..

4.......................

5.

6.

5. Name or Names of the Guardian/s ofthe minor Children of the Depositor :

(a) Whether Natural Guardian :.

(b) Whether Guardian appointed by a Court of Law in India:..(If so, attach a certified copy or duly attested copy of such Order)

(c) In whose custody the Minor/Minors is / are?:

6. Claimant/s name/s and address in full:

(i)

(ii)

(iii)

(iv)

I/We submit the following documents. Please return the original death certificate to us afterverification:

1. Death Certificate (Original + 1 photocopy) issued by: ..

2. Succession certificate/ Letter of Indemnity ( on the format provided by the Bank for claims upto Rs 50000)


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We request you to pay the balance amount lying to the credit of the above named deceased to

Mr/Ms on my/our behalf.(name of the person in whose name settlement cheque is to be issued)

The details of the Bank account of the said Mr/Ms are as under:

Account type (Savings Bank/Current):

Account No:

Name of the Bank:

Name of the Branch(with address and Telephone No.):.................

.

MICR code IFSC Code:..

I/We hereby solemnly affirm that the above statements are true and correct to the best of my/our

knowledge and belief.

Yours faithfully,

Name of Claimant(s) Address Signature (s)

1..

2..

3..

4..

Date:

Place:


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Exim Bank

Annexure - 3

RECEIPT

Received with thanks from Export-Import Bank of India, Mumbai , a sum of Rs. _______________

(Rupees _____________________________ only) by Bankers Cheque No.________________

dated ____________ in favour of ____________________________________________________ in

full and final settlement of my/our claim as successor on the balance in fixed Deposit Account(s)

No(s).. standing in the name of the deceased

Mr/Ms ________________________________. I/We do not have any other claim from the Bank

henceforth.

Place:

Date:

(Signature of all the legal heirsOver a revenue stamp)


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Exim Bank

Annexure - 4

DECLARATION in case funds are settled in favour of a Minor

I, father and natural guardian of

Master/Baby . hereby certify that

the proceeds of your Cheque No..dated..favoring

..issued by you in settlement of the balance in account

numberof Late.

will be utilized for the benefit of the minor only.

Signature of the guardian

Exim Bank Claim Form

Documents

Transcript of Exim Bank Claim Form