Format of Application for Locker Surrender
To,
________________
______________ Branch
Locker Surrender/Discharge Certificate
I/we hereby certify that I/we have this day withdrawn all the property belonging to us, stored in locker number _______, key bearing number ____ leased on _______, and that the locker and its key are hereby surrendered in token of termination of the lease.
Place:
Date:
(Name & Signature of hirer/s)