AGREEMENT TO INDEMNITY FOR LOST RECEIPT



I, AA., aged _________ years, son of_________, resident of _________, hereby acknowledge to have received (state the article or cash which may have been received), the receipt for which I have lost and for myself, my heirs, executors and administrators, I undertake in consideration of such delivery or payment to hold _________ its agents and servants, harmless and indemnified in respect of all claims to the said goods/articles/money; and I, BB., aged _______ years, son of _________, resident of _________, the undersigned, signing below the said AA., the recipient of these goods/articles or money, certify that the first signer is the bona fide owner and that I, BB., the second signer stand surety and undertake the whole of the said liability equally with the recipient and for this purpose I also affix my signature hereto.



Witnesses:

Sd. AA.



Recipient.



Sd. BB.



Surety.