| Form-B |
| INDEMNITY |
| [For issuance of duplicate securities] |
|
Note: This indemnity is to be executed in the presence of a Public Notary / Gazetted Officer
|
| [To be submitted in non-judicial stamp paper of appropriate value] |
|
I/We,
Son / daughter / spouse of
residing at
having Permanent Account No (s)
do hereby solemnly affirm and state on oath as follows.
|
|
1. That I/we, am/are the sole/joint holder/s of the Securities in following folios. I/We request you to issue duplicate certificate(s) for securities, as detailed below in my/our name(s):
|
|
**In case of non-availability of Certificate Nos./Distinctive Nos./ Folio nos., security holder shall obtain the same from RTA.
|
|
2. That the above securities were acquired by me/us for valuable consideration out of my/our own investment/funds against allotment in Public Issue/allotment in Right Issue or acquired from the market/through inheritance in the year(s)
|
|
3. I/We hereby jointly and severely agree and undertake to indemnify and keep indemnified, saved, defended, harmless, the aforesaid (Name of the Company/RTA) and its successors and assigns for all time hereafter against all losses, costs, claims, actions, demands, risks, charges, expenses, damages, etc., whatsoever which you may suffer and/or incur by reason of your, at my/our request, issuing the said Duplicate Securities as herein above mentioned, to the undersigned.
|
IN WITNESS WHEREOF the said 1) Mr. /Ms. (Name and signature of the witness)
And 2) Mr. /Ms. Name and signature of the witness , have hereunto set their respective hands and seals this day of
|
Signed before me at: on: |
Signature of Notary / JMFC
Official stamp & seal of the Notary Magistrate/ Notary & Regn. No.:
|
| FOR OFFICE USE ONLY |
| Signature checked by: |
