DEPARTMENT OF POSTS
Claim application form for settlement of the claim to a Savings Bank Account of the deceased depositor where nomination has been registered with the Post Office
To
The Postmaster
…………………………….
Sir
I/We hereby claim the payment of the balance at credit of the Savings Account
No…………………………… standing in the name of the deceased ………………… in
the books of …………………………… (name of post office). In support of the claim,
I/We hereby submit
(i) Passbook of Account No………………….
(ii) A certificate of death of the depositor
(iii) A certificate of death of the other nominee, if any
The nomination was registered at ……………………………. Post Office under
No……………………….. dated ……………………….
Yours faithfully
Date ………………………. Signature or thumb impression of the
Address ………………….. claimant if illiterate
Date ………………………. Signature of the Guardian appointed
Address of Guardian to receive the amount on behalf of
Minor nominee(s)