Specimen of Indemnity Note




Specimen of Indemnity Note :





INDEMNITY NOTE




I hereby acknowledge to have received from the Western Railway a percel, valued at $ 127789, which was despatched to my address from the Mumbai station of the Western Railway on about the 25th Januaryday of 2006, the Railway receipt for which has been lost and for myself, my heirs, executors and administrators I undertake in consideration of such delivery as aforsesaid to hold the President of India, his agent and servant of Railway Administration, it's agents and servants harmless and indemnified in respect of all claims to the said goods.


And I, the undersigned, signing below the consignee of these goods certify that the first signor is the bonafide owner of the goods and that I undertake the whole of the said liability equally with the consignee and for this purpose, I affix my signature hereto.


  1. Signature of Witness……………………

    Father’s Name……………………….

    Caste…………………..

    Age………………….

    Residence …………………….

    Profession………………….

  2. Signature of Witness…………………..

    Father’s Name………………..

    Caste…………………..

    Age………………..

    Residence……………………

    Profession……………………



Signature of Consignee…………

Father’s Name………………

Caste……………….

Age……………

Residence…………………

Profession………………..


Signature of Surety…………………..

Father’s Name……………..

Caste……………….

Age………………

Profession………………….

Residence…………..




Executed in my presence.


Station Stamp


Station Master


NOTE : Before submitting the Indemnity Note to the railway authorities the signatures of the Consignee must be got attested from his bankers.





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