{"id":2350,"title":"FORM OF LETTER OF INDEMNITY (for Lost / Misplaced Annuity Cheque/s under Individual Pension Plans)","purpose":"claim","insurer":{"slug":"lic","name":"Life Insurance Corporation of India"},"source_pdf":"https://licindia.in/documents/d/guest/form-of-letter-of-indemnity","sha256":"c3b515fae23716715089638c456880915d3212d6cf304536c35aa4c2bfb8b72b","pages":2,"collected":"2026-10-20","instructions":{"about":"This form is for annuitants under Individual Pension Plans to request issuance of duplicate annuity cheque(s) when the original cheque(s) is lost or misplaced.","notes":["No other attestation is necessary besides the witness signature.","This letter is to be signed and dated by the annuitant and witnessed.","Use the exact cheque details and policy information as per records."],"title":"FORM OF LETTER OF INDEMNITY (for Lost / Misplaced Annuity Cheque/s under Individual Pension Plans)","submit":{"to":"The Life Insurance Corporation of India","how":"","address":""},"purpose":"claim","sections":[{"title":"Letter of Indemnity Details","fields":[{"help":"Enter your policy number(s) as printed on your policy document.","type":"text","label":"Policy No./s.","options":[],"required":true,"pdf_field":""},{"help":"Enter the name of the life assured as per the policy.","type":"text","label":"On the Life of","options":[],"required":true,"pdf_field":""},{"help":"Enter the cheque number of the lost or misplaced cheque.","type":"text","label":"Cheque no.","options":[],"required":true,"pdf_field":""},{"help":"Enter the name of the bank on which the cheque was drawn.","type":"text","label":"Bank","options":[],"required":true,"pdf_field":""},{"help":"Enter the place where the letter is signed.","type":"text","label":"Dated at","options":[],"required":true,"pdf_field":""},{"help":"Enter the date on which the letter is signed.","type":"date","label":"Date","options":[],"required":true,"pdf_field":""},{"help":"Sign here as the annuitant requesting the duplicate cheque.","type":"signature","label":"Annuitant’s Signature","options":[],"required":true,"pdf_field":""}],"filled_by":"annuitant"},{"title":"Witness Details","fields":[{"help":"Enter full name of the witness.","type":"text","label":"Full Name","options":[],"required":true,"pdf_field":""},{"help":"Witness must sign here.","type":"signature","label":"Signature","options":[],"required":true,"pdf_field":""},{"help":"Enter the occupation of the witness.","type":"text","label":"Occupation","options":[],"required":false,"pdf_field":""},{"help":"Enter the address of the witness.","type":"text","label":"Address","options":[],"required":false,"pdf_field":""}],"filled_by":"witness"}],"deadlines":[],"applies_to":"Lost / Misplaced Annuity Cheque/s under Individual Pension Plans","attachments":[],"declarations":["The annuitant declares that the original cheque(s) has been lost or misplaced and not transferred or dealt with by them.","The annuitant undertakes to return the original cheque(s) to the insurer if found for cancellation.","The annuitant and their heirs, executors, and administrators agree to indemnify and keep the insurer harmless from all claims or liabilities arising from issuing the duplicate cheque(s)."],"dropped_labels":5},"pdf_fields":null,"fillable_pdf":false,"send_to":[],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/lic/2350-form-of-letter-of-indemnity-for-lost-misplaced-annuity-cheque-s-under-individual"}