From. No. 3762
To all to whom these presents shall come name addressInhabitants send Greeting whereas a policy of Insurance Numbered 784808544 for Rs. 1,00,000 /-was granted on 14.12.2009 by the Life Insurance Corporation of India established by the Life Insurance Act 31 of 1956 (hereinafter referred to the Corporation) on the life of name AND WHEREAS on the said name solemnly affirming that the said policy no. 784808544 which was/were lost irrecoverably DURING TRAVELLING was/were not assigned. mortgaged, or dealt with in any other manner except for the assignment. notice of which may have already been given to the Corporation and undertaking to return to the Corporation the original Policy/Policies is/are recovered subsequently. AND WHEREAS the said Corporation has an the said name undertaking to enter in to with the said Corporation a Covenant of the nature hereinafter appearing agreed to issue to him the said name the duplicate of the said Policy/Policies No./Nos 784808544 NOW KNOW YE AND THESE PRESENTS WITNESS that in purchase of the said agreement and in consideration of the said Corporation having at or before the execution of these presents agreed to issue the said duplicate of the said Policy/Policies 784808544 to the said name they the said
name do hereby for themselves their heirs, executors of administrators covenant with the said corporation, its successors and assigns that name their heirs, executors or administrators will from time and all times save and keep harmless and indemnified the said Corporation, Its successors and assigns of and from all actions, suits, costs, claims and demands of whatever nature and kind so ever which may be instituteds, preferred claimed or made against the said Corporation, its successors or assigns by any person or persons by reason of his, her or their possession of or right to the said original policy/policies 784808544, nameA have hereunto put their hands at Nedumangad this 20th day of March 2015
Signed and delivered by the within-named.
In the presence of: