Sample Indemnity Bond

INDEMNITY BOND

                                                                                                                                                                                                                                                                                     

   Date:

I, MD. JOYNAL ABEDIN, HUSBAND, LATE RAJIA SULTANA, MADDA RASULPUR, KUTUBPUR, FATULLAH, NARAYANGONJ do hereby solemnly declare and affirm as under:

1.     That my WIFE applied for Insurance on his/her life to American Life Insurance Company (incorporated in 1921 in the U.S.A as Limited Company) and Policy No. 1153646 Tk. 100000. (Taka ONE LAC) only was accordingly issued by the said American Life Insurance Company on her life.

2.     That my Late RAJIA SULTANA died on 05-02-2015.

3.     That the said Policy was not assigned in any way or any other way parted or dealt with the said policy or done anything which would create any encumbrance, lien or charge thereon.

4.     That my WIFE had appointed me as Beneficiary under the said policy to receive the Policy moneys in the event or his/her death prior to the maturity of the policy.

5.     That the said policy has been lost and I am unable to find the said document notwithstanding the fact that I have made every proper and diligent search thereof.

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6.     That I undertake to return the said policy document to American Life Insurance Company should I hereafter receive the same.

7.     That I have requested that the claim proceeds of the above Policy man be paid to me in the capacity of the Beneficiary.

8.     That in consideration of payment of the claim proceeds of the above policy, I, hereby agree and undertake to indemnify and hold harmless the said American Life Insurance Company from all claims, demands, suites and actions and from all costs, charges and expenses arising therefrom based upon any title or interest established by any act or myself and assigns or successors of heirs.

9.     That my above statements are true to the best of my knowledge and belief and nothing contained herein are false and nothing has been concealed or suppressed.

  

WITNESS: Signature: ............................ Name: .................................. Address: ..............................

SIGNATURE: Signature: ............................ Name: .................................. Address: ..............................