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DECLARATION INDEMNITY AGREEMENT FOR SMALL ESTATES Name of Deceased: __________________________________________________________ Name of Personal Representative/Next of Kin: _____________________________________ NOTE: The term “personal representative” means, if there is a will, the executor(s) named in the Deceased’s will or, if there is no will, the next of kin representing the estate, as the case may be. 1. No application has been made for either Letters Probate or Letters of Administration for the estate of the Deceased. 2. I/ We authorize Canadian Imperial bank of Commerce, CIBC Mortgage Corporation and CIBC Securities Inc. (each being “CIBC”) to pay or deliver the assets below to: (Insert Product type and Account Number): ________________________________________ Assets of the Deceased with CIBC Account, Bank Account: $__________________________ Sign & Date Here if deceased made a Will: (Executor/ Next of Kin) ________________________________________________ (Witness) Sign and date above ___________________________________________ Sign & Date Here if deceased died Intestate (No Will): (Executor/Next of Kin)________________________________________________ (Witness) Sign and date above __________________________________________
