AGREEMENT TO INDEMNITY FOR LOST RECEIPT
An indemnity given by a person who has received goods, articles or money but has lost the original receipt. The recipient acknowledges receipt and, for himself and his heirs, executors and administrators, undertakes to hold the payer or deliverer, its agents and servants, harmless and indemnified against all claims to the goods or money. A second signer certifies that the recipient is the bona fide owner and stands surety, undertaking the whole liability equally with the recipient.
AGREEMENT OF INDEMNITY FOR LOST RECEIPT
I, Mr. ____________________, aged ______ years, son of ____________________, resident of ____________________________________, hereby acknowledge to have received (state the article or cash which may have been received), the receipt for which I have lost; and for myself, my heirs, executors and administrators, I undertake, in consideration of such delivery or payment, to hold ____________________, its agents and servants, harmless and indemnified in respect of all claims to the said goods/articles/money.
And I, Mr. ____________________, aged ______ years, son of ____________________, resident of ____________________________________, the undersigned, signing below the name of the said ____________________, the recipient of these goods/articles or money, certify that the first signer is the bona fide owner; and that I, ____________________, the second signer, stand surety and undertake the whole of the said liability equally with the recipient; and for this purpose I also affix my signature hereto.
Signature: ________________________
Recipient
Signature: ________________________
Surety
WITNESSES:
1. ________________________
2. ________________________
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