AFFIDAVIT FOR TRANSMISSION OF SHARES

AFFIDAVIT FOR TRANSMISSION OF SHARES
I, __________________ son of / daughter of/ wife of ___________, aged
years, resident of _____________________________________ do solemnly
and sincerely swear and state as under:
(1) That Mr. / Mrs. / Miss __________________, the shareholder of _______
_______________ (mention here the name of the company), resident of
_________________________ died on _____________ at ___________.
(2) That the late Mr. / Miss ______________________________ died
intestate, leaving behind me as his / her legal heir:
(3) That under the Law, I am the only heir legally entitled to inherit the assets/
estate of the said deceased and that no other person has any right, title,
interest, claim in or to the said assets/ estate of the deceased.
(4) That the late Mr./ Miss. ___________________________ held in _______
______________ (mention here the name of the company) ___________
No. of shares bearing Distinctive No.______________.
(5) That I am entitled to get the said __________shares referred to in the
preceding paragraph held by the deceased, and, hereby request the
Board of Directors of _____________________ ( mention here the name
of the company) to effect transmission of these Shares to my name and
hereby state and undertake that no other person shall claim any right, title,
interest, now or at anytime hereafter, in or to the said______________
shares of ___________ (mention here the name of the company ) and
that no other person has any objection whatsoever to the Company’s
effecting transmission of the said Shares to my name.
(6) Sworn on this _____________ day of __________ 20XX at _________
(place).
(7) Before me: Signature of the Deponent
(Signature of the person before whom the Affidavit is sworn)
VERIFICATION
I solemnly affirm that what is stated herein above is true to the best of my
knowledge and belief, and that no part thereof is incorrect.
Place:
Date:
Signature of Deponent: