Affidavit – Loss of Share Certificate
Sworn affidavit declaring that a share certificate has been lost.
What this format contains
Affidavit
I, [SHAREHOLDER NAME] son of _______ [NAME], aged __ years, residing at ________, do hereby solemnly affirm and state as under:
That I am the registered holder of equity shares of [COMPANY NAME] bearing Folio No. __________, comprising [QUANTITY] fully paid-up equity shares of face value [AMOUNT] each, represented by share certificate(s) bearing Certificate No(s). __________ and Distinctive No(s). from __________ to __________.
That the aforesaid original share certificate(s) have been lost and are not traceable despite diligent search conducted by me. The loss was discovered on or about Date:__________.
That the said share certificate(s) has not been pledged, hypothecated, or otherwise encumbered by me, and no third-party rights have been created in respect thereof to the best of my knowledge and belief.
That I have not sold, transferred, or delivered the said shares or the above share certificate(s) to any person, nor executed any instrument of transfer in respect thereof.
That immediately upon discovering the loss, I lodged complaint vide FIR/eFIR/Police Complaint No. __________ dated __________ at __________ Police Station, [PLACE] (copy enclosed).-
That I hereby undertake to surrender and deliver to the Company the original share certificate(s), if found or recovered hereafter.
That this Affidavit is made to request the Company to issue duplicate share certificate(s) in lieu of the lost certificate(s) in accordance with applicable laws and Company policy.
I say that the statements hereinabove are true to my knowledge and belief and nothing material has been concealed therefrom.
Solemnly affirmed at [PLACE] on this __________ day of __________, _____.
DEPONENT
_____________ [SHAREHOLDER NAME]
VERIFICATION
Verified at [PLACE] on 18th Day of [DATE] that the above contents are true and correct to the best of my knowledge & belief.
_____________ [SHAREHOLDER NAME]