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[To be executed on non-judicial stamp paper (Or Franking) of value Rs. 50]
I ........................... S/o ............................. resident of ........................................ hereby solemnly declare and state as under: (1) That I am the registered shareholder of ______________ shares of GSEC Limited, as per the particulars given below: Folio No. Share Certi. No. Distinctive Nos. of Share Certificates From To No. of Shares Face Value (Per Share)
(2) That the aforesaid shares to the best of my knowledge and belief, have been misplaced and the same are not forthcoming. I have searched, or caused search to be made for the said share certificates, but even after careful search, have not been able to find the same. (3) That I have not sold or pledged or otherwise disposed of the said share to any person, bank or other party whatsoever since the date of their acquisition through allotment/transfer by me and I am now the sole and absolute owner of the said shares.
(4) That I make the above statement out of my own free will in full senses and without any coercion or compulsion whatsoever. (5) That to the best of my knowledge and belief, the said share certificates have either been lost or been accidently destroyed. Place: . Date: ................... DEPONENT
VERIFICATION I/We ................................................................... hereby declare that whatever has been stated above are true to the best of my knowledge and belief and nothing relevant has been concealed and no misstatement has been made. Place: . Date: ................... DEPONENT
Solemnly declared and affirmed at ______________ on this _____ day of __________________, 20___ on identification at ______ am / pm before me.