Affidavit on Rs 2/- Stamp Paper
I hold inter alia ___________ shares of the face value of Rs 10/- each in the Cosmo Ferrites Ltd as per details below:
Share Certificate No.	No. & Kind of Shares	Distinctive Nos.
The Share Certificate(s) in respect of the said shares has been lost and is not forthcoming. The said share certificate was not accompanied by any blank transfer deed signed by me and that I have not, nor has any person by my order in any manner disposed or parted with or pledged the said certificate or assigned my interest therein or any part thereof to any person. I am sole and absolute owner of the shares covered by the said Share Certificate(s). I will surrender or cause the same to be surrendered to the Company if and when the same is found.
I, therefore, request to issue a duplicate of the said Share Certificate(s). In consideration of the Company so doing, I do hereby indemnify the Company and bind myself, my heirs, executors and administrators to pay all claims, costs, damages, demands, expenses and losses which the said company, may sustain incur or be liable for in consequence of having issued duplicate share certificate at my above said request. The company may realise the said claims, charges, costs, damages, demands, expenses and losses from me personally or my heirs, executors or administrators or my inproperting as the case may be.
In witness whereof I have signed THIS _______________________ DAY OF _______________ 20____
Place:
Date:		Signature of Shareholder
Witness No. 1		Witness No. 2
Name in block letters:		Name in block letters:
Full Address:		Full Address:
Signature:		Signature:
We the undersigned certify that the above facts are true and bind ourselves to make good all claims, charges, costs, damages, demands, expenses and losses which the said company may sustain incur or be liable for in consequence of complying with the request contained above and they will be entitled to release all claims, charges, costs, damages, demands, expenses and losses from our persons of our heirs of our properties as the case may be:
Witness No. 1		Witness No. 2
Name in block letters:		Name in block letters:
Full Address:		Full Address:
Signature:		Signature:
Surety No. 1		Surety No. 2
Name in block letters:		Name in block letters:
Full Address:		Full Address:
Signature:		Signature: