To,

Date:___/____/2015

FlipkartInternetPrivateLimited
Place:
OzoneManayTechPark,
'B'Block,7thFloor,SurveyNo.56/18&55/9,
HosurRoad,Garvebhavipalya
Bangalore
560068

DECLARATIONCUMUNDERTAKING

Ref:RefundofRs.____________/
(Rupees_____________Only)inlieuofreturn/rejectof
____________(mentionproductdescription)(referredtoasProduct).

DearSir/Madam,

I.________________________S/D/W/o____________________anIndianinhabitant
residingat
__________________________________________________________________________
__________________________________________________________________________
hereby,declarethatIhaveplacedorderfortheProductvideorderNo._________,said
Productisreturnedforthereason_____________________________(mentionreason).
FurtherI,statethatthepaymentmadewithrespecttotheProductispaidthroughbank
accountheldbythirdpartyi.e.,Mr./Ms./Mrs._______________,withAccount
No._______________________,_______________Bank,____________Branch,IFSC
Code:_________________.

IrequestyoutorefundRs.______________________(Rupees____________Only)tothe
aforesaidaccountbywayofelectronicfundtransferandIherebyagreeandundertakethat
therefundmadeintheaforesaidmannershallgiveFlipkart.comvalidandcompletedischarge
inrespectoftheFlipkartsobligationstorefundtheaforesaidamounttome.

Iherebyagreetoindemnifyandkeepyoufullyandeffectivelyindemnifiedof,fromand
againstallcostschargesand/orexpensesthatmaybecausedtoorsufferedbyyou,asa
resultofanyfutureclaimsontherefund/Productbymeand/orfromanyoneclaimingunder
me.Ishallnotdisputeorcontesttheexistence,execution,veracityorvaliditythisDocument.

Yoursfaithfully

(Name:_________________)
ContactNumber:________________________