ANNEXURE XIV

AGREEMENT TO INDEMNIFY

To be stamped as an Agreement on
Stamp Paper of Rs.20/-

I, Shri/Smt. ________________________________________________ am the mother/father of Kumar / Kumari
__________________________________ who was the registered holder of _________________ units issued by the UTI
Mutual Fund/SU UTI under its RAJLAKSHMI UNIT SCHEME/PLAN -II/CHILDREN’S GIFT GROWTH F UND/UTI
CHILDREN’S CAREER PLAN (RUS/RUP/CGGF/UTI-CCP) covered by Unit Certificate/membership Advice/Membership
Certificate No.___________________________ Whereas Kumar / Kumari
___________________________________________________ registered holder of ___________ units
_________________________ issued under the RUS/RUP/CGGF/UTI-CCP died on ________________ No alternate child
has been named / the alternate child also expired. We are the legal heirs of Kumar / Kumari
____________________________________ I/We would request you to please settle the claim in our favour against
indemnify.
Now these presents witnesseth that in consideration of the UTI Mutual Fund/SU UTI agreeing to pay me the repurchase price
of the units standing to the credit of the deceased without the production of legal representation. I Shri/Smt
_________________________________________ the father/mother of the said deceased do hereby agree to indemnify the
UTI Mutual Fund/SU UTI, its heirs and successors and assignees from and against all costs, charges, losses or damages that it
M.P. / M.L.A /CR of UTI MF with CC/FO.
If the Face Value of units exceeds Rs.10000/- : Donor or Only by a stipendary Magistrate or by a judicial officer administering.
This includes Civil Judge, Notary Public, Labour Court Judge, Presiding Officer of Tribunals, etc.
If the Face Value of units is upto Rs .10000/- : Donor/Magistrate (either stipendary or honorary)/ gazetted officer
of Central or State Government / Officer of IDBI / RBI / Manager of nationalised or State Co-operative Bank /
Signature of executant/s
Name & Address
I _____________________________________ father / mother do hereby disclaim any rights to the said settlement and the
cheque may be issued in favour of the name of ____________________________________
(father/mother)
Disclaimer’s Name & Signature
(Mother or Father)
Attested by any of the undernoted officials:
may incur or suffer by reason of its paying the said amount to me to the exclusion of all others.
Executed this ______________ day of ________ 20