------50/- STAMP PAPER (NOTARY)------

LETTER OF SUBROGATION:

To:

The National Insurance Company Ltd.

3, Middleton Street, Prafulla Chandra Sen Sarani, Kolkata, West Bengal, 700071.

Mobile No…………………………………………..IMEI No………………………………………

Policy No…………………………...

Claim No……………………………

1. I hereby acknowledge in consideration of your paying full.And final settlement in respect of theft of the under mentionedMobile Insured under policy No……………….....issued by theNational Insurance Company Ltd.

2. I hereby subrogate to you all my/or rights and remedies (To the extent provided by law) against person or person /Authority whoever is liable in respect there of.

3. I hereby guarantee that I am the person entitled to enforce the terms of contracts to any documents of title or receipts evidencing the contract of transportation or bailment or

parking relating to and concerning the mobile described under the above policy.

4. I hereby subrogate to you all my/ or rights and remedies I have in consequences or arising from loss to the undersigned goods and or mobile and we further hereby grant to you full power to take and use all awful ways and means to recover the said loss / damage from whom it may concern.

5. I/We also hereby authorized you to use my/our name in any suit, Complaints, actions or proceedings that you may jointly in my/our name in relations to any of the matters hereby.

Subrogated to you I/we undertake for my self/our self to assist and concur in any matters or proceeding which you may deem expedient or necessary in such suits, complaints, actions

or proceeding and to execute all deeds /and/or documents.

Including any and all pleading and release which may be necessary therefore and generally to assist therein by all means in my/ our power.

6. I/we hereby point you, your officer and agents and their successors, severally as my/our attorney in fact with irrevocably power to receive or collect any and all such claims and to initiate, prosecute, comprise, arbitrate or withdraw at your expenses of any and all legal proceedings which you may deem necessary to enforce such claim before any court,

tribunal or forum and toexecute in my /our name documents which may be necessary to carry into effect the purpose of this agreement.

7. I/we undertake if called upon by you do so my self /our self to institute any such action or proceedings that you direct on your behalf it being understood that you are to indemnify me /us and any other person whose names may necessarily be used against any cost, charges, or expenses which may be incurred in respect of any action or proceedings that may be take by virtue of this Agreement.

8. The payment receiptedfor herein accepted with the understating that the said payment shall not encore to the benefitOr any carrier of bailer under the provisions of any contract of carriage of otherwise. That in making the said payment the under writer does not waive any rights to subrogation or otherwise against any carrier or bailer, and acceptance of this receipt shall not prejudice or take away any rights or remedies which you as the under writer would otherwise have by virtue of such payment.

9. I /we further agree that any monies collected or received from any authorities or persons shall be your property to the extent of the amount paid by you to me /us mentioned in clause 1 about to have indemnified to me /us in the amount specified in clause 1 above any monies recovered by you in excess of the amounts mentioned in clause I above is to be paid over you to me/us immediately. If any amounts are received in the first instance by me/I undertake to make over to you immediately the amounts so received to the extent of the amount paid by you (including interest) to me as per clause I above.

10. I hereby further agree and undertake that in the event of the Lost/damaged mobile and /or contents thereof subsequently being traced, we undertake to accept and take delivery of the same and the claim shall then be readjusted on the correct basis of the then loss/damage and in the event of any refund proving to be due to the undertake on demand to make such refund to you.

As witness we set out hands this XX day of XXXXX, 2011.

Witness…………………..

Signature ………………….

Address……………………

…………………………….

……………………………. Signature of Insure/Claimant

Mr.………………………..

Cause of loss:

Approximate

FIR No:

Police Station: