AFFIDAVIT TO BE FURNISHED BY THE SHAREHOLDER TO THE COMPANY FOR ISSUANCE OF DUPLICATE SHARE CERTIFICATE (S).

The Board of Directors,
_________________________________________ Limited/ Private Limited,
Regd. Office:_______________________________
Affidavit of Mr./Ms._______________________________,
S/o/D/o, of Mr. _________________________________
aged about _________ years,
resident of __________________________________________.
I, the above named deponent, solemnly affirm and state as under:
.That I am the applicant in the application being submitted for issuance of duplicate Equity share certificate(s) and as such I am fully conversant with the facts deposed to herein below.
.That ____________ Equity shares of the face value of Rs. __________ each fully paid-up as per details given hereunder stand registered in my name in the books of _________________Limited/ Private Limited (hereinafter referred to as “the Company”).

Certificate No. No. of Shares Distinctive No(s).
—— —- ——-
.That the certificate (s) in respect of the aforesaid Equity shares has been lost from my custody and is not forthcoming.
.That the certificate(s) in respect of the aforesaid Equity shares were not accompanied by any blank transfer deed(s) signed by me and that I have not, nor has any person by my order or on my behalf or in any other manner disposed off, parted with the said Equity share certificate(s)or assigned our interests therein or part thereof to any person.
.That notwithstanding our diligent efforts, we have not been able to trace/locate the said share certificate(s).
.That we have requested the Company to issue in our names, duplicate share certificate(s) in lieu of the aforesaid share certificate.
.We solemnly verify that the facts stated above are true and nothing material has been concealed.

DEPONENT
Signed at _____________ this ___day of ____,

VERIFICATION
I, _______________________________the above named deponent, do hereby verify on oath that the contents of the affidavit above are true to my personal knowledge and nothing material has been concealed or falsely stated. Verified at _____this _____day of ______

DEPONENT

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