To,

Date: ___/____/2014

Flipkart Internet Private Limited
Place:
Ozone Manay Tech Park,
'B' Block, 7th Floor, Survey No. 56/18 & 55/9,
Hosur Road, Garvebhavipalya
Bangalore-560068

DECLARATION CUM UNDERTAKING

Ref: Refund of Rs. ____________/ (Rupees _____________ Only) in lieu of return/reject of
____________(mention product description) (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./Mrs. _______________, with Account No._______________________,
_______________ Bank, ____________ Branch, IFSC Code: _________________.

I request you to refund Rs. ______________________(Rupees ____________ Only) to the
aforesaid account by way of electronic fund transfer 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: ________________________