AFFIDAVIT FOR SELF DECLARATION BY THE COMPANY'S SHARE HOLDER

Before the Ld. Notary public at……………(Name of place)

A F F I D A V I T

I, ___________________, aged about ____ years, _______________(Address with pin code), India do solemnly affirm and any as follows:-

1) I/We am a member of ____________________(Name of Company) holding ____ Shares bearing Distinctive Nos ______ to _____ with folio no. _______ and Share Certificate Nos _____ & _____ in the aforesaid company.

2) I/We hereby declare that the aforesaid Share Certificate(s)/Debenture certificate(s) for _____ shares with Distinctive Nos. ______ to ______ have been lost/misplaces/destroyed and I/We have made effort to be locate the same. I/We have not pledged or deposited by way of security any of the Shares/Debentures script, not have I/We sold or transferred any of these Shares/Debentures and that I/We shall deliver those original Share Certificate/Debentures Certificate if any when found.

3) I/We undertake(s) to indemnify the Company against any proceedings, claims, damages, expenses and liabilities by reason of the issue of fresh Certificates in lieu of the lost/misplaced/destroyed Share certificates/Debentures Certificates. I also indemnify the Company if my claim is made by any third party in respect of the said lost Share Certificates/Debentures Certificates.

4) I/We solemnly affirm that this declaration is true and that solemnly affirmed at _______________(Name of place).

Dated this _____________

_________________

D E P O N E N T

Identified by me

Advocate, ______________(Name of place).