INDEMNITY BOND FOR ISSUE OF DUPLICATE SHARES CERTIFICATE

To,

The Company Secretary,

_________________________ (Name of Company)

_____________________________ (Name of Palce),

____________________ (Name of City with pin code)

WHEREAS

I, ___________________________, Son/Daughter/Wife of ______________, aged _____________ years, residing at ________________________________ (Address with pin code, P.O, P.S and District), hold ________ equity shares of face value of Rs. _____ each of _____________________ (Name of Company), having its registered office at _____________________________________ (Address with pin code), as per the details given below:-

Folio No.	Certificate No.	Distinctive Nos.		No. of Shares
		From	To

WHEREAS

The share certificate No. _____________ in respect of the above shares has been lost or mislaid and is not traceable. I declare that 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 disposed off, parted with or pledged/ deposited by way of security the said share certificate or assigned my interest therein or any part have neither been sold or transferred to anybody by me and I am entitled to the custody of the certificate of title relating to such shares as I am the absolute owner of the same as registered shareholder. I undertake to surrender the said share certificate to the company if and when the same is found at a later date.

NOW THEREFORE:

I, have requested the company to issue duplicate share certificate in lieu of the original shares covered under Folio No. ______________ and bearing Certificate No. _________________ held by me.

In consideration of the Company having agreed to issue duplicate share certificate for the aforesaid shares in my name, I am executing a bond in favour of the Company.

Upon the Company, having agreed to issued duplicate share certificate for the aforesaid shares, I the undersigned applicant hereunder for myself my heirs, executors, administrators and assigns do hereby jointly and severally covenant with the Company, its successors and assigns and agree and undertake at all times save, defend and to indemnify and keep indemnified the Company, its successors and assigns its estate and effects, and its directors, manager, secretary and shareholders and their heirs, executors and assigns from and against all actions, suits, proceedings, accounts, claims and demands whatsoever for or on account of the said shares or dividends or any part thereof or otherwise in connection with the same, and from and against all losses, costs, claims, actions, demands, risks, charges, expenses, damages and losses arising in any manner howsoever.

IN WITNESS WHEREOF I, the applicant herein have signed and set my hands on this ________ day of _____________ month _________ year.

Name and address of the Shareholder(s) Signature of the Shareholder

___________________________

______________________________________

_________________________________________

Name and address of Witness Signature of the Witness

Place :

Date: