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Lic Form 3815b

This document is an indemnity bond between the Life Insurance Corporation of India and a policy payee or payees. It states that an insurance policy has been lost or misplaced, and in exchange for payment to the payee, the payee agrees to indemnify and hold harmless the Corporation from any claims or legal actions that may arise regarding the lost policy. The payee signs the bond in the presence of witnesses to finalize the agreement.

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Dinesh Bijalwan
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30K views

Lic Form 3815b

This document is an indemnity bond between the Life Insurance Corporation of India and a policy payee or payees. It states that an insurance policy has been lost or misplaced, and in exchange for payment to the payee, the payee agrees to indemnify and hold harmless the Corporation from any claims or legal actions that may arise regarding the lost policy. The payee signs the bond in the presence of witnesses to finalize the agreement.

Uploaded by

Dinesh Bijalwan
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Form No.

3815 B
LIFE INSURANCE CORPORATION OF INDIA

To be stamped Rs. At the stamp office


or Collector’s Office BEFORE EXECUTION or to be copied
out On a non-judicial stamped Paper of equal value.

To all to whom present shall come

_____________________________________________________________________________
(Name of Payee/all Payees)
_____________________________________________________________________________
_____________________________________________________________________________
(Place of residence of Payee/Payees)

___________________________________________________ inhabitants send Greetings


whereas a Policy of Insurance Numbered __________________ of Rs. ____________________
was granted on ________________________________________________ by the Life
Insurance Corporation of India, established by the Life Insurance Corporation Act 31 of 1956
(hereinafter referred to as the Corporation) on the life of
________________________________________________________________________
(Name of Policyholder)
And WHEREAS ______________________________________________ which was in
(Policy No.)
Possession of ________________________________________ has been lost or misplaced
(Name of Policy Holder)

And whereas the said Corporation has on the said _____________________________________


_____________________________________________________________________________
(Name of the Payee/all payee)
Undertaking to enter into with the said Corporation a convenient of the nature hereinafter
appearing agreed to pay the said __________________________________________________
(Name of Payee or Names of Payees)
______________________________________________________ the value of the said Policy
viz. Rs. ____________________________ now known and these presents witness and in
pursuance of said ______________________________________________________________
(Name of Payee/Name of Payees)
(the receipt whereof is hereby acknowledged) they the said _____________________________
(Name of Payee/Payees)
_____________________________________________________________________________
_____________________________________________________________________________
to hereby for themselves, their heirs. Executors or administrators Convenant with the said
Corporation. Its successors and assignees that they said _______________________________
(Name of Payee/Payees)
_____________________________________________________________________________
_____________________________________________________________________________
Their heirs. Executors or administrators will from time to time and 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 demand of whatever nature and kinds ever which may be
substituted, preferred, claimed or made against the said Corporation as successor or assignees
by any person or persons reason of his /her their possession of the right to the said original
(Pol. No. ________________________________________)
By reason of anything in relation to the policy.

_____________________________________________________________________________
_____________________________________________________________________________
In witness whereof the said ______________________________________________________
(Name or Names the Payee/s)
Have hereinto put his/her hands at ____________ this day of _______________ 200 ________.
Signed and delivered the said _____________________________________________________
(Name or Names the Payee/s)
_____________________________________________________________________________

In the presence of : 1)________________________


Signature of Payee/s

1) Full Signature of witness _________________________


W
Name of the witness ________________________________
I Designaton _______________________________________

T Address __________________________________________

N _________________________________________________
2)________________________
Signature of Payee/s
E
2) Full Signature of witness _________________________
S
Name of the witness ________________________________
S Designaton _______________________________________

E Address __________________________________________

S _________________________________________________

Note : If this Bond is signed in Vernacular one of the attesting witness should be requested to
certify that the contents of this Bond were explained to the party in vernacular before
execution. Illiterate Person must affix their thumb impression which should be attested by
Magistrate, S.E.M. a Gazetted Officer, a Block development Officer or Class 1 Officer of the
Corporation Provided he is fully satisfied about the identity of the claimant.

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