ADARSH CO-OPERATIVE BANK LTD, SIROHI

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1 ADARSH CO-OPERATIVE BANK LTD, SIROHI Claim from nominee to recognize his claim to the deposit*/safety locker* Annexure-I Shri/Smt/Kum Nominee/appointed on behalf of the minor nominee hereby declare that I am the nominee/appointed on behalf of the minor nominee of the deceased Shri/Smt. further declare that I am nominated to claim the deposit monies /articles held with Branch in safe custody/safety locker by Shri/Smt deceased. The deposit monies/ articles held in safe custody/safety locker are held in Account/Locker No. Safe custody receipt No. of Shri/Smt. deceased. Shri/Smt. Nominee/appointed on behalf of minor nominee) Signature Date Address: Witness: 1. Magistrate or Judicial Official 1. Name Or Address 2. An officer of the Central or Sate Government Or Signature 3. An Officer of a Bank 1. Name Or Address 4. Twp persons acceptable to the bank Signature (Strike out whichever is not applicable)

2 vkn'kz dks&vkwijsfvo csad fyiz/kku dk;kzy;] fljksgh Annexure- II vkn'kz dks&vkwijsfvo csad fy- 'kk[kk mùkjkf/kdkjh izek.k i= izlrqr djus dh vko';drk ls eqfdr ikus ds fy;s izkfkzuk i= vkn'kz dks&vkwijsfvo csad fy- fljksgh ds e`rd /kkjd iq= }kjk izkir fd lnl;rk /kkjd :i;s es a fuoklh¼lfkku½ fd@dk fo/kok@t;s"b gwaa esa,rn~}kjk frffk iwozd?kks"k.kk djrk gw a fd mijksdr lnl;@tek dùkkz us dksbz ofl;r ugh dh gs izkfkzuk djrk gw a fd eq>s mi;qdr lnl;rk@tekvksa dh 'krksz ds vuqlkj mùkjkf/kdkjh izek.k izlrqr djus fd vko';drk ls eqdr dj fn;k tk;s vksj es a,rn~}kjk frffkiwozd?kks"k.kk Hkh djrk gwa fd uhps fy[ks c;ku tgka rd esjh tkudkjh vksj fo'okl ls lgh gsa 1- d- e`rd dk iqjk uke o e`r;q ds le; dk irk vksj O;olk; D;k gs \ [k- e`rd dh tkfr vksj /kez D;k gs \ x- D;k ;g fgunq] fl[k] tsu ;k cks) Fkk ftldh leifr dk mùkjkf/kdkjh fgunq mùkjkf/kdkjh vf/kfu;e 1956 ij vk/kkfjr gs \?k- D;k og eqflye Fkk ftldh leifùk dk vf/kdkj eqflye dkuwu ij vk/kkfjr gs \ 2- mldh e`r;q dc vksj dgka gqbz \ D;k mlds }kjk dksbz olh;r ukek fd;k Fkk\ D;k e`rd us mijksdr lnl;rk@[kkrk /kkjd ds vurxzr feyus okyh jde ds vfrfjdr dksbz nwljh,slh leifùk NksMh gs ftlds fy;s :i;k ikus dk vf/kdkj gksus dk izek.k i= tsls mùkjkf/kdkjh gksus dk izek.k i= ldls'ku ¼lfVZfQdsV½ vkfn izkir dj fy;k x;k gs ;k izkir fd;k tkuk gs [k- D;k e`rd us iwoz es a csad ds fdlh lnl; fd _.k vnk;xh dh tekur ns j[kh gs ;fn gka rks mldk uke,oa lnl; la[;k

3 a a a 5- ¼v½ D;k e`rd us vius ihns uhps fy[ks lacaf/k;ks es ls dksbz lacaf/k NksMs gs ;fn gka rks muds iqjs uke vksj vk;q fy[ksa d½ iq= iqjk uke vk;q [k½ iqf=;ka iqjk uke vk;q x½ fo/kok ;k fo/kok;s@fo/kqj iqjk uke vk;q?k½ ekrk M½ iwoz e`r iq=ksa vfkkzr~ os iq= ftudh e`r;q lnl;@tekùkkz ls igys gks xbz gsa p½ iwoz e`r iqf=;ka ¼vFkkZr~ os iqf=;ka ftudh e`r;q lnl;@tek drkz ls igys gks xbz gks½ ds iq= o iqf=;ka ¼N½ iwoz e`r iq=ksa ds iwoz e`r iq=ksa ¼vFkkZr~~ ukrh ds iq=,oa iqf=;ka,oa fo/kok;sa½ ¼t½ firk ¼>½ HkkbZa ¼V½ cgusa ¼v½ ;fn Åij fns; lacaf/k;ksa es a ls dksbz ukckfyx gs rks ;g crkbz;s fd ukckfyx fdlds lkfk jg jgs vksj budk Hkj.k iks"k.k dksu dj jgk gs fo'ks"k ¼fgUnqvks a ds fy,½ ;fn bl izi= ds Øekad 5¼v½ es myysf[kr dksbz lacaf/k xksn fy;s x;s Fks rks muds ckjs es a xksn fy;s tkus ls lacaf/kr iwjk C;kSjk nhft;s 5-¼c½ D;k e`rd us vius ihns iz'u 5¼v½ ds mùkj esa O;fDr dk lnl; /kkjd ls fn;s x;s lacaf/k;ks a ds dksbz vksj laca/kh NksMs gs 'ks;jl (sharers) jsthm~;qjhl (Residuaries) ;k fmlvsuv fdumjm (Distant Kindered) ds :i ea s ;fn gka rks mudk fueufyf[kr fooj.k nsa 6- ;fn e`rd us vius fins Åij fn;s x;s laca/ksa ls dksbz Hkh lacaf/k ugh NksMk gs ysfdu dqn nwj ds iqjk uke lecu/k] vk;q uksv%& ;g fooj.k flqz eqflye lnl;ksa ds fy;s nsuk t:jh gsa

