AFFIDAVIT

I _________ son/daughter/wife of _________ resident of _________ do hereby solemnly affirm and declare as under:-
1.    That I am citizen of _________.
2.    That I am residing on the above address from _________ years.
3.    That I confirm that have an Account at your Bank in  _________ Branch.
4.    That I further confirm that my Passbook has been lost.
5.    That my Account no. is “_________”.
6.    That please _________.
7.    That it is my true statement.

DEPONENT

VERIFICATION:-
Verified at _________ on this _________ that the contents of this affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein.

DEPONENT

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