[ To be executed on Rs.100/- Non
Judicial stamp paper]
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< > equity shares
having distinctive numbers from < > to < > of the face
value of Rs.<
>/- (Rupees < > only) stand registered in the name of the Late name of the deceased> in the books of
THE company < >, late
<name of the deceased> who died
on <date> leaving behind him the following
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Sl. no
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NAME
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AGE
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RELATION
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The above mentioned shares / debentures were the separate and
self-acquired property of the deceased. Under the Hindu Succession Act, 1956,
the persons mentioned above his only heirs are entitled to inherit the
aforesaid shares /
debentures
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I therefore, request the company to transmit these aforesaid shares
/debentures stand registered in the name of the Late < >, in my name and also to pay
me dividend payable by the company without production of succession
certificate or letters of administration or probate.
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In consideration of
the above having agreed to comply with my request on my executing a bond in
favour of the company, I, the applicant, hereunder for myself, my heirs,
executors, administrators and assigns to hereby jointly and severally covenant with the company, its
successors and assigns that we and each of our heirs, executors,
administrators and assigns will, on the company transferring the said shares
/ debentures into my name and paying to me the dividends already due, at all
times save, defend and keep indemnified the company its successors and
assigns, its estate and effects, and the directors, manager, company
secretary and shareholders of the company, their heirs, executors and assigns
from and against all actions, causes of actions, suits, proceedings,
accounts, claims and demands whatsoever for or on account of the said shares
/ debentures of the dividends of any part thereof, or otherwise in connection
with the same and from and against all claims, damages, costs, charges, expenses
and losses arising in any manner howsoever.
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In witness whereof,
I, the applicant herein have signed and set my hand on < >
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( Signature of
Claimant(s))
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Witness-1
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Address
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Witness-2
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We, the undersigned,
certify that the above facts are true and bind ourselves as sureties to make
good all claims, charges, costs, damages, demands, expenses and losses which
the said company may sustain, incur or become liable for in consequence of
claims, charges, costs, damages, demands, expenses and losses from our
persons or our Properties, as the
case may be.
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Witness-1
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(Signature of Surety)
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Witness-2
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