FORM - III

LETTER OF DISCLAIMER

To,
Chief / Branch Manager
___________ Branch (Branch Code ______),
State Bank of India,
__________________

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FORM - III

Dear sir/madam,
Savings Account Number ___________
In the Name of Late _____________
Balance – Rs. _____________ (Rupees ________________ only) lying in MOD
and Rs.___________ (Rupees _____________ only) lying in savings account.
With reference to the above accounts, I/we, the following legal heir of late Shri
_____________ have to advise that I/we have no interest in the above assets and as
such I/we have no objection to your paying the balance amount lying in the above
account with you in the name of the aforesaid Shri ____________ to: -

SR. NAME RELATIONSHIP WITH THE

NO DECEASED
.
1.
2.

Such delivery of the payment of the balance of the above account would be
completely binding to me/us and I/we will not question the Bank’s action in so
doing if any proceedings. I/we undertake to bind ourselves, my heirs and legal
representative not to revoke the declaration made herein.
SR. NAME(S) OF THE AGE (IN SIGNATURE
NO DISCLAIMER(S) YEARS)
.
1.

Signed before me this _______ day of April, 2023.

KNOWN TO ME AND
IDENTIFIED BY ME

ADVOCATE

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