Format of Affidavit for Loss of Share Certificates

     

Format of Affidavit for Loss of Share Certificates

To
(Name and address of the Company/its STA)

I/We ........ s/o........ aged .................. years. ...,.......... and ................s/o........... aged ............. years ............. residing .............. at .................... solemnly affirm and declare as follows:

1.That I/we am/are the sole/joint holder/s of ………. Number of equity shares/debentures/bonds/units in ....... (name of the company)

Folio No                No of shares   Certificate No               Distinctive Nos
                                                                                                        From      To

2. That the above shares were acquired by me/us for valuable consideration out of my/our own investment/funds against allotment in Public issue/allotment in Right issue or acquired from the market in the years(s)......

3. That I/we have not pledged the original certificate by way of security or collateral or otherwise have not sold the above mentioned shares anytime to any person.

4. That the stop transfer instructions given by me/us are not on the grounds of the non-payment by my/our Broker/Sub-broker.

5. That I/we have genuinely lost/misplaced the above mentioned shares.

6. That I/we am/are solely responsible for any future liabilities in respect of the above mentioned securities.

7. This Affidavit is executed in favour of the company on my/our own volition and is in the form as required by the company/its agent forwarded to me/us vide its letter No............... dated.............

Verification

I/We solemnly affirm that the statement contained in the above paragraphs are true to the best of my knowledge, information and belief and that nothing material has been concealed from being disclosed.

                                                                                                                            DEPONENTS

Solemnly declared and affirm on identification at..... on this ...... day of …….
1. ...................
2. ...................

Before the Executive Magistrate or Notary Public.

(To be executed on a non-judicial stamp of such value as prescribed in the Stamp Rules of the State where it is executed)

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