To be signed on stamp paper and given to the insurer, so that it issues a duplicate of a lost or destroyed policy bond.
Date: 1 April 2026, at Ludhiana
THE INDEMNIFIER:
Harjinder Singh Gill, son of Sh. Gurmeet Singh
House No. 412, Sector 38-A, Chandigarh 160036
Phone: 98765 43210
Email: harjinder.gill@example.com
IN FAVOUR OF (the Insurer):
ABC General Insurance Company Limited
Regional Office, SCO 25, Sector 17-E, Chandigarh 160017
1.1 The Insurer issued a life insurance policy, number P/141234/01/2026/003318, dated 2 April 2026, to Gurmeet Singh (the Policy), for a sum of ₹5,00,000 (Rupees Five Lakh only). The Indemnifier is the policyholder.
1.2 The policy has not been assigned, pledged or charged to any person.
2.1 The original policy bond (the Original) was lost. The bond was kept in a steel almirah that was flooded in the monsoon of August 2026, and the papers inside were destroyed. I searched the house and my bank locker and did not find it.
2.2 A report of the loss was made to the police: Report No. 41 dated 2 October 2026, Police Station Sector 17, Chandigarh.
2.3 The Indemnifier has searched for the Original and has not found it.
3.1 The Indemnifier asks the Insurer to issue a duplicate of the policy bond (the Duplicate) in place of the Original.
4.1 In return for the Insurer issuing the Duplicate, the Indemnifier promises and agrees as follows.
4.2 If the Original is found, the Indemnifier will return it to the Insurer for cancellation at once and will not use it for any purpose.
4.3 The Indemnifier will make good to the Insurer any loss, claim, cost or expense that it suffers because it issued the Duplicate, including any claim by a person who holds or claims under the Original, or under an assignment or charge that the Indemnifier did not disclose to the Insurer.
4.4 The Indemnifier will pay any fee that the Insurer's rules require for issuing the Duplicate.
4.5 The statements in this bond are true to the best of the Indemnifier's knowledge, and the Indemnifier has kept back no fact that the Insurer would reasonably want to know.
4.6 This bond is given for the benefit of the Insurer and its successors, and it binds the heirs and legal representatives of the Indemnifier.
5.1 Signed by the Indemnifier at Ludhiana on 1 April 2026 in the presence of the witnesses named below.
_________________________
Harjinder Singh Gill
The Indemnifier
House No. 412, Sector 38-A, Chandigarh 160036
Witnesses (two):
- 1. Name: _________________ Address: _________________ Signature: _________________