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Indemnity for a Duplicate Policy Bond

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You and the insurer
The policy and the loss
Signing the bond

Step 1 of 3

You and the insurer

Your full name (the Indemnifier)Needed

For example: Harjinder Singh Gill

Your addressNeeded

House / flat / plot no.

Street, sector or locality

City area and PIN code

Your phone numberNeeded

A number somebody can be reached on. Ten digits is the usual Indian form, and a country code in front of it is fine if you want it there.

For example: 98765 43210

Son, daughter or wife ofNeeded

For example: son of Sh. Gurmeet Singh

You are giving this bond asNeeded

the policyholderthe assignee of the policythe nominee of the deceased policyholderthe legal heir of the deceased policyholder

Insurance company's name (the Insurer)Needed

For example: ABC General Insurance Company Limited

Insurer's addressNeeded

House / flat / plot no.

Street, sector or locality

City area and PIN code

More details — you may leave these

Your email addressYou may leave this

An email address somebody actually reads. Notices under a document like this can be sent to it, so a working one matters more than a tidy one.

For example: harjinder.gill@example.com

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INDEMNITY BOND FOR A DUPLICATE POLICY BOND

To be signed on stamp paper and given to the insurer, so that it issues a duplicate of a lost or destroyed policy bond.

THE INDEMNIFIER:
__________, __________
__________
Phone: __________

IN FAVOUR OF (the Insurer):
__________
__________

1. THE POLICY

2. THE LOSS OF THE ORIGINAL

2.3 The Indemnifier has searched for the Original and has not found it.

3. WHAT THE INDEMNIFIER ASKS

3.1 The Indemnifier asks the Insurer to issue a duplicate of the policy bond (the Duplicate) in place of the Original.

4. THE INDEMNITY

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. SIGNING

_________________________
__________
The Indemnifier
__________

Witnesses (two):

1. Name: _________________ Address: _________________ Signature: _________________

2. Name: _________________ Address: _________________ Signature: _________________

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