Annexure_D

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FORMAT OF AFFIDAVIT/DECLARATION FOR CHANGE OF SIGNATURE

(Please type this Affidavit after carefully reading the notes mentioned below the format)

AFFIDAVIT

I, __________ son/daughter/spouse of _____________ aged ___, residing at __________________, do hereby solemnly affirm and declare as under:

1. That  I, Shri/Smt. (Name of the shareholder/s), am holding _____ equity  shares in (the name of the company) covered under Folio No. _______ and Share Certificate No(s). ___________, bearing Distinctive Nos. ________ to __________ of the face value of Rs.__/- each.

   Folio No.    Certificate Nos    Distinctive Nos.    Shares covered in each certificate

The abovementioned shares have been acquired by me out of my own investments/funds against (allotment in Public Issue/ Right Issue/Bonus issue) or from the market in the year____). 

2. I am residing at the abovementioned address and have not changed my address in the past three years.

OR

I am residing at the abovementioned address for the past (period of time at the present address) and before that I was staying at (the earlier address )  for  (period of time at the earlier address)

2. That I have changed my signature.

OR

That my signature has changed/altered by passing of time.

Therefore I request that the specimen signature registered in the records of the Company be cancelled and my present signature be taken on record against the same.

4. I hereby affirm that the Transfer Deeds for sales of securities bearing my signature appended hereinbelow can be taken as validly executed by me for all purposes, and intents of transferring the ownership of securities held by me under the Folio No. ________.

5. On registering the new signature in the records, I do hereby covenant with the Company, its successors and assigns and agree and undertake at all times save, defend and to indemnify and keep indemnified the Company, its successors and assigns its estate and effects, and its directors, manager, secretary and shareholders and their heirs, executors and assigns from and against all actions, suits, proceedings, accounts, claims and demands whatsoever for or on account of the said shares or dividends or any part thereof or otherwise in connection with the same, and from and against all losses, costs, claims, actions, demands, risks, charges, expenses, damages and losses arising in any manner howsoever.

I am executing this declaration to be submitted to the concerned authorities for the change of signature.

I hereby state that whatever is stated herein above are true to the best of my knowledge.

Solemnly affirmed at ________ )

On this ____ day of ______ 200__)           (Signature of the Applicant)

Deponent

Identified by me                                                          Before Me

Advocate                                                          S.E.M./ Oaths Commissioner/Notary

NOTES:

1. Affidavit should be on Non-judicial stamp paper of Rs.100/-.

2. Please do not just type this format as it is.

3. Affidavit should be attested by Notary/S.E.M/ Oaths Commissioner.

2008 www.ggdandekar.com.