INDEMNITY BOND

To, The General Manager / Manager, Vasai Vikas Sahakari Bank Ltd. Adminstrative Office,_______________ Branch. Dear Sir, Ref: ___________________________________________________ I / We was / were in possession of Vasai Vikas Sahakari Bank Ltd., Fixed Deposit Receipt / Pay order / Demand Draft / Dividend Warrant bearing No. ____________, dated ___________ for Rs. _______________ issued by your ________________ Branch in favour of ________________. The said __________________________ is lost or misplaced by me / us and though I / We made a thorough and diligent search for the misplaced _________________ I / We have not been able to trace it. I / We declare that the said Fixed Deposit Receipt / Pay order / Demand Draft / Dividend Warrant has not been sold, mortgaged, pledged , transferred or assigned or dealt with any manner by me / us. I / We have requested you to issue me / us the duplicate Fixed Deposit Receipt / Pay order / Demand Draft / Dividend Warrant in lieu of the original or refund the amount of Pay Order / Demand Draft. You have agreed to do so, on the faith and strength of aforesaid representation and on my / our executing such indemnity in favour of the Bank as hereafter appearing. In consideration of the promises, I / We so as to bind myself / ourselves and my / our respective heirs, executors and administrators jointly and severally agree and undertake form time to time and at all time hereafter by my / our executing such Indemnity in favour of the Bank and its Board of Directors, Committee, Officers as hereinafter appearing: a) to keep you safe and indemnified against all claims, demands, suits, actions, proceedings, loss, damage, costs, charges and expenses (the legal costs between attorney and client) which may be made or brought or commenced against you or be paid, sustained, suffered, or incurred by you as the consequence direct or indirect by reason of the issue of such duplicate Fixed Deposit Receipt / Pay Order / Demand Draft / Dividend Warrant or by the reason of payment or refund of the amount in respect of the said Fixed Deposit Receipt / Pay order / Demand Draft / Dividend Warrant No. ___________________ in pursuance of the forgoing request.

b) to pay to you on demand the amount of any such loss, damage, costs, charges and expenses together with interest @ 18% per annum from the date of payment by you until reimbursement by me / us.

c) that you shall have the right to set if any amount payable to me / us by you hereunder against the amount of my / our said Fixed Deposit Receipt / Pay Order / Demand Draft / Dividend Warrant etc.

d) that if the old Fixed Deposit Receipt / Pay Order / Demand Draft / Dividend Warrant be located at any time hereafter I / we will return it to the Bank for cancellation.

Yours Faithfully,

Before Me

The general Manager / Manager, ________________ Branch