ANNEXURE –1
[see para 56(2)(iii)]
DEPARTMENT OF POSTS
Claim application form for settlement of Savings Certificates of the deceased
holder who died on …………….. where nomination has been registered with
Post Office

To
The Postmaster
………………………
Sir,
In connection with the settlement of claim of Post office certificates standing
in the name of the deceased …………………… in the books of …………………… (name of
Post office), I hereby claim the payment of the value of the Post Office Certificate(s)
No………. The payment may be made by cash/cheque or money; order (after
deducting commission). In support of the claim, I hereby submit :
(i) Death certificate of the Deceased
(ii) Death certificate(s) of other nominee(s), if any
The nomination was registered at …………………. Post office under
No……………. dated…………………….
Yours faithfully,
Address……………………….. Signature or thumb impression of
Date ……………………….. the claimant if illiterate.
Address……………………….. Signature of the Guardian
Date ……………………….. appointed to receive the amount
on behalf of minor nominee(s)
[ Form revised vide DG Posts letter No.79-90/88-SB dated 26.9.1989]