SBI Life Insurance Company Limited

INDEMNITY BOND FOR CLAIM PAYOUT WITHOUT ORIGINAL POLICY DOCUMENT

(To be stamped Rs.________ of the Stamp Office or Collectors BEFORE EXECUTION or be copied out on non

JudicialStampedpaperofequalvalue.)

Toalltowhomthesepresentshallcome__________________________________________________

________________________________________________________________________________of
(NamesofPolicyHolderorClaimants&Surety*)

_____________________________________________________________________________________

_____________________________________________________________________________________
(ResidentialaddressofPolicyHolderorClaimants)

____________________________________________________________WhereasaPolicyofInsurance

Numbered___________________________forRs.____________________wasgrantedon

___________________________bytheSBILifeInsuranceCompanyLimited,havingitsCentral

ProcessingCentreat______________________onthelifeof

____________________________________________________________________________
(NameofPolicyholder)

andWHEREAS______________________________________________________________whichwasin
(PolicyNo.orAssignmentDeedDated)

Possessionof___________________________________________________hasbeenlostormisplaced
(NameofPolicyholderorClaimant)

andwhereasthesaidCompanySBILIFEhasonthesaid________________________________________

_____________________________________________________________________________________
(NamesofPolicyHolderorClaimants&Surety*)

undertakingtoenterintothesaidCompanyacovenantofthenaturehereinafterappearingagreedto
paytothesaid________________________________________________________________________
(NamesofPolicyHolderorClaimants)

_______________________________________________________________thevalueofthesaidPolicy

viz.Rs.________________________nowknowyeandthesepresentswitnessthatinpursuanceofthe
saidagreementandinconsiderationofthesaidCompanyhavingagreedtopaythevalueofthesaid
Policytothesaid_______________________________________________________________________
(NamesofPolicyHolderorClaimants&Surety*)

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 SBI Life Insurance Company Limited
(Thereceiptwhereofisherebyacknowledged)theythesaid__________________________________
_____________________________________________________________________________________
(NamesofPolicyHolderorClaimants&Surety*)

theirheirs,executorsoradministratorswillfromtimetotimeandatalltimessaveandkeepharmless
andindemnifiedthesaidCompanySBILIFEitssuccessorsandassigneesofandfromallactions,suits,
costsclaimsanddemandsofwhatevernatureandkindsoverwhichmaybeinstituted,preferred
claimedormadeagainstthesaidCompany,itssuccessororassigneesbyanypersonsorpersonby
reasonofhis,her,theirpossessionoforrighttothesaidoriginal
____________________________________________________________________________________
[PolicyNo.orAssignmentDeedDated]

byreasonofanythinginrelationtothepremises.

Inwitnesswhereofthesaid_______________________________________________________________
(NamesofPolicyHolderorClaimants&Surety*)

havehereuntoputtheirhandsat_____________this_______________dayof_______________20____

Signedanddeliveredbythesaid__________________________________________________________
(NamesofPolicyHolderorClaimants&Surety*)
_____________________________________________________________________________________

InthePresenceof:

1)FullSignatureofWitness:__________________ FullSignature________________ Recentstamp

size
Designation:_______________________________ NameofPolicyholder/Claimant Photographof
Policyholder/
Address:__________________________________ __________________________ Claimant

_________________________________________

2)FullSignatureofWitness:__________________ FullSignature________________ Recentstamp

size
Designation:_______________________________ NameofSurety* Photographof
Surety*
Address:__________________________________ __________________________

_________________________________________
__________________________________________________________________________________
Note:IfthisBondissignedinVernacularoneoftheattestingwitnessesshouldberequestedtocertifythatthe
contentsofthisBondwereexplainedtothepartyinvernacularbeforeexecution.IlliteratePersonsmustaffixtheir
thumbimpressionwhichshouldbeattestedbyMagistrateS.E.M.AGazettedofficer,aBlockDevelopmentOfficer
orClass1OfficeroftheCorporationProvidedHeisfullysatisfiedabouttheidentityoftheclaimant
* If the net claim amount exceeds Rs. 5 lacs, then the document should be executed jointly by the
Policyholder/ClaimantandSurety

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