AFFIDAVIT
FOR DUPLICATE SHARE CERTIFICATE
I, ______________________ son of
/ daughter of / wife of __________________, aged ______ years, resident of
__________________________________ do solemnly and sincerely swear and state as
under:
- That I
am the shareholder of ____________________________ (mention here the name
of the company) and hold _________________________ shares of the Nominal
value `______ each as per the
details below:
|
Folio
No.
|
No. of
Shares Held
|
Share
Certificate No.
|
Distinctive
No. of Shares Held
|
|
|
|
|
|
- That
the said share certificate covering that said shares has been lost /
misplaced / not received and it is not in my possession.
- That I
have not transferred the said shares or any of them in favour of any other
person and I have not executed an instrument of transfer for the said
shares in favour of any person.
I hereby request the Board of
Directors of __________________________ (mention here the name of the company)
to issue to me the duplicate share certificated for the said shares.
I confirm that if original share
certificate(s) is / are found, I will surrender or cause it / them to be
surrendered to the Company.
Sworn on this ____________ day of
___________ 20XX at _______________ (Place).
Signature
of the Deponent
Before me:
(Signature of the person whom the
Affidavit is sworn)
VERIFICATION
I solemnly affirm that what is
stated hereinabove is true to the best of my knowledge and belief, and that no
part thereof is incorrect.
Place:
Date:
Signature of the Deponent
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