Affidavit format for death claim settlement in bank

Deceased person name: S. Pothireddy

Account No.: ______________

Bank name: ________________

 I _____________ of late ________________ resident of _______________

tehesil and district ______________do hereby solemnly affirm and declare as
under: -

1)      The late __________ is my ____________ who expired on ________. (death

certificate enclosed).
2)      That He/she the following account with ____________ (bank).
3)      That he left behind the following legal heirs- :
a.       __________________
b.      __________________
c.       __________________ wife of late ___________
4)      That the deceased had no children of my afore said expect the mention
above.
 

___________________

Signature (deponent)

Verification:

 Verified that the content of my above-said affidavit are true and correct to the best
of my knowledge and nothing has been concealed therein.

Verified at ____________ on ____________.

_______________________
 

Signature (deponent)