Affidavit and indemnity bond, issue of a duplicate share certificate

Part A — Affidavit of the registered holder, on non-judicial stamp paper of the value required in the State, sworn before a notary public or an oath commissioner

AFFIDAVIT

I, [Shareholder's full name], son / daughter / wife of [Shareholder's father's, mother's or husband's name], aged about [Shareholder's age (years)] years, residing at [Shareholder's residential address], do hereby solemnly affirm and declare as follows:

1. That I am the registered holder of [Number of shares covered by the lost certificate(s)] equity shares of Rs [Face value of each equity share (Rs)] each of [ABC Private Limited] (CIN [Company's CIN]), bearing distinctive numbers [Distinctive numbers: from] to [Distinctive numbers: to], covered by share certificate no(s). [Lost share certificate number(s)], registered in my name at folio no. [Shareholder's folio number].