Annexure A

LETTER OF DISCLAIMER
(Stamped Rs.200/- e-stamp as per the Karnataka stamp Act applicable)

The Branch Manager

CANARA BANK
Vivekanandanagar Branch
MYSURU-570 023
Dear Sir,
Locker No. 406. Key No. 6. Class/Size/Type-D in the name of SHYLAJA, Balance
Rs.________________
With reference to the above account, I, the following legal heirs of the late Smt. Shylaja, have
to advise that I have no interest in the above assets and as such have no objection to your
paying the balance amount lying in the above account with you in the name of the afore said
late Smt. SHYLAJA to Sri.H.L.CHANDRASHEKARA.
Such delivery of the payment of the balance in the above locker would be completely binding
on me and I will not question the Bank’s action in so doing if any proceedings. I undertake to
bind myself, my legal heir/s and legal representative/s not to revoke the declaration made
herein.
S. No. Names of the claimants (Who Age Signature
relinquish their rights)
1. H.L Chandrashekara 65

Signed before me this 16th September of 2021.

Executed at Mysore and Solemnly
affirmed and declared before me
at Mysuru on 16.09.2021

NOTARY, MYSURU