ROYAL INSURANCE CORPORATION OF BHUTAN LTD.

HEAD OFFICE: THIMPHU

(Bond To Be Executed In Missing Case)

I, the undersigned claiming benefits hereby acknowledge the receipt of Nu.

.. only ........................................................................ (in words) from
Royal Insurance Corporation of Bhutan Limited being the death compensation
of.......... C.I.D No.... under
the Rural Life Insurance Scheme who went missing on .. and is
presumed to be dead as per the missing person report issued by the concerned authority.
The missing person was related to me as my

In consideration of RICB paying me the aforesaid amount, I do hereby undertake to

inform and agree to reimburse RICB the claimed amount in the event of re-appearance of
the above mentioned missing person at any point of time. In witness whereof, this Bond is
signed voluntarily by me in presence of the witness on Day Month Year.

Name of claimant
Legal Stamp
CID Card No./Valid
Document No.
Village
Gewog
Dzongkhag
Signature of the
Mobile No. Claimant

Name of witness
CID Card No.

Address
Signature of
the Witness
Mobile No.

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