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REQUEST LETTER FOR ISSUE OF DUPLICATE SHARE CERTIFICATE(S)

Date: __________

To,
The Board of Directors
____________________________ PRIVATE LIMITED
Registered Office: ____________________________

Subject: Request for Issue of Duplicate Share Certificate(s)

Dear Sir / Madam,

I am a shareholder of the Company holding Equity / Preference Shares under Folio No. __________. I wish to inform you that the original Share Certificate(s) issued to me by the Company has / have been lost / misplaced / destroyed.

I therefore request the Company to kindly issue Duplicate Share Certificate(s) in lieu of the original Share Certificate(s) in accordance with the provisions of the Companies Act, 2013 and the applicable Rules made thereunder.

The relevant details of the Share Certificate(s) are as under:

• Folio No.: __________
• Certificate No.(s): __________
• Distinctive No.(s): __________
• Number of Shares: __________

I confirm that the said Share Certificate(s) are not in my possession and have not been pledged, transferred or otherwise dealt with by me.

I am enclosing herewith the following documents for your necessary action:

1. Indemnity Bond duly executed in original
2. Affidavit regarding loss / misplacement of Share Certificate(s)
3. Copy of Police Complaint / FIR (where applicable)
4. Self-attested copy of PAN / Identity Proof
5. Self-attested copy of Address Proof
6. Any other document as may be required by the Company

I request you to kindly take the above on record and arrange to issue the Duplicate Share Certificate(s) at the earliest.

Thanking You,

(Signature of Shareholder)

Name: __________________
Address: ________________
Contact No.: ____________
Email ID: _______________