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INDEMNITY CUM AFFIDAVIT ON STAMP PAPER OF RS 300/- TO BE NOTARISED This Indemnity cum Affidavit is executed at ___________ this ____ day of ________, by : (1) Mr ______________ Age: ____ years, Occupation: ____, residing at ____________________ (hereinafter referred to as Indemnifier 1 ) (2) Mr ______________ Age: ____ years, Occupation: ____, residing at ____________________ (hereinafter referred to as Indemnifier 2 ) (3) Mr ______________ Age: ____ years, Occupation: ____, residing at ____________________ (hereinafter referred to as Indemnifier 3 ) (4) Mr ______________ Age: ____ years, Occupation: ____, residing at ____________________ (hereinafter referred to as Indemnifier 4 ) (5) Mr ______________ Age: ____ years, Occupation: ____, residing at ____________________ (hereinafter referred to as Indemnifier 5 ) (hereinafter, collectively referred to as Indemnifiers ).

12. In case deceased was member of Hindu Undivided Family(HUF), full details of surviving legal members: Name Address Relationship with …

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