Fill in Bank Affidavit (Lost Passbook / Lost FD Receipt / Dormant Account)

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Bank Affidavit (Lost Passbook / Lost FD Receipt / Dormant Account)

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BANK AFFIDAVIT: LOST PASSBOOK / LOST FD RECEIPT / DORMANT ACCOUNT

I, __________, __________, resident of __________, holding __________, ordinarily resident within __________ (the "Deponent" or "I"), do hereby solemnly affirm and declare as follows:

1. THE ACCOUNT

2. PARTICULARS OF THE CASE

3. INDEMNITY

3.2 I understand that the Bank may also ask for a separate indemnity bond on its own wording and on stamp paper of the value it requires, and I will sign one if the Bank so requires.

4. DECLARATION

4.1 Every statement made above is true to my own knowledge and belief, and I have concealed nothing material. I am aware that making a false declaration in an affidavit is an offence, and that the Bank is relying on this affidavit in acting on my request.

VERIFICATION

DEPONENT

Signature: ______________________________
__________

ATTESTATION

Notary Public / Oath Commissioner
Registration No. and seal: ____________________

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