Affidavit for Loss of Share Certificates

Please fill up the details as applicable in the relevant sections of these Affidavit.

This affidavit is to be executed on a non-judicial stamp of such value as prescribed in the Stamp Rules of the State where it is executed.

Specimen – 1

Affidavit for Loss of Share Certificates

I/We …….. son/daughter/spouse of …….. aged about ……………… years residing at ………………………………., do hereby 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. ………..and Share Certificate No………, bearing Distinctive Nos……..To…….. of the face value of Rs……/- each.
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 is 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.

Specimen – 2

Affidavit for Loss of Share Certificates

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

• That I/we am/are the sole/joint holder/s of………….number of equity shares/ debentures/bonds/units in………… (name of the company), as detailed here below:

• 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 year(s)……
• The above certificate/s along with the Transfer Deed/s duly executed by the registered holder(s) and by me/us which were sent by me/us to the company/ its agent have been lost or misplaced in transit/has been lost from our end.
• I/We have not sold the above-mentioned securities at anytime to any person nor have pledged these securities or acted upon in any manner so as to create any third party rights/interests.
• That the stop transfer instructions given by me/us are not on the grounds of the non-payment of my/our Broker/Sub-broker.
• That I/we have genuinely lost/misplaced the above-mentioned securities with/without validly executed Transfer Deed(s).
• That I/we am/are solely responsible for any future liabilities in respect of the above-mentioned securities.
• 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 statements contained in the above paragraphs are true to the best of my/our 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.

Specimen – 3

Affidavit for Loss of Share Certificates

I/We, (name of the shareholder) jointly with (name of the first joint holder) & (name of the second joint holder), son/daughter of (for first holder) ________________________ aged ___ years, an Indian Inhabitant/NRI presently residing at _______________________________________________________________________________ for last ____ years, do hereby solemnly affirm and declare as follows:

• I/We (name of the shareholder) jointly with (name of the joint holder(s)) is/are the registered holder(s) of the Company holding __________ shares under Folio No. _________ of Rs _____/- in the Company and the original share certificates in respect of _______ shares as detailed below has/have been lost/destroyed/misplaced and is/are not traceable.

• That (name of the shareholder) jointly with (name of the joint holder(s)) has/have not sold, transferred, pledged or otherwise disposed off the said shares.
•  I/We have searched or caused searches to be made for the said share certificate(s), but even after careful and diligent search, I/We have been unable to trace the same.
• Since the said share certificate(s) was/were issued, I/We have not sold, mortgaged, pledged or otherwise encumbered or disposed off the said shares or parted with the possession of the said share certificates in any manner and the said shares is/are my/our absolute property to the best of my/our knowledge and belief, the said share certificate(s) has/have either been lost or destroyed or misplaced. In case at any time I/We locate the said share certificate(s) or any of them, I/We shall immediately surrender the same to the Company.
• I/We have already executed Indemnity Bond for issuing duplicate share certificate(s) in lieu of the original share certificates for the aforesaid shares held by me/us.
• Therefore, I/We request the (Name of the Company) to issue duplicate share certificate(s) in lieu of the original share certificate(s) for the aforesaid shares.

VERIFICATION

I/We am executing this declaration to be submitted to the concerned authorities of the Company.

 We, the above mentioned persons verify that the statements contained in the above paragraphs are true to the best of our knowledge and believe that nothing material has been concealed.

Place:

Date:

SIGNATURE OF DEPONENTS