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Date :

Name :
Address :


Dear Sir,

Reg : Indemnity cum Letter for Issue of fresh cheque.

Ref : Cheque No: ________ Dated: _________. Amount Rs: ________.

Drawn on ______________ Issued in favour of ____________________.

I / We was / were until recently in possession of the above-mentioned cheque issued by you in
my / our favour. I / We regret to inform you that the above mentioned cheque has / have been
either lost or misplaced and cannot be traced in spite of my / our having made a due and diligent
search for the same. I / We assure you that I / We have not created any right or interest in the
said cheque or in the debt represented by it in favour of any person whomsoever.

I / We have requested you :

To issue a duplicate cheque in lieu of the aforesaid cheque which has/have been lost ; and You
have agreed to accede to my/our above request on the faith and strength of my/our
representations and assurances and on giving you indemnities, undertakings and authorities as
hereinafter appearing.
In consideration of the premises, I so as to bind myself and my heirs, executors, administrators,
estates and effects jointly and severally hereby agree and undertake with you and successors
and assigns as under :

1) To keep you safe and indemnified from time to time and at all times from and against all
claims, demands, actions, proceedings, loss, damages, liability costs (Legal costs being
between Attorney/Advocate and clients), charges and expenses whatsoever, which may
be made or brought or commenced against you or be paid, sustained, suffered or
incurred by you howsoever as consequence direct or indirect of your issuing to me/us
duplicate cheque and granting the advance as aforesaid.
2) To pay to you and make good on demand by you the amount of such loss, damage,
liability, costs (legal costs being between Attorney / Advocate and clients), charges and
expenses together with the interest at 18% p.a from the date of payment by you until
reimbursement by me / us.

3) To return to you the original Cheque as aforesaid should the same be found by me or us
or should again come into my/our possession at any time hereafter.

Yours faithfully,
( Signature with Name )
In consideration of the premises, I / We (name/s of the guarantors/s) of the undersigned jointly
and severally guarantee to you, MDIndia Healthcare Services (P) Limited on demand by you, the
due payment of all moneys payable to you under the foregoing letter by the executants thereof.

1) Signature :

Name :
Occupation :
Address :

2) Signature :

Name :
Occupation :
Address :