Request Application Format for Cancellation of Pay Order/Demand Draft
Attached herewith please find the original Pay Order/Demand Draft No. for the amount of (xxx/-) money (Date) favoring (Date) which you issued at my/our request.
I/We request you to please cancel the above mentioned Pay Order/Demand Draft and accordingly mark the instrument as cancelled in your records and refund the amount thereof to me/us as it is no more required.
In consideration of the bank agreeing at my/our request to cancel the above mentioned Pay Order/Demand Draft and refund the amount thereof to me/us, I/We hereby undertake and agree to indemnify the bank against all claims, demands, losses and expenses suffered or incurred by the bank arising out of or as a result thereof.
I/We agree that if any claim is made by the beneficiary of the said PO/DD subsequent to the cancellation thereof, the bank shall without notice to me/us, be entitled to debit the amount of the PO/DD to my/our account.
Signed by me/us this (Day) of (Date).
Witnesses: (State two witnesses details and their signature)