Adam Frankel
General Counsel · Technology & AI
15+ years as General Counsel to technology, cloud & AI companies
AGREEMENT TO INDEMNITY FOR LOST RECEIPT
Open Legal LibraryUpdated 9 Jul 2026
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. ________________________
About this template
What is this template?
This document is a combined indemnity and guarantee specifically for situations involving a lost proof of payment. It is not a simple receipt or a general release of liability, as it specifically binds a second person as a surety to cover potential losses.
When should you use it?
Use this when a customer requests a refund or the release of held property but cannot produce the required paperwork, and you require a guarantor to co-sign the indemnity. Use a standard 'Release and Waiver' if no goods or money are being exchanged at the time of signing.
What's inside
| Clause | Name | What it does |
|---|---|---|
| Paragraph 1 | Acknowledgement of Receipt | The recipient acknowledges receipt of specific articles or cash and confirms the original receipt has been lost. |
| Paragraph 1 | Indemnity Undertaking | The recipient and their heirs agree to hold the payer and its agents harmless against all claims regarding the delivered items. |
| Paragraph 2 | Surety Guarantee | A second signer certifies the recipient is the bona fide owner and accepts equal liability for the indemnity. |
Who it's for
- an individual claiming specific goods or cash from a business when the original proof of purchase is missing
- a business requiring a guarantee from a third-party surety before releasing funds for a lost receipt claim
How long it runs and how it's signed
How long
Used once
Signed by
Recipient, Surety
Witness
Required
Notarisation
Not required
Also needed
Two witnesses must sign
Jurisdiction
India
Document info
GitLaw document. Document created on Fri Jun 26th, 2026. Last updated on Thu Jul 9th, 2026.
This document is public
Licensed under CC BY 4.0 (Attribution).
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