Application Form for Bond Of Indemnity

Company Name(s): 

Place: Date :
[ To be executed before stipendiary Magistrate / civil judge / labour court judge / Munsif of civil court / presiding officeor f
labour court / presiding officer of income tax tribunal or Customs tribunal or sales tax tribunal / Tehsildar / Talukdar /
Mamlatdar / Notary Public/Honorary Magistrate/Gazetted office or f Central or State Government/Post Master of Post
Office(permanent employee in charge of Post Office)/Chief Representative of UTI Mutual Fund/Manager of Nationalised
Bank/M.P or M L A ]
Applicant/sName Applicant/s Signature
Signature of witness:
Address :
Before Me ( with seal)
THIS AGREEMENT made the ____________ day of _______________ Two Thousand and ___________ BETWEEN
__________________________ residing at _________________
___________________________________________________________________________ (hereinafter referred to as the
applicant/s) of the first part and UTI Mutual Fund/Specified Undertaking of Unit Trust of India(hereinafter referred to as
UTIMF/SUUTI) of the second part, WHEREAS the Certificate/s No(s)-----------bearing distinctive
No.(s)__________________________________ for ________units standing in the name(s) of
________________________________ in the register of the unitholders of the UTIMF/SUUTI and WHEREAS the applicant/s
has/have represented to the UTIMF/SUUTI that the said certificate(s) has/have been lost / misplaced / stolen / destroyed and
the applicant/s has / have not been able to trace it/them though diligent search has been made therefor. The applicants
have further stated that they have not sold, transferred, pledged or otherwise dealt with these certificates. AND WHEREAS
the applicant(s) is/ are desirous of having duplicate(s) of the certificate in respect of those units and WHEREAS the
UTIMF/SUUTI has agreed to issue duplicate(s) of the certificate(s) on the said applicant(s) agreeing to indemnify the
UTIMF/SUUTI as hereinafter mentioned NOW THIS AGREEMENT WITNESSETH that in consideration of UTIMF/SUUTI having
agreed to issue duplicate certificate(s) for the said units/shares the applicant(s) does / do hereby for himself / herself /
themselves and his / her / their respective heirs, executors and administrators jointly and severally covenant with the
UTIMF/SUUTI that the applicant(s) , his / her / their heirs, executors or administrators or any one of them will indemnify the
UTIMF/SUUTI or their successors against all costs and expenses and all losses or damages which may be incurred or suffered
by the UTIMF/SUUTI or their successors in consequence or by reason of the UTIMF/SUUTI issuing duplicate(s) as aforesaid or
by reason of two certificates for the same units/shares namely original and duplicate being outstanding at the same time.