AFFIDAVIT FOR THE ISSUE OF DUPLICATE SHARE CERTIFICATES OF A PUBLIC LIMITED COMPANY
Before the Secretary, XYZ Ltd . .................
 
	Affidavit of A aged about  ………………..son of Shri  ………………..	resident of ..........................
 
I, A, aged about ………………..son of Shri ………………..resident, ...........................	solemnly affirm and state as follows:
 
1.	That I am a shareholder of XYZ Ltd  ………………... 	and as such fully conversant with the facts deposed to below.
2.	That I subscribed for 200 shares of XYZ Ltd. and was issued a certificate of shares No  ………………... 	for 200 shares for Rs. 2,000 in my name on ………………......by the said company.
3	That on ………………..when I was returning from my office to residence in bus No. at about p.m., my  brief-case containing important papers including the original certificate of shares bearing No ……………….. . of XYZ Ltd. have been lost, for which I have lodged FIR with  ………………..Police Station  …………being
	F. I. R  ………………...dated 
4.	That the stolen brief-case and the original certificate of shares could not be traced so far.
5.	That the intimation of loss of certificate of shares may be recorded in the company's records and duplicate certificate in lieu of the lost certificate may be issued to me.
6.	That I have not transferred the shares to any person.
 
I, A, the above named deponent, do hereby verify that the contents of paras 1 to 4 and 6 are true to my personal knowledge and contents of para 5 are my submissions to the company. Nothing material has been concealed and no part of this is false. So help me God.
 
	Verified at ………………..on this ………………..day of ………………..20  ………………..
	Date. ………………..								Deponent