Draft a specimen affidavit for issue of duplicate Share Certificate, as the original Share Certificate issued by the Company has lost. Assume data.

Affidavit (On stamp paper of ₹10/- or above) I, [Deponent's Name] S/o or D/o [Father's/Husband's Name], R/o [Address], do hereby solemnly affirm and declare oath as under: That I am a Shareholder of [Company Name] Ltd, holding 1000 Equity shares having Folio No. [Folio Number], Certificate No. [Certificate Number] to [Certificate Number] and distinctive nos. [Distinctive Numbers]. That the said share certificates, covering the above said shares have been lost. That the FIR has been registered in [Police Station Name] P.S. vide no. [FIR Number] dated [Date of FIR]. That I have not sold and / or transferred the said shares in favour of any other person or persons. That I have not pledged, created any charge or encumbrance on said shares in favour of any person or persons. That I have filed a request to the Company viz [Company Name] to issue duplicate certificate for the said shares. (Deponent) Verification I, the above named deponent, verify that the contents of paragraphs 1 to 6 of this affidavit are true to my Personal knowledge and belief. Sd/- A.B. Dated. [Date] Solemnly affirmed before me on this [Date] day of [Month], 2013 (time) by the deponent. Sd/- (Oath Commissioner)