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INDEMNITY BOND

I, s/o Sh. r/o do


hereby declare that I filed my Income Tax return for the
Assessment Year 2008-09 in the office of Addl.CIT Range #
on 28.07.2008 vide receipt No.____________________
declaring net taxable income at Rs. claiming refund of Rs.
- under PAN# . The refund voucher has
not yet been received by me till today.

Since till date I did not receive the refund


voucher, it was gathered that my return was processed by the
Department on 30.03.2010 resulting refund of Rs. -. Till
date I have not received the refund voucher. I, therefore
request the Department to issue me a duplicate refund voucher
of the said amount with uptodate interest till date. I hereby
undertake to return the original refund voucher in case it
reaches my hands in future and I indemnify Department of
Revenue/ President of India to repay the loss, if any occurs to
the Department in the event of issue of duplicate refund
voucher.

( )

(Deponent)

VERIFICATION

I hereby declare and certify that the above


information is correct to the best of my information and belief
and that nothing has been concealed therein.

Contd.. 2
( )
(Deponent)

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