INDEMNITY BOND FOR REQUEST OF ISSUE A DUPLICATE POLICY BOND

INDEMNITY BOND FOR REQUEST OF ISSUE A DUPLICATE POLICY BOND

I/We ____________________, Aged about __________years, presently residing at _____________________________________(Address with pin code, P.O, P.S and District), do hereby solemnly state, affirm and execute this Indemnity Bond on this _______day of _______ month _________ year  as under:

 

1. That, I/We had applied for an Insurance Policy with the _______________________________ (Name of Insurance Company) for a sum of Rupees ______________ (Rupees in word) only.

 

2. That in response to our proposal, the Policy Documents for the Insurance Policy bearing policy No. ______________ was issued to me/us on _________________ (dd/mm/yyyy) date of issuance.

 

3. That the Insurance policy document is lost and/or misplaced irrecoverably. I/We state that there is no willful suppression of any material fact.

 

4. That, I have neither assigned, pledged or in any way disposed of or dealt with the said policy nor have I/We created any pledge or encumbrance on the said policy.

 

5. That on my request for issuance of duplicate policy bond, Reliance Life Insurance Company Limited has agreed to issue a duplicate of the said policy bearing No____________________subject to my undertaking to indemnify the company against any claim that may be made on the basis of the policy against any consequential losses/damage/expenses.

 

6. I/We, therefore hereby to indemnify and keep indemnified the Company, its Officers and agents from all actions, suits, costs, claims, demands and against any loss, costs, charges, penalty, damages and expenses that the company may suffer or incur on account of any claim being made by any other person claiming on the basis of the possession of the said insurance policy or other wise and the company being required to  make payment of the amount under the said policy to such person.

 

7. I/We further indemnify and keep indemnified the Company, its Officers and agents from any other amount/s payable of whatsoever nature including but not limited to any amount payable under a decree or order of any court/forum or adjudicating authority, legal fees and expenses in relation to the prosecution or defense or settlement of any claims/demands whatsoever arising out of the said policy.

 

8. I/We undertake that in the event of the original Insurance Policy being found the same will be returned to the Company  forthwith.

 

 

IN WITNESS WHEREOF THIS INDEMNITY BOND HAS BEEN SIGNED, SEALED AND EXECUTED BY THE PARTIES ON THE DAY, MONTH AND YEAR AS WRITTEN ABOVE.

 

 

Name of the Policy Holder

 

_________________________________

 

_________________________________

 

 

Signed and delivered by me in presence of

 

 

W I T N E S S:

 

 

1. Full name and signature of witness ________________________________

 

Address ___________________________________________________________

 

 

 

 

2. Full name and signature of witness ________________________________

 

Address ___________________________________________________________

 

 

 

                                                                          ANNEXURE-1

 

                                                                    C E R T I F I C A T E

 

 

Certified that the contents of this Indemnity Bond were explained by me to Life Assured / Proposer in his/her vernacular language and that he/she affixed his/her signature/Left Hand Thumb Impression to this bond in my presence after thoroughly understanding the contents of the same.

 

 

Full name and address of the attesting witness ______________________________

____________________________________________________________________________

 

 

 

Signature _________________________________________