Unclaimed Deposits /Inoperative Accounts: Claim Form
Date: From……………………..
The Branch Manager
State Bank of India,
_______________ Branch
Dear Sir / Madam,
I/We the undersigned Mr./Mrs./Ms/___________________________________in
the capacity of
Self
Nominee
Legal Heir
Others (please specify)
request for settlement of claim, for Deposits account(s) held with your Bank in the
name(s) of Mr./Mrs./Ms/Others________________________________________
Name Account No. and Other details:
(with documentary proof)
Name of Claimant(s) :
Communication Address with Pincode:
DOB PAN No. Passport No. Tel./Mob. No.
I/We understand that claim will be settled post due diligence and authentication of
documents and in subject to bank’s process & policy. I/We undertake to submit
the document as may be necessary for the Bank to process the claims and agree to
execute the required documents to settle the claim.
Signature: __________ _
Name : __________
………………………………………………………………………………………
Customer Acknowledgment slip (to be filled in by Bank official)
Date:
Received a request from Mr./Mrs./Ms. ____________________________ for
claiming Unclaimed Deposits/Inoperative Accounts.
State Bank of India Signature of Bank Official with Bank seal
______________Branch
