QUESTIONNAIRE FORM FOR DUPLICATE SHARE CERTIFICATE/S
Form to be filled in by the applicant(s) for issue of duplicate certificate(s)
in respect of security/ies for which original certificate(s) is/are lost.
“Q”
Name of the Company : STANROSE MAFATLAL INVESTMENTS AND FINANCE LTD.
1.
Full name of holder and joint holder(s), if
any. (Fill in identical order)
2.
Number and kind of security/ies held by the
holder(s) for which duplicate certificate(s)
is/are being sought.
3.
Distinctive number of security/ies in respect
of which certificate(s) is/are lost.
4.
When and how did the holder(s) acquire the
security/ies in respect of which certificate(s)
is/are lost
R/Folio
No.of security/ies (in
figures)
Kind of security/ies
EQUITY SHARES
(Quote atleast approx date/period)
5.
When were the certificate(s) lost or found to
be missing ?
6.
Full statement of the circumstances
regarding loss of the above certificate(s).
7.
Were any signed transfer form(s)
accompanying the lost certificate(s) ? If so
give full particulars of the transaction.
(Quote atleast approx date/period)
If your answer is YES, you must furnish the company with a
`Prohibitory Order’ from a competent court to stop transfer of securities
in the name(s) of any other persons.
8.
Were these security/ies sold/mortgaged/
pledged or otherwise disposed of either by
the holder/applicant or by any other person
? If so give full particulars of transactions.
If answer is yes, attach document(s) in support of your statement.
9.
Was diligent search made for the missing
certificate(s) ?
10. If the Board of Directors of the Company is
prepared to issue duplicate certificate(s)
is/are the applicant(s) prepared to fulfill the
conditions preliminary to the issue of
duplicate certificate(s) viz. (a)
Advertisement in Government Gazette
and/or newspaper/s (may be waived in case
of small quantity) (b) execution of
indemnity with approved surety/ies, and
Affidavit, if any, etc.
For Office use only
Signature checked by
Address:
_____________________________________________
_____________________________________________
PIN:
Date:
___________________________________________
Signature(s) of the applicant(s)
(Pto)
.. 2 ..
Notes:
1.
Questionnaire form for issue of duplicate share certificate/s must be signed by all the person/s
whose name/s are presently registered with the Company as holder/s of security/ies.
2.
Where the loss does not pertain to the entire holding in the Ledger Folio, kindly quote the
Distinctive numbers of certificate/s in your possession to enable the Company to determine and
convey to you the distinctive numbers of the lost certificate/s.
3.
In case of certificate/s is/are lost together with duly signed/executed transfer deed/s, the
Company may undertake to issue duplicate certificate/s only after lost transfer deeds have
become time-barred.
4.
In case lost certificate/s stand in sole name of a deceased holder, the heir(s) must establish
his/their title to the security/ies on production of Succession Documents before procedure for
issue of duplicate is undertaken.
5.
In case certificate is lost by transferee with signed transfer deed before lodgement/registration in
name of the transferee then the applicant will have to furnish contract Note, etc. to substantiate
the purchase of the securities.