: INDEMNITY BOND :

(Form for Claiming Reimbursement of Medical Expenses)

KNOW ALL MEN BY THESE PRESENTS that I, PARVATI

RAGHUNATH KAWADE, widow of Late Shri Raghunath P.Kawade,
Residing at Survey No.64, Ghorpadigaon, Pune – 411 001,
(hereinafter called ‘the Obligor’ ), which expression shall unless
excluded by or repugnant to the context, include her heirs,
executors, administrators and legal representatives and
…2…
 -: 2 :-
WE (1) Dipak Ranpise, son of ________________ Resident of
NIBM Road, Wanawadi, Pune and
(2) Shivram Sapkal son of ___________________ Resident of
C/o CDA, Southern Command, 1, Finance Road, Pune – 411 001,
Sureties on behalf of the Obligor (hereinafter called ‘the Sureties’ ),
which expression shall unless excluded by or repugnant to the
context include their heirs, executors, administrators and legal
representatives) bind ourselves jointly and severally to pay to the
President of India (hereinafter called ‘the Government’ which
expression shall unless excluded by or repugnant to the context
include his successor and assigns) on demand and without demur a
sum of Rs. 34,705/- (Rupees Thirtyfour thousand seven hundred
five only) for which payment will and truly to be made we bind
ourselves firmly by these presents
Dated this _________ day of _________ 2013. WHEREAS the
aforesaid RAGHUNATH P.KAWADE was at the time of his death in
the employment of Government

AND WHEREAS the said Shri. RAGHUNATH P.KAWADE

Died on the ________ day of _______________ and there was due to
him the sum of Rs. _______________(Rupees ________________________
_______________________________________________________________)
towards reimbursement of medical expenses.

AND WHEREAS the above bounded Obligor Smt. Parvati

Raghunath Kawade, claims to be entitled to the said sum as his
wife, of the said RAGHUNATH P. KAWADE. But has not obtained
letters of administration of or a succession certificate to the property
and effects of Shri RAGHUNATH P.KAWADE

AND WHEREAS the Obligor has satisfied the Government that

she is entitled to the aforesaid sum and that it would cause undue
delay and hardship if she were required to produce letters of
administration of or a succession certificate to the property and
effects of Shri. RAGHUNATH P. KAWADE

AND WHEREAS the Government desires to pay the said sum

to the Obligor but under Government rules and orders, it is
necessary that she should first execute a bond with two sureties to
indemnify against all claims to the amount so due to the said Shri
RAGHUNATH P. KAWADE, before the said sum can be paid to the
Obligor.

NOW THE CONDITION of this Bond is such that if after

payment has been made to the Obligor, the Obligor or the Sureties
shall in the event of a claim being made by any other person against
the Government with respect to the aforesaid sum of Rs. 34,705/-,
(Rupees Thirtyfour thousand seven hundred five only), refund to the
Government, the sum of Rs. 34,705/-, (Rupees Thirtyfour thousand
seven hundred five only), and shall otherwide indemnify and save
Government harmless from all liability in respect of the aforesaid
sum and all costs incurred in consequence of any claim thereto
THEN the above written bond or obligation shall be void but
otherwise the said bond shall remain in full force, effect and virtue.
 -: 3 :-

IN WITNESS WHEREOF the parties hereto set their respective

hands the day and the year first above written.

Signature
Dipak Ranpise,
Surety No.1

Signature
Shivram Sapkal
Surety No. 2

Smt. Parvati Raghunath Kawade

Obligor
Signed by the abovenamed
Obligor in the presence of

1. Signature
Name :
Address :

2. Signature
Name :
Address :