Duplicate Share Certificate format as per procedure

AFFIDAVIT FORMAT 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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