[ Deposit under Guarantee Scheme to decongest the storage facilities at banks ]

Annex – Guarantee Bond Format

The Regional Director / Chief General Manager

Reserve Bank of India

Issue Department

(Address)

Dear Sir,

In consideration of the Reserve Bank of India consenting to make an immediate payment of the value of exchange for the Legal Tender withdrawn notes in the denominations of ` 500 and ` 1000, hereafter referred to as Specified Bank Notes (SBNs) tendered by us (Name of the Bank) pending detailed examination of the tender, we (Name of the Bank) hereby agree to abide by the conditions imposed by the (Regional Director / Chief General Manager) in such cases and at once make good, without demur, any deficiency that may be found to exist in such tenders in SBNs including shortages, mutilated notes, built up notes, counterfeit notes, etc. We also authorise Reserve Bank of India to recover the shortages and other deficiencies by debit to our current account maintained with the Reserve Bank. The undertaking will remain in force until revoked by a notice in writing.

Yours faithfully,

For and on behalf of

(Name of the bank)

(Signature of the authorised official)                                                 Dated the (Date) day of

(Designation of the Authorised Officia)                                            (Month) (Year)

(Official ID / Seal No.)