Section I Deceased Account Holder
Name:
Mailing Address:
Last 4 of Social Security No.:
State:
City:
Zip:
Date of Death:
Section 2 Person Providing Notification to the Bank
Name:
Mailing Address:
Telephone:
State:
Relationship:
City:
Zip:
Email:
Are government benefits such as Supplemental Security Income or Civil Services Pension deposited into any
of the accounts for the benefit of the Deceased?
Yes No Unknown
*If yes, please indicate which accounts:
Yes No Unknown
*If yes, please indicate which accounts:
Was the Deceased holding any accounts in Trust, as the Trustee?
MKT-418A-W 15H264 (12/15)
Yes No
Notification date: Received by: Dept.:
Death Certificate provided:
Savings Bank
Deceased Customer Notification
1. Complete Sections 1 - 3 of this form.
2. Drop off this form and a copy of the death certificate at any American Savings Bank (“ASB”) branch or mail to:
American Savings Bank; Attn: Successor Relations; PO Box 2300; Honolulu; HI 96804-2300
Account types
Deposit Account(s)
Personal Loan(s)
Line(s) of Credit
Mortgage(s)
Safe Deposit Box(s)
Account # Account types
Retirement Account(s)
Insurance & Investments
Credit Cards
Other Accounts
(Business,Trusts,
IOLTA, etc.)
Account #
Internal use
Name:
Mailing Address:
Telephone:
State:
City:
Zip:
Email:
Section 3 Personal Representative/Estate Administrator:
Yes No Unknown
Has probate been opened?
If yes, please provide us the contact information of the personal representative or estate administrator and a
copy of the Court Order appointing said person. Please include mailing address, phone number, and email.
We are sorry for your loss and would like to assist you as best we can during this difficult time. Please follow the steps below to notify
us of an account holder’s passing so that we can update their accounts.
This form is for notification purposes only and does not give permission to access funds or obtain information.
Please refer to our Decedent Account Guide for additional information or visit any of our branches for personal assistance.
