INDEMNITY TO DRAWER OF LOST CHEQUE

To

_________________________________

In consideration of your having this day given me a second cheque for Rs _______________

being the amount of a previous cheque No _____________ dated _____________ drawn by you

in my favour which I have lost, I hereby undertake to refund to you the said sum of

Rs ________________ in the event of the earlier cheque being presented to and paid by your

bankers within _______ months and to indemnify you against all expenses which

may be incurred by you in relation thereto.

Dated ______________

Signed________________