DRAFT LETTER FOR POLICE COMPLAINT FROM: The Police Officer in Charge Dear Sir, I /We bring to your kind attention that I am the register holder for SBI shares /Bonds as per details below, Sr No Folio Certificate no Distinctive No No of shares/bond The said share/bond certificate(s) has/ have been Lost/Misplaced / Stolen on.at home/during travelling/ I have applied for Duplicate certificate(s) to the State Bank of India and for which as per SEBI guidelines clause 09(a), I have been requested to provide them with the acknowledgement copy of police complaint for Lost /Misplaced /Stolen original share/bond certificate. As such, it is requested that this complaint for Lost/Misplaced/Stolen original Share/Bond certificate(s) may be registered in your general diary and I may be provided with the acknowledged copy of the said complaint to take up the matter with state Bank of India for Issuance of Duplicate share/bond certificate. Thanking you Yours Faithfully Signature OIC, PS Seal & Stamp of Police station
APPLICATION FOR ISSUE OF DUPLICATE SHARE/BOND CERTIFICATE (Applicable for physical Share /bond certificate). Details of Share/Bond Holder(s): Sr No Name of Share /Bond holder Address of Holder Mob No & ID 3. Details of Shares/Bonds Sr No Folio no Certificate No Distinctive No s No of shares/bonds 3. Date / Period & Place where the Certificate(s) were Lost or found Missing. Date Period Place Incident if any 4. Was diligent search made for the missing certificate(s): Yes / No 5. Details of the Complaint filed with Police Authorities Complaint filed on Acknowledged on FIR No Police station Name & Address Undertaking I /We.. are willing to execute the following documents to enable the Bank to issue me duplicate Share/Bond certificate. a. Indemnity with Surety on Rs 500 stamp paper duly notarized. b. Affidavit on Rs 00 stamp paper duly notarized. Date: Signature Place:
AFFIDAVIT I/We (Full name & address of Share/ Bond holder) Solemnly affirms and say that what is stated in the application dt for issue of Duplicate Share /Bond certificate are true and that nothing material had been concealed. Date 3 Signature of applicant(s) Solemnly affirmed at (place) on the.. day of..0.. Signed in presence of...... Full name & Address of Magistrate Signature of Magistrate/ Notary Use space below to affix Notarial/ Court fee stamp Official Seal of Magistrate/Notary
, State Bank of India Corporate Centre, State Bank Bhavan Madam Cama Road, Mumbai 4000 LETTER OF INDEMNITY Whereas. I/We (Name of Share/Bond Holder (s)) residing at. is/are holding SBI shares/bonds as detailed below. Sr No Folio No Certificate No Distinctive No No of shares/bonds. The original share/bond certificate(s) as detailed above has been Lost/Misplaced and the same are not traceable. 3. I/ we therefore, hereby request the SBI (hereinafter referred as BANK ) to issue me/us Duplicate share certificate(s). In consideration of the SBI having agreed to issue Duplicate share certificates(s) for the aforesaid shares in my/our name, I/we are executing Indemnity Bonds in favor of SBI. 4. I/We (Name of Share/Bond Holder (s)) And. (Name & address of surety) For ourselves, our respective heirs, executors and administrators do hereby jointly and severally covenant with the Bank, its successors and assigns that we and our heirs, executors and administrators respectively will at all times and from time to time save, defend and keep harmless and indemnified the Bank, its successors and assigns the directors and officers thereof and their respective heirs, executors and administrators and their each of their estates and effects from and against all actions, causes, suits, proceedings, accounts, claims and demands whatsoever on account of the said security/ies or any of them or the loss or non-production of certificate(s) thereof on the part of any person or person(s) whomsoever and against all damages cost, charges, expenses and sums of money incurred in respect thereof or otherwise in relation to the Shares/Bonds and I/we the said (Name of share/ Bond holders) and (name of Surety) undertake on demand by the bank to return and re deliver such duplicate certificate(s) and without such demand to produce and return to the bank the original Certificate(s) when found or Traced and to take all actions, suits and proceedings at our own cost as the Bank shall Require for the recovery thereof or otherwise in relation to the above shares/bonds. Dated.... Seal & Signature of Magistrate & Notary Signature of Share/Bond Holder Signature of Surety
A. Details of Surety* Name SURETY KYC Form Private & confidential Address 3 Age 4 LL & Mobile No 5 PAN No 6 ADHAR No *A person cannot stands as Surety for spouse/ family members B. Details of employment Name of Employer Address of Employer & place of Employment No.of years of Service Annual Salary Rs. C. Details of immovable property owned: (Absolutely in own name and not as member of a Hindu undivided family. Specify whether consisting of house or more lands. Furnish documentary evidence) Area Survey No Location Value Rs.in lacs Rent Realised D. Details of Business Owned: (Furnish documentary evidence) Nature of Address & Location Annual Turnover Annual Profit Extent of Interest Business E. Liabilities, If Any, with Nature of Liability Amount Whether Bank/FI Signature of surety List of documents enclosed:.. 3. be verified by local SBI Branch manager or Notary Public Verified by Notary Public Verified by Branch Manager Full Name & Address Full Name & Address