Tel/Mobile No:- ___________

                                                Date:- ___________________


The Hon’ Secretary,

___________ CHS Ltd.


                        Ref:-  (1) Folio No:- ________

                                    (2)Share Certificate No. _____

                                    (3) Distinctive Nos. ____ to____

                       Sub:- Request for issuance of Duplicate  Share Certificate in lieu of the original Share Certificate held by me in the ______ CHS Ltd.


            I, am a member of the ______CHS Ltd and I hold 5 shares of the above description in the said society of which you are the Secretary.

            The said shares were issued to me for being a member of the said society in respect of flat No. _________ of which I am the bonafide and rightful owner.

            The shares under reference were lost and/or misplaced, while in my possession and could not be retrieved in spite of the best efforts made by me. Under the circumstances, I am enclosing herewith a Letter of indemnity-cum-Affidavit, as per your specifications. The said document is duly executed on a Stamp Paper of Rs. ___/-and attested by a Notary under his Seal. By this document I am bringing on record the relevant facts pertaining to the loss of the said Share Certificate and also indemnifying the Society and its officers etc. against the apprehended loss.

            In view of the above, I hereby earnestly request you to do the needful by issuing me a Duplicate Share Certificate. I hereby undertake to pay all the necessary charges and the incidental expenses thereof, if any.

Thanking You.

                                                    Yours Sincerely,

                                                         (Mr. ABC)

Letter of Indemnity-cum-Affidavit

            I, Mr. ABC,  an adult Indian, aged about ____years; occ:-___, resident of ___________________, do hereby on solemn affirmations swear and state as under:-

            I say that  I am as above and hold 5 shares of the face value of Rs.50/-each of __________CHS Ltd., a Co-operative Housing Society formed under the provisions of Maharashtra Co-operative Societies Act, 1960, having its registered office at _____________, (hereinafter referred to as the ‘said society’ for the sake of brevity) vide Share Certificate No. _______, bearing distinctive Nos. ______to _______ under Folio No-______, which were issued to me by the ‘said society’ for being a member thereof in respect of Flat No._____, being and situate at_____________.  I say that the Share Certificate in respect of the aforesaid shares was issued to me against the cash payment made to the ‘said society’ vide receipt no._______, dated______.

            I say that the  Share Certificate under reference was lost and/or misplaced, while in my possession and could not be retrieved in spite of the diligent efforts made by me and my family.

            I say that I have reported the loss of the said Share Certificate to ______________Police Station situated at _________, vide Missing Articles Report No_______ of ______.

            I say that I have not sold or transferred or mortgaged the aforesaid flat in favour of any person nor have I created any kind of third party interest therein. I further say that I have not pledged or deposited by way of security or parted with the said Share Certificate to anyone, in any manner whatsoever.

            I say that in view of the above facts and circumstances, I desire to obtain a Duplicate Share Certificate for the purpose of my record. Hence, I have made an application in that regard to the ‘said society’.

            In view of the above, I along with my legal heirs, executors, administrators and assigns do hereby jointly and severally covenant with the ‘said society’ that I, the said covenanting party and each of my legal heirs, executors, administrators and assigns shall, upon the ‘said society’ issuing a Duplicate Share Certificate to me in lieu of the original Share Certificate, undertake at all times to save, defend and keep harmless and indemnified the ‘said society, its President, Vice-President, Secretary, all office bearers, members, officers, servants and nominees, as well as the estates and effects held by them from and against all actions, causes of actions, suits, proceedings, accounts, claims and demands whatsoever, either at law or in equity or otherwise, for or on account of the said Share Certificate or otherwise in connection with the aforesaid shares at the instance of any person or persons whomsoever and from and against all damages, costs, liabilities, charges and expenses that may accrue to them in any manner whatsoever, at any time in future.

            I say that whatever is stated herein above is true and correct and I believe the same to be true to the best of my knowledge, information and belief,

            IN WITNESS WHEREOF, I, have hereunto set my hand to this writing this___day of_____20___.

Solemnly Affirmed at ______.

Interpreted, Explained & Identified

by me,


Advocate High Court



Before Me,


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