AFFIDAVIT CUM INDEMNITY LETTER

I/We ________________________________ (s/o, w/o, d/o) _________________, aged_______

years, residing at_______________________________________________________________,
do hereby solemnly affirm and state as follows:

1. I/We am/are the legal heirs of Mr.K.MUNUSAMY ACHARI and the deceased is my/our
Husband.

2. I/We further state that I/We the following legal heirs are the only legal heirs entitled to claim the
balance deposit/amount/jewels/ornaments and other valuables the ontents held in the locker/safe
custody.

No. Name Age Relationship to the

deceased
1 M.Vijaya 62 Wife (Widow)
2 M.Jabaraj 43 Son (Married)
3. T.Gethiseyal 42 Daughter (Married)
4. M.Milgal 41 Daughter (Married)
3. I/We further state that the deceased was holding an Locker account (hereinafter referred
to as “the account”) _______________, Chennai Poonamalle High Road branch of
Karur Vysya Bank ( herein after referred to as “the Bank (herein after referred to as
“the Bank”). At the time of the death of the deceased the account was having a credit of
Rs.______ (balance amount in the account) which includes interest upto ________ (date
of payment) (amount being now paid)

4. I/We affirm that We are the sole legal heirs of the deceased who are entitled to receive
the amount standing in the credit of the account belonging to the deceased.

5. I/We have requested the bank to make the payment of the amount standing in the credit
of the account belonging to the deceased together with interest thereon as applicable to
Mr/Ms_______________________, being one of the legal heifs for and on behalf of all
the legal heirs.

OR

I/We have requested the bank to hand-over contents of the safe deposit locker/items held
in safe custody to Mr/Ms______________________ being one of the legal heirs for and
on behalf of all the legal heirs.

6. I/We are aware that the Bank has agreed to settle our claims relying on this affidavit and
We agree to indemnify the bank in respect of such payment or delivery of the contents of
items in safe deposit locker or held in safe custody against any claim made by any person
for the amount standing to the credit of the account of the deceased.

7. I/We for ourselves and our respective heirs, executors and administrators jointly and
severally agree, affirm and undertake that thebank, its successors and assigns and its
managers, agents, officers and servants and their respective estates and effects are and
shall from time to time and at all times hereafter be kept safe and saved harmless and
indemnified for and in respect of such payment and against all actions lossess, cost,
charges, expenses and demands whatsoever in respect of the said payment or delivery of
the contents of items in safe deposit locker or held in safe custody.

All the averments made herein before are true and correct and I/e put my/our
signature/mark on this _____ day of ________ 2023 at Chennai in the presence of me.

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Signature of witness Signature(s) of deponents (Claimants)

AFFIDAVIT CUM INDEMNITY LETTER

We 1.DUGGANI GOMATHI Daughter of Shanmuga Sundaram Marudachalam & wife of

D.Sivakumar, aged 48 years, residing at No.21-9-1/3/5, Jagarlamudi Vari Street, Madhuranagar,
Vijayawada, Satyanarayanapuram, Krishna, Andhra Pradesh-520 011 and
2.M.MUGUNTHAPRIYA Daughter of Shanmuga Sundaram Marudachalam & wife of
Kempt Joshua, aged 41 years, residing at No.63, Second Avenue, Prithivipakkam, Ambattur,
Chennai-600 053, do hereby solemnly affirm and state as follows:

8. We are the legal heirs of S.MARUDACHALAM and the deceased is our Father.

9. We further state that We the following legal heirs are the only legal heirs entitled to
claim the balance deposit/amount/jewels/ornaments and other valuables the ontents
held in the locker/safe custody.

No. Name Age Relationship to the

 deceased
1 DUGGANI GOMATHI 48 DAUGHTER
2 M.MUGUNTHAPRIYA 41 DAUGHTER

10. We further state that the deceased was holding an Locker account (hereinafter referred to
as “the account”) A.c 1280001B028, Ambattur branch of Karur Vysya Bank ( herein
after referred to as “the Bank

11. We affirm that We are the sole legal heirs of the deceased who are entitled to receive the
amount standing in the credit of the account belonging to the deceased.

