INDEMNITY BOND

The Indemnity Bond executed this 10th day of September 2008 by _______________ s/d/o ______________
____________________________ in favour of the Assistant Commissioner of Income Tax, Allahabad, do
hereby furnish the Indemnity Bond for the refund of Rs. ________ ( _________________________ ) for the
Assessment Year 2003-2004.

The refund voucher cheque no. ____________ dt. ______________ for Rs. ______________ issued by you
has not been encashed by me till date. The Manager, ______________________________ has informed that
the above cheque has been misplaced. Please issue a fresh cheque against me.

In case the refund voucher cheque has been found or encashed by me, I shall be held responsible for Rs. Rs.
________ ( _________________________ ).

( _________________________ )