TO

THE BRANCH MANAGER

CENTRAL BANK OF INDIA

SHAHABAD MOHAMMAD PUR

NEW-DELHI-110061

DATE: 01/05/2018

AFFIDAVIT REGARDING MY LOST PASSBOKK

I, SARITA W/o Sh. SANDEEP KUMAR aged about 32 years, presently

residing at HNO-978 SHAHABAD MOHAMMAD PUR NEAR OLD SHIV

MANDIR NEW-DELHI- 110061, do hereby solemnly affirm and declare

as under:

1. That I am the holder of the Savings Bank A/c No 3061598609 in

the Central Bank Of India situated at Shahabad Mohammad Pur New-

Delhi 110061 .

2. That I have lost my bank pass book of A/c No 3061598609

since 15 days I had deposited a Sum of Rs 24000/- on 16/04/2018 in

my Bank A/c personally and after that I have lost my pass book.

3. Thereby I request you to issue a new pass book to me so that I

can have the correct info of my Bank a/c no 3061598609 in Centarl

Bank of India situated at SHAHABAD MOHAMMAD PUR NEW_DELHI

110061.

4. That the deponent states that the contents of the accompanying

affidavit may be read as part of this affidavit which is not being

reproduced here for the sake of brevity.

 Deponent

VERIFICATION

Verified at Delhi on this ----- Day of May 2018 that the contents of the

above affidavit are true and correct to the best of my knowledge and

belief and no material has been concealed there from.

Deponent