4 a lacaf/k tsls firkekg] firkekgh HkkbZ;ksa ;k cguksa ds cppksa vkfn NksMs gs rks,sls lhkh nwj ds lacaf/k;ks a ds uke vksj vk;q fyf[k,a 7- iz'u 5 o 6 ds mùkj es a fn[kyk;s x;s lacaf/k;ksa es ls dksu dksu ls lacaf/k fgllk jkf'k@tek jkf'k fd jde ds nkosnkj gs vksj D;k bu lacaf/k;ksa es a ls fdlh ds chp bl laca/k es a dksbz fookn gsa 8-,d,slh /kuh ekuh O;fDr dk iqjk uke vk;q vksj irk nhft;s tks e`rd ds oklh;ks a ds lkfk la;qdr :i ls {kfr iwfrz vuqcu/k Hkjus dk rs;kj gsa vkt lfkku fnukad ekg o"kz lk{kh dk glrk{kj nkokdùkkz glrk{kj uke irk in irk ;g C;ku fueufyf[kr es a ls fdlh,d ds leeq[k Hkjk gksuk pkfg;s ¼1½ csad izcu/kd ¼2½ 'kifk vk;qdr ¼3½ MkWDVj ¼4½ jktif=r vf/kdkjh ¼5½ ek/;fed fo ky; dk iz/kkuk/;kid ¼6½ eq[; ikslv eklvj ¼ijUrq 'kk[kk ikslv eklvj ugha½ ¼7½ n.muk;d ¼8½ xzke iapk;r vfkok LFkkuh; cksmz dk v/;{k

5 No Objection Letter Annexure-III To, The Adarsh Co-operative Bank Ltd. Branch. Dear Sir, I/We understand that Mr./Mrs./Miss (Claimant) son/wife/daughter/husband of the late Mr./Mrs. resident of has claimed as a legal heir of the deceased, the following amounts lying to the credit of the deceased and/or the contents of the locker No. lying with the Adarsh Co-operative Bank Ltd. Branch:- 1. T.D.R. No(s) for Rs. due on 2. S.B. A/c No. having credit balance of Rs. 3. C.D. A/c No. having credit balance of Rs. 4. R.S.D. A/c No. having credit balance of Rs. 5. Contents of locker No. having value Rs. as on date In respect of the above, I/We son/wife/daughter/brother/mother/husband of the late Mr./Mrs./Miss hereby declare that I/We have renounced all interest or share in the proceeds of the aforementioned accounts and/or contents of locker No. and have no objection to the refund by the Bank of the proceeds of the aforesaid accounts and/or release of contents of locker to the aforesaid claimant without insisting of Succession Certificate or other legal representation. Yours Faithfully, Date Full Adreess: (Signature) (Relation with deceased) (The signatures of declarer/s should be attested by Ist class Magistrate /Notary Public /Branch Manager if personally known to him. However, Sarpanch/Tehsildar may attest the signatures of the executants on the presence of the Branch Manager who will attest his signature)

6 Branch Manager Adarsh Co-operative Bank Ltd. Branch. Letter be completed and signed by the surety Annexure- IV I beg to inform you that I am prepared to execute an Indemnity bond in favour of the Adarsh Co-operative Bank Ltd. By Shri/Shrimati.. Resident of or the claim under its share money opposites of late Shri/Shrimati..(Membership No ) /(account No.) without insisting on legal evidence of title. Consequently I have filled in the questionnaire from given below:- Question Answer 1. Are you related to the member/account holder? 2. What is your present occupation and permanent Address? 3. What is your approximate monthly income and What are its sources? 4. What property movable or immovable do you process And what is the present value thereof? 5. Is the property free from encumbrance? I do here be solemnly assure the Adarsh Co-operative Bank Ltd. Branch that I have thoroughly understood and correctly answered the above question Declared at...the....day of..19. Witness & counter signed Signature.. Signature of the declarent Name Full Name Address & Seal Father's name of the declarant..... Present Address.

7 ADARSH CO-OPERATIVE BANK LTD. Annexure-V In consideration of the Adarsh Co-operative Bank Ltd., registered under the Multistate Co-operative societies Act, 2002 having agreed to pay to (Name of all Payees) of (Relationship) (Name of Deceased member/account holder) the sum of Rupees due under Shares Money/Deposits on the Name of deceased without recurring production of Probate or letters of Administration or Succession Certificate granted to the estate of (Name of deceased member/depositor) We (Name of all payees) and our Heirs, Executors and (Name of Surety) Administrators do hereby agree to keep the said Adarsh Co-operative Bank Ltd, (Branch) harmless and indemnified from and against all claims against it on the part of any person or person whomsoever all damages, costs and expenses which the said Adarsh Co-operative Bank Ltd, may sustain or incur in consequence of any such claim or claims. In witness whereof we the said (Name of Payees) and have (Name of Surety) set our hands at (Place) this (date) day of (Months) 19 (Year) (Name of all payees in the presence of) Signed and delivered by the said (Name of all payees in the presence of) and (Name of Surety) (1) (2) (Signature) 1- Full Signature Of witness Designation Address 2- Full Signature Of witness Designation Address Note:- (1) If this bond is signed in Vernacular one of the attesting witness should be requested to certify that the contents of this Bond were explained to the party in vernacular before execution. (2) Thumb impressions should be attested by a Magistrate or a Gazetted Officer or close Ist Officer or Manager of Adarsh Co-operative Bank Ltd. Provided, he is fully satisfied about the identity of the Party. (3) To be & deposit or Rs. 200 whichever is lower with non judicial revenue stamp.