Affidavit for duplicate certificate

Stamp paper of value Rs. 100/-

AFFIDAVIT FOR DUPLICATE CERTIFICATE

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Folio No-----------
I/We------------------------------------------------------------------------------------------------------

Wife/Son/Daughter of ------------------------------------------------------------ and ------------------------------------------------------------------------------------------------------ Wife/Son/Daughter of----------------------------------------resident of----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------do solemnity and sincerely swear and state as under:

1. That----------------------------Equity shares of RS. /- each having distinctive Nos.---------------------------- to ----------------------------------- are registered in my/our name(s) in the books of ___________________________. .
2.That share certificate(s) No. ------------------------------------was/were issued to me/us by the company for the said shares.

1. 
   That the said share certificate(s) covering the said share(s) has/have been lost and it is/they are not in my/our possession.
   

4. That I/we have not transferred the said share(s) or any of them in favour of any other person and I/we have not executed any instrument of transfer for the said share(s) in favour of any person.

5. 
   That I/we have filed a request to the company, viz. __________________________ ________ to issue a duplicate certificate(s) for the said shares.
   

Place:

Date: DEPONENT(S)

VERIFICATION

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I/We solemnly verify that the facts stated above are true and that nothing material has been concealed.

Place:

Date: DEPONENT (S)

Note:

1. 
   In case of Joint holdings all the shareholders should sign.
   

2. 
   Strike out whichever is not applicable.
   

3. 
   This affidavit should be verified in the presence of a First Class Magistrate or a Notary Public. In the event of verification in the presence of a Notary Public, the affidavit should contain the notarial stamp (OR) This Affidavit should be verified in the presence of Consulate General, Indian High Commission at------------------------------------------------------- and should contain their stamp.