Loss of Bank Fixed Deposit (FD) Receipt Indemnity Bond on Stamp Paper

Before the Ld. Concerned Authority / Notary Public At Ghatal, Dist.- Paschim Medinipur, West Bengal AFFIDAVIT (On Non-Judicial Stamp Paper of ₹100 Non-Judicial Stamp Paper) In the matter of: Loss of Bank Fixed Deposit (FD) Receipt Indemnity Bond on Stamp Paper I, [Deponent Name], [S/O / D/O / W/O] [Father / Husband Name], aged about [Age] years, by faith [Religion], by occupation [Occupation], residing at Vill.- [Village / Ward No.], P.O.- [Post Office], P.S.- [Police Station], Sub-Division- Ghatal, Dist.- Paschim Medinipur, Pin- [Pin Code], West Bengal, do hereby solemnly declare, affirm and state on oath as under:- 1. That I am the sole deposit holder of Term Deposit Receipt No. [FD Receipt No] issued by the bank for ₹[Deposit Amount]. 2. That the original deposit certificate has been lost / misplaced and cannot be found despite diligent search. 3. That I have not pledged, assigned, mortgaged, or transferred the said certificate as collateral to any third party. 4. That I undertake to indemnify the Concerned Authority against all liabilities arising from the issuance of a duplicate deposit. Verification:- I, the above-named deponent, do hereby verify and declare that the statements made in paragraphs 1 to 4 above are true and correct to the best of my personal knowledge, belief and derived from authentic records. No material facts have been suppressed, concealed or misstated herein. If any statement is subsequently found to be false or incorrect, I shall be liable to face statutory legal prosecution under the Indian Penal Code / Bharatiya Nyaya Sanhita and relevant provisions of Indian Contract Act 1872 & Banking Directives. Solemnly affirmed and signed on this [Date] day of [Month], [Year] at Ghatal. ___________________________ Deponent Signature / LTI Identified by me and signed in my presence: ___________________________ Advocate, Ghatal Dewani Court Dist.- Paschim Medinipur, West Bengal