Received from State Bank of India, _______________________ Branch a sum of
Rs. ___________ (Rupees ________________________________________ only) in connection with the full and final settlement of claim of the balances in Savings Bank / Current Account / RD / TDR / STDR Account No(s) _________________________ of Shri/Smt./Kum. ___________________________ who expired on / not traceable since __________________.