Death Claim Form PDF
Death Claim Form PDF
Death Claim Form PDF
2. Particulars of Policy
i. Policy No.
Village Taluka
City District
State Country PIN
6. Age of Claimant
Years
(If the claimant is a minor, the person who represents himself to be the minor's guardian/ appointee should fill up the entries 8 to 13
overleaf.)
________________________________________________________________________________________________________
Note - If claimant has obtained probate of will of the insurant or certificate of succession or letters of administration, the documents
or certified copies should accompany the form: _______________________________________________________________
________________________________________________________________________________________________________
Note. - The answer to the following must be filled by a person who represents himself or herself to be the guardian/appointee of a
minor who claims payment of a policy.
10. If you are not the father or mother of the minor, have you been appointed guardian of the minor by nomination, will or deed or
under any enactment in force in India? Please state and produce the documents in support your claim: ________________
________________________________________________________________________________________________________
12. Name of the Post Office (if it is Sub Office, write the name of Head Office as well) at which the payment is desired.
i. Name of Sub Post Office
i. Account No.
Date:________________
Signature of Claimant
Name:
Phone no.:
Office:
Residence:
Mobile no. :
Certified that I have personally enquired into the truth of the above statements and the signature of the applicant is genuine.
1.
2.
1.
2.
ATTESTED
NOTARY PUBLIC
ANNEXURE-II
(Affidavit)
To
The Chief Postmaster General/ Postmaster General,
(1) That I /We am/are the only heir(s) of the deceased…………………………………. who died at ………………………..on …………………………..
I/We alone represent the estate of Shri/Smt……………………………………………….
(2) That the deceased…………………………………………………….did not leave any Will and therefore I/We are the only successor(s) to the
estate of the said deceased.
1.
2.
3.
DEPONENTS
Verification: I/We, the above-named deponents do hereby verify on solemn affirmation in……………………………….(name of place) that the
contents of this affidavit are true to the best of my/our knowledge and nothing material has been concealed.
Dated…………………………
1.
2.
3.
ATTESTED DEPONENTS
OATH COMMISSIONER
ANNEXURE-III
(Letter of disclaimer on Affidavit)
To
The Chief Postmaster General/ Postmaster General,
1.
2.
3.
DEPONENTS
VERIFICATION: I/We, the above-named deponents do hereby verify on solemn affirmation that the contents of this affidavit are true to the best of
my/our knowledge and nothing material has been concealed.
Dated………………………
1.
2.
3.
I identify the deponent(s) who is/are personally known to me and who has/have signed in my presence.