_______________ aged __ years, do hereby solemnly declare and say as follows:-
1. That I am employed
with____________________. (Hereinafter referred to as "the bank").
2. That the Bank has
presently taken residential premises being Situated at ______________ known as
_________________(hereinafter referred to as "the said premises")
situate at---________________from _______________ on leave and license basis
for the purpose of providing residential accommodation for me and my immediate
3. At my request, the
Bank has permitted me to use the premises as per terms and conditions of the
Agreement dated __________________, as perquisite to my service.
4. I do hereby declare,
agree and undertake that:-
5. I shall vacate the
said premises on the expiry or earlier determination of the said leave and
license agreement dated ___________________ .
shall use the premises only for the purpose of residence of myself and I shall
not part with the possession of the premises or any part thereof to any one
shall not commit any breach of any of the terms and conditions of the Agreement
under which the Company has taken possession of the premises.
confirm that I am aware of the terms and conditions of the Agreement under
which the company has acquired the said premises on leave and licence basis.
confirm that on happening of any of the following events, _____________shall be
at liberty to demand and take possession of the said premises and I shall
indemnify and keep ________________ indemnified against any loss or damage
which __________________ may suffer or incur due to my non-compliance,
intentioned or otherwise, with any of the following:-
not vacating the premises on termination of my employment with the company for
any reasons whatsoever (whether any retirement, resignation or otherwise).
not vacating the premises on my services being transferred from Mumbai to any
place outside Mumbai.
6. On my committing
breach of any of the terms and conditions of the Agreement under which the
company holds the premises.
7. I further declare
that the undertaking and assurance given by me in paragraph 4(d) above is and
shall be binding on my family, my heirs, administrators, executors and legal
representatives and any person staying in the said premises at the time of my
8. In the event of my
committing any breach of any of the terms and conditions under which I have
been allowed to use the premises ______________ shall be entitled without
prejudice to his other rights to take such legal action of proceedings against
me including criminal proceedings as ______________________ may lawfully be
undertaking-cum-indemnity shall be binding on me till I am occupying the said
10. I confirm that what
has been stated hereinabove is true to my own knowledge and that on the basis
of the declaration made by me herein ___________________has permitted the bank
the use of the premises.
declared by the aforesaid
this ____ day of ___________, 200
this ___ day of _____ 200