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Indemnification Agreement Replacement Cashiers Check

Agreement made on [Date], between [Bank Customer], of [Address], referred to as customer, and [Bank], of [Address], referred to as bank.

1. Customer has requested that bank issue a cashiers check to replace banks original cashiers check Number [--], dated [Date]. A copy of the original cashiers check is attached as Exhibit Marked "A", and incorporated by reference.

[Indicate how check was lost, stolen or destroyed, for instance: Banks records show that the original check was placed in the United States mail on [Date]. However, to date, customer has not received the check].

2. Customer warrants that [person authorized to endorse check, such as: [Name] is the only person authorized to endorse checks in [Name] own behalf or the only persons authorized to endorse the check on customers behalf are [Name] and [Name]; neither of these persons has endorsed the check in question].

Customer further warrants that customer does not know of the location of the original cashiers check. However, if customer should find the check, customer agrees to promptly deliver it to bank.

3. Customer agrees to indemnify bank against any claims, losses, or liabilities bank might incur as a result of a finding by a court of proper jurisdiction that the check bears the genuine indorsement of [Customer or customers authorized representatives]; the check was properly endorsed to the person bringing the proceeding; and that person is a holder in due course.

4. Bank agrees to notify customer immediately on receipt of a claim on the cashiers check by a person claiming to be a holder in due course. Bank further agrees to allow customer to defend against any such claims. Such notice and opportunity to defend are conditions precedent to customers indemnification obligations under this agreement.

In the event that such proceedings are brought, and the court finds that the signature was unauthorized, the parties shall share the expenses of defending against the action, including reasonable attorney fees.

Dated:

Signature

[Name of Customer]

Signature

[Name and title of bank representative]

*** If Required By State Law ***

This Section for Notary:

Acknowledgment

STATE OF -------)

) ss: [Date]

COUNTY OF ------)

On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

Witness my hand and official seal.

[Signature]

[Name of Notary Public]

My commission expires: [date]

(Seal)