Confirmation of balance of Account

To,

______________ Bank

_______________ Branch

Date:

Dear Sir,

Your Loan account on which you are liable singly with Mr./Messrs _________ was balanced on _________ and it showed a debit balance of Rs. __________ on that day inclusive of interest.

The securities listed at foot were held by the bank on your account on that day.

Please confirm correctness of the balance and the securities by returning this form duly signed.

Details of Securities FDR No. ________ dated _________ for Rs. _________

Yours faithfully,

___________________

Sd/- Manager

I/We do hereby confirm the correctness of the securities mentioned above and acknowledge that the sum of Rs._________ is due on me/us as stated above.

Dated:

Signature