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    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:

    1. 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.
    1. That ____ Equity shares of the face value of Rs. 10/- 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).




    1. That the certificate (s) in respect of the aforesaid Equity shares has been lost from my custody and is not forthcoming.
    2. 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.
    3. That notwithstanding our diligent efforts, we have not been able to trace/locate the said share certificate(s).
    4. That we have requested the Company to issue in our names, duplicate share certificate(s) in lieu of the aforesaid share certificate.
    5. We solemnly verify that the facts stated above are true and nothing material has been concealed.



    Signed at _____________ this ___day of ____,



    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 ______





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