12. I M.MUGUNTHAPRIYA have requested the bank to hand-over contents of the safe
deposit locker/items held in safe custody to DUGGANI GOMATHI being one of the
legal heifs for and on behalf of all the legal heirs.

13. We are aware that the Bank has agreed to settle our claims relying on this affidavit and
We agree to indemnify the bank in respect of such payment or delivery of the contents of
items in safe deposit locker or held in safe custody against any claim made by any person
for the amount standing to the credit of the account of the deceased.

14. We for ourselves and our respective heirs, executors and administrators jointly and
severally agree, affirm and undertake that thebank, its successors and assigns and its
managers, agents, officers and servants and their respective estates and effects are and
shall from time to time and at all times hereafter be kept safe and saved harmless and
indemnified for and in respect of such payment and against all actions lossess, cost,
charges, expenses and demands whatsoever in respect of the said payment or delivery of
the contents of items in safe deposit locker or held in safe custody.

All the averments made herein before are true and correct and I/e put my/our
signature/mark on this 3rd day of March 2023 at Chennai in the presence of me.

Signature of witness Signature(s) of deponents (Claimants)

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 No-Objection Certificate from the Legal Heirs

Format of NOC from other Legal Heirs for Transmission of Units in favour of
Claimant wherein the Sole Holder OR all Joint Holders in the folios are deceased

WITHOUT REGISTERING ANY NOMINATION

DECLARATION

I DUGGANI GOMATHI Daughter of SHANMUGA SUNDARAM MARUDACHALAM

aged 48 years, residing at No.21-9-1/3/5, Jagarlamudi Vari Street, Madhuranagar,
Vijayawada, Satyanarayanapuram, Krishna, Andhra Pradesh-520 011 the legal
heir(s) of late Mr.SHANMUGA SUNDARAM MARUDACHALAM declare as follows
–
 1. That the above named deceased Unitholder was holding the following
Schemes /folios of SUNDARAM Mutual fund in his / her name as single
holder/Joint holder:

Scheme Name Folio No. No. of units held

1) SUNDARAM MIDCAPFUND-REG-DIV 501763481573 ALL

2. That the deceased had died intestate on 16.02.2022 and without registering any
nominee.
3. That I/We are the legal heirs of the deceased unit holder, apart from the
Claimant M.MUGUNTHAPRIYA who has applied for the transmission of the
aforesaid units:

Name of the Legal Address and contact details Age Relationship

Heirs with the
deceased
No.21-9-1/3/2, Jagarlamudi Vari
1) DUGGANI GOMATHI Street, Madhura nagar, Vijayawada 47 Daughter

4. I / we hereby declare that, I / we do not desire to make any claim in respect of

the title to the aforesaid units held by the deceased and I / we hereby wilfully
relinquish & renounce all my /our rights in respect of the aforesaid units and
shall have no legal claim upon said units in future.
5. Accordingly, I / we declare that I / we have NO OBJECTION WHATSOEVER in
SUNDARAM transmitting the aforesaid UNITS in favour of the Claimant(s) Mr. /
Ms. ______________________________.

6. I / we hereby state that whatever is stated herein above are true to the best of
my/our knowledge and nothing has been concealed therein.

Deponents Signatures
1) _________________________________
2) _________________________________
3) _________________________________

VERIFICATION
We hereby solemnly affirm and state that what is stated herein above is true to our
knowledge and nothing has been concealed therein and that we are competent to
contract and entitled to rights and benefits of the above mutual fund units.
Solemnly affirmed at ________________________________

Deponent(s) (1) ____________(2) __________________(3) ____________________

Signed before me
Place
Date

Individual Affidavits to beiven by ALL the Legal Heirs

(For Transmission of Units on death of Sole Unit Holder / all Unit Holders in case of joint
holding, where NO NOMINATION has been registered)
Each Deponent (legal heir) shall sign separate

I DUGGANI GOMATHI Daughter of SHANMUGA SUNDARAM MARUDACHALAM aged

48 years, residing at No.21-9-1/3/5, Jagarlamudi Vari Street, Madhuranagar, Vijayawada,
Satyanarayanapuram, Krishna, Andhra Pradesh-520 011 do hereby solemnly affirm and state on
oath as follows.
That Mr.SHANMUGA SUNDARAM MARUDACHALAM @ (“the deceased Unitholder”)
held the following units in SUNDARAM Mutual Fund in his / her name as single holder / joint
holder:
 Scheme Name Folio No. No. of
units held

