BAJAJ ALLIANZ LIFE INSURANCE
COMPANY LTD.
GE Plaza,
Airport Road Yerawada, Pune 411006
INDEMNITY BOND
(To be stamped Rs __________ (in words) ______________
At the stamp office or collector's office before execution or to be copied on a
non-judicial stamped be executed before a magistrate or to be notarized)
To all to whom these presents shall come ___________ (Name of
payee/s) _______________ (Place of residence of the payee/s)/ Whereas a
policy of insurance Numbered _____________________ (policy number) for
Rs. ________________________
In word ______________________________________________________
Was granted on ____________________ (date) by Bajaj Allianz Life
Insurance Co Ltd (herein after called as the company) on the life ___________________
(Name of life assured) and whereas company has on the
__________________________________________________
_______________________________________________________
(Name or payees) under taking to enter into with the company a covenant
of the nature hereinafter appearing agreed to pay ______________. (name
of payee/s) the value of the policy viz.Rs
_____________________(in words) without requiring production of probate
or letters of administration or succession certificate granted on the estate ___________________ (name of the policy holder) and.
Now know by these presents that in pursuance
of the said agreement and in consideration of the company having agreed to pay the
value of the policy to _______________.
(name of payees) the receipt whereof hereby
acknowledged) they - _______________(Name of the payee/s) do hereby for
themselves, their heirs, executors or administrators,
covenant with the company its successors and assign that ______________ (name of payee/s) their heirs
executors or administrators will from time to time and at all times safe and
keep harmless and indemnified the company, its successors and assigns of and
from all actions, suits , costs, claims and demands of whatever nature and kind
whatsoever which may be instituted, preferred, claimed or made against the
company its successors or assigns by any person or persons by reason of his or
their possession of or right to the original _______________ (policy
number or assignment deed dated)by reason of anything in relation to the
policy.
In witness whereof the
__________________________________________
_______________ (Name of payee/s) have herein put hands at
_________ (place) _________________(date)
Signed and delivered by the _____________________
(Name of payee/s)
Signature of
Payee's
I certify that the above signature/s is/are that of ______________ (Name/s of the Payee/s) who had affixed the same after
understanding the contents.
Sworn Before Me:
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