LIC policy bond lost Form No 3815 stamp paper 500/ (for maturity or surrender)

                                                                                                                         From. No. 3815

               To all to whom these presents shall come  name ,address Inhabitants  send  Greeting  whereas  a  policy of Insurance  Numbered 785204042  for Rs........................./- was granted on …...................  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 n.s NAME and WHEREAS 785204042, .............. which was in the possession of  n.s NAME has been lost  due to Eaten  by  white ants. And whereas the said Corporation has on the said  NAME undertaking to enter into with the said Corporation a covenant of the nature hereinafter appearing  agreed to pay the said  NAME the value of the said Policy, viz’ Rs................../- now

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know he and these presents witness that in purchase of the said NAME (the receipt whereof is hereby acknowledged) they the said NAME to hereby for themselves their heirs, executors or administrators Covenant with the said Corporation, its successors and signs, that they the said NAME their heirs, executors or  administrators  will  from time to time and or  at  all times save and keep harmless and indemnified the said Corporation , its successors and assignees of and from all actions suits, costs claims and demands of whatever nature and kinds ever which may be instituted, preferred , claimed or made against the said Corporation, its successors or assignees by any person or persons of his , her or their possession of right to the said original 785204042/...................... by reason of anything in relation to the premises. In witness where of the  NAME have hereunto put their hands at Nedumangad  this 7^th  date of  December 2015.

Signed and delivered by the said NAME

                                                                                                            Signature

In the presence of:

1.  Full Signature of Witness

            Name and of witness :          

           

            Designation                 :          

           

            Address                       :          

2.  Full signature of Witness

            Name and witness       :          

            Designation                 :

           

            Address                       :