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    Form-B (Indemnity)

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    jamesbond50
    This document is an indemnity form for the issuance of duplicate securities. It requests the duplicate issuance of securities and details the original securities. The holder agrees to indemnify and hold harmless the company/RTA for any losses in issuing duplicate securities to the undersigned based on this request.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Form-B (Indemnity)

    Uploaded by

    jamesbond50
    99 views2 pages
    This document is an indemnity form for the issuance of duplicate securities. It requests the duplicate issuance of securities and details the original securities. The holder agrees to indemnify and hold harmless the company/RTA for any losses in issuing duplicate securities to the undersigned based on this request.

    Original Title

    Form-B ( Indemnity)

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    © © All Rights Reserved

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    This document is an indemnity form for the issuance of duplicate securities. It requests the duplicate issuance of securities and details the original securities. The holder agrees to indemnify and hold harmless the company/RTA for any losses in issuing duplicate securities to the undersigned based on this request.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    99 views2 pages

    Form-B (Indemnity)

    Uploaded by

    jamesbond50
    This document is an indemnity form for the issuance of duplicate securities. It requests the duplicate issuance of securities and details the original securities. The holder agrees to indemnify and hold harmless the company/RTA for any losses in issuing duplicate securities to the undersigned based on this request.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    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 executed on a Non-Judicial Stamp Paper of appropriate value and to be Notarized)


    Presently for the State of Maharashtra Rs.500/-
    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):
    Distinctive Nos.
    Company Name Folio No/s Securities Face Value Security
    held Certificate No. From To

    **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 ____________________

    Signature of All Holder(s) / Applicant(s)

    Signature-1: ______________________________________

    Signature-2: ______________________________________

    Signature-3: ______________________________________
    Tel No.
    For Office Use Only checked ONLY
    Email Id
    Signature checked by: _________________________________
    Date:

    Signed before me:

    at:

    on:
    X -----------------------------------------------
    Signature of Notary / JMFC
    Official stamp & seal of the Notary Magistrate/ Notary & Regn. No.:

    Address of First holder / Applicant:


    ---------------------------------------------------------------------------------

    ---------------------------------------------------------------------------------

    ---------------------------------------------------------------------------------

    Pin code: ___________________

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