Indemnity Bond Format for IT Refund

							INDEMNITY BOND
Name of the Assessee :
PAN No. :
Assessment Year :

I…………………………..Son/Wife/Daughter of…………………….. resident of India
do hereby agree to Indemnify the Government of India for any loss that may occur on
issuing refund of Rs………………(Rupees…………………….) for its year
ending…………………..

I have not received the original Refund order and I declare that no refund has been
claimed by me or any other person in respect of the aforesaid refund order.

Date:………………….. Signature…………………
Place………………….. Name………………………