Life Insurance Corporation of India

Form No. 3815

To all to whom these present shall come HEMANTA Kumar

BANERJEE
of Vill.- AUGRAM,p.o.- Debi Parulia, p.s.- khargram , Dist. -
Murshidabad,pin no. 742137,West Bengal,inhabitiants and
Greetings.

Whereas a Policy of Insurance Numbered 423677623 for 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 HEMANTA Kumar BANERJEE
and WHAREAS 423677623 which was in Possession of HEMANTA
Kumar BANERJEE has been lost or misplaced and whareas the
said Corporation has on the said HEMANTA Kumar BANERJEE
undertaking to enter into the said Corporation a covenant of the
nature hereinafter appearing agreed to pay to the said HEMANTA
Kumar BANERJEE the value of the said Policy viz. Rs.
…………………..now know yet and these presents witness that in
pursuance of the said agreement and in consideration of the said
Corporation having at or before the esecution of these present
paid the value of the said HEMANTA Kumar BANERJEE (the receipt
whereof is hereby acknowledged) they the said HEMANTA Kumar
BANERJEE do hereby for themselves ,their hairs, executors or
administrators covenant with the said corporation its successors
and assigns ,that the said HEMANTA Kumar BANERJEE their hairs,
executors or administrators, will from time to time and at all times
save and keep harmless and indemnified the said Corporation its
successors and assigns; of and from all actions, suit costs ,claims
and demands of whatever nature and kind so ever which may be
instituted, preferred claimed or made against the said Corporation
its successor or assignees by any person or persons by reason of
his, her or their possession or right to the said original 423677623
by reason of anything in relation to the premises.

In witness whereof the said HEMANTA Kumar BANERJEE

have hereunto put their hands at kandi this 14 day of
January,2024.

Signed and delivered by the said HEMANTA Kumar BANERJEE.

In the presence of :

……………………….
Signature

W Full Signature …………….. ……………….

I of witness Signature

T Designation : ………………………………
N Address : ……………………………………
E
S Full Signature
S of witness ……………… …………………
Signature
E Designation : …………………
Signature
S Address …………………….. of Surity ……………………
Designation : ……………….

Adrress : …………………….
N o t e : If this Bond is signed in Vernacular one of the attesting
witnesses should be requested to certify that the contents of this
Bond were explained to the party in vernacular before execution.