To,

Date: _09/03/2014

WS Retail Service Private Limited

No. 447, 1/B, 1st Floor, 1st A Cross,
12th Main, 4th Block,
Koramangala, Bangalore-560034

Place:Jalandhar

DECLARATION CUM UNDERTAKING

Ref: Refund of Rs. 465/- (Rupees Four Hundred Sixty Five Only) in lieu of
return/reject of Philips SHM3100U/97 Wired Headset (Black) (referred to as Product).

Dear Sir/Madam,

I. ________________________ S/D/W/o ____________________ an Indian inhabitant residing

at ____________________________________________________________________________
______________________________________________________________________________
hereby, declare that I have placed order for the Product vide order No. _________,
said Product is returned for the reason _____________________________ (mention
reason). Further I, state that the payment made with respect to the Product is paid
through bank account held by third party i.e., Mr/Ms. _______________, with Account
No._______________________, _______________ Bank, ____________ Branch, IFSC Code:
_________________.
I request you to refund Rs. ______________________(Rupees ____________ Only) to the
aforesaid account by way of Refund through CHEQUE and I hereby agree and
undertake that the refund made in the aforesaid manner shall give Flipkart.com
valid and complete discharge in respect of the Flipkarts obligations to refund the
aforesaid amount to me.
I hereby agree to indemnify and keep you fully and effectively indemnified of, from
and against all costs charges and/or expenses that may be caused to or suffered by
you, as a result of any future claims on the refund/Product by me and/or from any
one claiming under me. I shall not dispute or contest the existence, execution,
veracity or validity this Document.

Yours faithfully

(name:_________________)

Contact Number: ________________________