Affidavit cum Indemnity Letter

In respect of payment of balance in deposit accounts/contents of safe

deposit locker of deceased person.
(to be stamped with the duly payable for affidavit and Indemnity
Bond)
I, Bhagwan Dei, W/o Late Krishna Lal Yadav, aged about 74 years, R/o
Kharagpur, Sec-14, Indira Nagar, Lucknow, do hereby solemnly affirm and
state as follows:
1.

I am the legal heirs of Mr KRISHNA LAL YADAV and the deceased is

my husband.

2.

I further state that I am legal heir entitled to claim the balance

deposit/amount/jewels/ornaments and other valuables the contents
held in the locker:-

No.

Name

Age

1.
2.
3.
4.
5.
6.

Bhagwan Dei
Ashok Yadav
Manju Yadav
Ramdev
Meery Yadav
Ranjeet Yadav

74
53
48
43
40
33

3.

Relationship
deceased
Wife
Son
Daughter
Son
Daughter
Son

to

the

I further state that the deceased was holding an account SB A/c No.
4371 in Punjab and Sindh Bank Branch of Sector 14, Indira Nagar. At
the time of the death of the deceased, the account was having a
credit of Rs.......................... which includes interest upto .................
amounting to Rs. .....................

4.

I affirm that I am the sole legal heirs of the deceased who is entitled
to receive the amount standing in the credit of the account
belonging to the deceased.

5.

I have requested the bank to make the payment of the amount

standing in the credit of the account belonging to the deceased
together with interest thereon as applicable, to Smt. Bhagwan Dei
being one of the legal heirs for and on behalf of all the legal heirs.
OR
I have requested the Bank to hand over contents of the Safe Deposit
Locker to Smt. Bhagwan Dei, being one of the legal heirs for and
behalf of all the legal heirs.

6.

I are aware that the Bank has agreed to settle our claims relying on
this affidavit and I agree to indemnify the Bank in respect of such
payment/delivery of the contents of items in Safe Deposit Locker
against any claim made by any person for the amount standing to
the credit of the account of the deceased.

7.

I for ourselves and my respective heirs, executors and

administrators jointly and severally agree, affirm and undertake that
the Bank, its successors and assigns and its managers, Agents,
Officers and servants and their respective estates and effects are
and shall from time to time and at all times hereafter be kept safe
and saved harmless and indemnified for and in respect of such
payment and against all actions, losses, cost, charges, expenses
and demands whatsoever in respect of the said payment/delivery of
the contents of items in Safe Deposit Locker.
All the averments made herein before are true and correct and I put
my signature/mark on this 26th Day of June, 2015 at 11:00 am in the
presence of court.

Signature(s) of deponents. (Claimants)