ANNEXURE IV
INSTRUCTION SHEET FOR FILLING THE INDEMNITY BOND AND
AFFIDAVIT FOR TRANSMISSION OF SHARE/DEBENTURE
CERTIFICATE(S)
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Kindly ensure before submitting the Indemnity Bond and Affidavit to the Company
that :
1. Indemnity bond and Affidavit has been executed as per the draft sent by the
Company. Please note that Indemnity bond and Affidavit has to be executed on
Rs.200/- and Rs.100/- non-judicial stamp paper respectively.
2. Number of shares/debentures are mentioned in figures.
3. Share/Debenture distinctive numbers are correct.
4. Face value mentioned for shares/debentures are correct. Please note that face
value of shares is Rs.10/- each and of debenture Rs.50/- each.
5. Date of death mentioned correctly.
6. All details i.e. name, relation to deceased and age of legal heirs are mentioned.
7. The name of survivor mentioned.
8. Date of execution and place has been mentioned.
9. All legal heirs/deponents should sign Indemnity bond and Affidavit.
10. First survivor should mention his/her address for future communication.
11. The Indemnity bond should be signed by two witnesses and two sureties (name,
address and signature).
12. Affidavit should be verified in presence of a First Class Magistrate or a Notary
Public. In the event of verification in the presence of Notary Public, the Affidavit
should contain the notarial stamp.
ANNEXURE IV
INDEMNITY BOND FOR TRANSMISSION
_____ Equity shares having distinctive nos. from_________________ to
_____________________ of the face value of Rs.10/- each and ______
debentures having distinctive nos. from _________________ to
________________ of the face value of Rs.50/- each are standing
registered in the name of the late Shri/Smt. _________________________
in the book of DEEPAK FERTILISERS AND PETROCHEMICALS
CORPORATION LIMITED and late Shri/Smt. _______________________ died
intestate on this _______ day of ___________ leaving behind him the following:
1) 2) 3) 4)
The above mentioned shares/debentures were the separate and self aquired
property of deceased. Under the Indian Succession Act, 1925 / The Hindu
Succession Act, 1956 / Muslim Personal Law (Shariat) Application Act, 1937
or any other law applicable to the applicant (strike out whichever is not
applicable) the person(s) mentioned above is/are his/her only heir(s) and are
entitled to inherit singly/jointly the aforesaid shares/debentures.
I/We, therefore, request Deepak Fertilisers and Petrochemicals Corporation
Limited to transmit these aforesaid shares/debentures standing registered in
the name of late Shri/Smt. ______________________ in the name of
____________________ by the Company without production of succession
certificate or letter of administration or probate.
In consideration of the Company having agreed to transmit and register the
aforesaid shares/debentures in my/our name(s) on my/our executing a bond in
favour of the Company I/We the applicants, hereunder for myself/ourselves,
my/our heirs, executors, administrators and assigns DO HEREBY jointly and
severally covenant with the Company, its successors and assigns that I/we
and each of my/our heirs, executors, administrators and assigns will, upon
the Company transmitting and registering the said shares/debentures in
my/our name(s) and paying to me/us the dividends/interests already due on
the said shares/debentures, at all times save, defend, indemnify and keep
indemnified the Company, its successors and assigns, its estate and effects,
and its directors, manager, secretary and shareholders/debentureholders and
their heirs, executors and assigns from and against all actions, suits,
proceedings, accounts, claims and demands whatsoever for or on account of
the said shares/debentures or the dividend/interest or any part thereof, or
otherwise in connection with the same, and from and against all claims,
damages, expenses and losses arising in any manner howsoever.
In witness whereof I/We the applicants herein has/have signed and set
my/our hands this ______ day of _______ Two Thousand ___________.
Name & address of Witness No.1 Name of legal heir(s)
Signature(s)
_____________________________1 _______________________ __________
_____________________________2 _______________________ __________
Signature : ____________________3 _______________________ _________
4 ______________________
__________
Name & address of Witness No.2 Address
_________________________
__________________________ _________________________
Signature : _________________
Place :
Date :
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 Deepak Fertilisers and Petrochemicals
Corporation Limited may sustain incur or be liable or in consequences of
complying with the request contained above and the Company will be entitled
to recover all claims, charges, costs, damages, demands expenses and losses
from our persons or our properties as the case may be.
