BANK AFFIDAVIT: LOST PASSBOOK / LOST FD RECEIPT / DORMANT ACCOUNT
Executed at Ludhiana on 1 April 2026.
To
The Branch Manager,
State Bank of India, Model Town Branch, Jalandhar
I, Simranjit Kaur, daughter of Sh. Gurmeet Singh, resident of House No. 212, Guru Nanak Nagar, Jalandhar, Punjab 144001, holding Aadhaar 4444 5555 6666, ordinarily resident within the State of Punjab (the "Deponent" or "I"), do hereby solemnly affirm and declare as follows:
- 1. THE ACCOUNT
1.1 I am the holder of savings account No. 10234567890 with State Bank of India, Model Town Branch, Jalandhar (the "Bank"), in my own name.
1.2 I make this affidavit to the Bank because of the loss of my bank passbook.
- 2. PARTICULARS OF THE CASE
2.1 I have lost the passbook of the above account. Particulars of the passbook: Savings passbook issued by the Model Town branch in 2019; last entry made in June 2026
2.2 The loss happened as follows: Lost while travelling by bus from Jalandhar to Ludhiana on 3 September 2026; a lost-article report was lodged at Police Station Division No. 3, Jalandhar
2.3 I have not handed over, pledged or given the passbook to anyone as security, and I have not borrowed or allowed any loan against it.
2.4 I ask the Bank to issue me a duplicate passbook for the above account.
- 3. INDEMNITY
3.1 In consideration of the Bank acting on this affidavit, I undertake to indemnify and keep indemnified the Bank against all claims, demands, losses, damages and expenses the Bank may suffer or incur by reason of its acting on this affidavit, including if any lost passbook or receipt mentioned in this affidavit is later presented by any person, or if any statement made in this affidavit is found to be false.
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
Verified at Ludhiana on 1 April 2026 that the contents of paragraphs 1 to 4 above are true and correct to my own knowledge, that no part of it is false, and that nothing material has been concealed.
DEPONENT
Signature: ______________________________
Simranjit Kaur
ATTESTATION
Solemnly affirmed and signed before me on 1 April 2026 at Ludhiana, the Deponent having been identified to my satisfaction by Aadhaar 4444 5555 6666.
Notary Public / Oath Commissioner
Registration No. and seal: ____________________