1) SUNDARAM MIDCAPFUND-REG-DIV 501763481573 ALL

That the aforesaid deceased Unitholder(s) died intestate leaving behind him/her, the following
persons as the only surviving heirs as per the Succession Certificate* / Legal Heirship Certificate*
dated 23.06.2022 according to the Law of Intestate Succession by which he/she was governed at the
time of his/her death and without registering any nominee.*
OR
That the aforesaid deceased Unitholder died testate, leaving behind him/her, the following persons as
the legatees as per the Probated Will dated ____ and without registering any nominee.*
A notarised copy of the Succession Certificate* / Legal Heirship Certificate* / Probated Will is attached
herewith.

Name of the Claimant/s Address Ag Relation with

e the Deceased
1 M.MUGUNTHAPRIYA No.63, Second Avenue, 41 Daughter
Prithivipakkam, Ambattur, Chennai-
600 053

That among the aforesaid legal heirs, Master/Kum. years

is a minor and is being represented by Mr./Ms___________________________________ being his / her
father / mother / legal guardian.
I also indemnify the SUNDARAM Mutual Fund and its AMC and authorized Registrar through a
separate Indemnity letter with third party Sureties.

Signature of the Deponent: X

VERIFICATION
I hereby solemnly affirm and state that what is stated herein above is true and correct. The original
Death Certificate or original attested copy of the death certificate and nothing has been concealed
therein and that we are competent to contract and entitled to rights and benefits of the
abovementioned mutual fund units of the deceased.

Solemnly affirmed at Signature of the Deponent:

 Signed before me
Place:
Date:

Individual Affidavits to beiven by ALL the Legal Heirs

(For Transmission of Units on death of Sole Unit Holder / all Unit Holders in case of joint
holding, where NO NOMINATION has been registered)
Each Deponent (legal heir) shall sign separate
 I M.MUGUNTHAPRIYA Daughter of S.Marudachalam & wife of Kempt Joshua, aged 41
years, residing at No.63, Second Avenue, Prithivipakkam, Ambattur, Chennai-600 053 do
hereby solemnly affirm and state on oath as follows.
That Mr.SHANMUGA SUNDARAM MARUDACHALAM @ (“the deceased
Unitholder”) held the following units in SUNDARAM Mutual Fund in his / her name as
single holder / joint holder:

Scheme Name Folio No. No. of

units held
1) SUNDARAM MIDCAPFUND-REG-DIV 501763481573 ALL
2)
3)
That the aforesaid deceased Unit holder(s) died intestate leaving behind him/her, the following
persons as the only surviving heirs as per the Succession Certificate* / Legal Heirship Certificate*
dated 23.06.2022 according to the Law of Intestate Succession by which he/she was governed at
the time of his/her death and without registering any nominee.*
OR
That the aforesaid deceased Unit holder died testate, leaving behind him/her, the following persons
as the legatees as per the Probated Will dated ____ and without registering any nominee.*
A notarised copy of the Succession Certificate* / Legal Heirship Certificate* / Probated Will is
attached herewith.

Name of the Claimant/s Address Ag Relation with

e the Deceased
1 DUGGANI GOMATHI No.21-9-1/3/2, Jagarlamudi Vari 48 Daughter
Street, Madhuranagar, Vijayawada,
Satyanarayanapuram, Krishna,
Andhra Pradesh-520 011
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3

That among the aforesaid legal heirs, Master/Kum.

years is a minor and is being represented by Mr./Ms___________________________________ being
his / her father / mother / legal guardian.
I also indemnify the SUNDARAM Mutual Fund and its AMC and authorized Registrar through a
separate Indemnity letter with third party Sureties.

Signature of the Deponent: X

VERIFICATION
I hereby solemnly affirm and state that what is stated herein above is true and correct. The
original Death Certificate or original attested copy of the death certificate and nothing has been
concealed therein and that we are competent to contract and entitled to rights and benefits of the
abovementioned mutual fund units of the deceased.

Solemnly affirmed at Signature of the Deponent:

Place:
 Signed before me
Place:__________________

Date: