To all whom these presents shall come…………………………………………………………(name of all payees and

surety)
inhabitants send Greeting whereas a policy of insurance numbered………………………………………for
rs………………………………………Was granted on………………………………………by the life insurance
corporation of India. Established by the life insurance corporation Act. 31 of 1956 (here / inaftern referred to as the
corporation) on the life (Name of policy holder) ………………………………………………………………………………
and WHEREAS(policy No. assignment deed dated)
…………………………………………………………………………………which was in the possession of (Name of
policy holder)
……………………………………………………………has been lost or misplaced And whereas the said
corporation has on the said (name of all payees and surety) ……………………………………………………………………
undertaking to enter into with said corporation a covenant of the nature hereinafter appearing , agreed to pay the
said ………………………………………………………………(Name of Names or payees) the value of the said policy viz
Rs………………………………………………………………………now know he and these present witness that in
pursurance of the said agreement and in consideration of the said corporation having agreed to pay value of the said
policy to the said…………………………………………………………… Names of payee and payees) (the receipt where
of is hereby acknowledged) they the said …………………………………………………………… name of all payees and
surety)
do hereby for themselves , there heirs executors covenant with the said corporation its successors and assings
that they the said………………………………………………………………………..(name of all payees and surety) their
heirs, executors or administrators will from time to time and at all times save and keep harmless and indemnified the
said corporation ,successors and assigns , of the from all actions ,suits ,costs claims & demand of whatever nature
kind so ever which may instituted , preferred claimed or made against the said corporation its successors or assings
by any person or persons by reson of his/her or their possession or right to said original
………………………………………………………………………………. (Policy N. and assignment Deed date)By reason of
any thing in relation to the promises.