Name & address of Witness No.1 Name & address of Surety No. 1
_______________________________________________________________________
_________________________________________________________
Signature : _____________________ Signature : _________________
Name & address of Witness No.2 Name & address of Surety
No. 2
_______________________________________________________________________
_________________________________________________________
Signature : _________________________Signature : _____________________
Place :
Date :
NOTE : This Indemnity bond to be executed on Rs.200/- Non-
judicial stamp paper.
ANNEXURE IV
AFFIDAVIT BY LEGAL HEIRS FOR TRANSMISSION
I/We _____________________________ wife/son(s)/daughter(s) of
________________________ resident of ______________________ do solemnly
swear and sincerely state as under:
1 That ________ Equity shares having distinctive nos. from
___________________ to ______________ of the face value of Rs. 10/- each
and _______ debentures having distinctive nos. from ______________ to
______________ of the face value of Rs.50/- each are standing
registered in the name of late Shri/Smt. ____________________________
in the book of DEEPAK FERTILISERS AND PETROCHEMICALS
CORPORATION LIMITED.
2 That late Shri/Smt. _____________________ died intestate on this ________
day of ____________.
3 That late Shri/Smt.____________________________ left behind him/her the
following heirs;
Name Relation to deceased Age
1
2
3
4
4 That the above-mentioned shares/debentures were the separate and self
acquired property of the deceased.
5 That under the Indian Succession Act, 1925 / The Hindu Succession Act,
1956 / Muslim Personal Law (Shariat) Application Act, 1937 or any other
law applicable to the applicant (strike out whichever is not applicable) the
person mentioned at paragraph 3 is/are entitled to inherit the aforesaid
shares/debentures singly / jointly.
6 That the deceased Shri/Smt. _________________________ left no other heir
than those mentioned in clause 3 of this affidavit and that the persons
mentioned in the said clause 3 are his/her only heirs.
7 That I/We hereby declare that I/We have mutually agreed upon and have
relinquished my/our rights, title and interest in the said
shares/debentures and request the Company to transmit the aforesaid
shares/debentures standing registered in the name of late Shri/Smt.
________________________ in favour of __________________________
without production of succession certificate or letter of administration or
probate.
Signature(s) of Deponent
1. ____________________
2. ____________________
3. ____________________
4. ___________________
VERIFICATION
I/We the above named person(s) verify that the statements contained in the
above paragraphs are true to the best of my/our knowledge and belief and
that nothing material has been concealed.
Signature(s) of Deponent
1. ____________________
2. ____________________
3.
____________________
4. ____________________
Place :
Date :
NOTE : 1. This Affidavit to be executed on Rs.100/- Non-judicial
stamp paper
2. This Affidavit should be verified in the presence of the First
Class
Magistrate or a Notary Public under their Official Seal.
ANNEXURE IV
DEEPAK FERTILISRS AND PETROCHEMICALS CORPORATION
LIMITED
Form to be filled in by person(s) claiming title to the
shares/debentures of a deceased share/debenture holder without
legal representation.
1 Full name of the deceased share/debentureholder :
2 Date of death of the deceased according to English Calendar :
3 Number of shares/debentures held by the deceased holder in :
DFPCL (WITH DISTINCTIVE NUMBERS)
4 Shares held in other Companies (Please attach list) :
5 Particulars of property of the deceased other than that :
shown in column 3 above
6 Has the deceased left a will or any other Testamontary :
Instrument disposing of his property
7 Has the deceased left any debts? :
If so, please state the amount and nature of such debts:
8 Has the deceased left a widow/husband and/or children? :
If so, please state her/his/their name(s) and ages.
In case of daughers, please also state if they are married
Or unmarried.
9 By what Law is the family of the deceased governed? :
If Hindu or Mohamedan, please state which school of
Law is applicable.
10 Who are the heirs of the deceased according to the Law :
By which succession to his estate is governed?
11 Was the deceased (If Hindu) a member of a joint and :
Undivided Hindu family? If so, please state the names
And ages of the surviving coparceners
12 Applicant's/Applicants' :
1 Name(s) in full :
2 Age(s) :
3 Relationship with the deceased :
13 In whose possession are the certificates for the shares :
held by the deceased?
14 Any other information which the applicant desires to :
give in support of his/her/their claim to the shares of the
deceased.
Date :
Name & Address :
Signature(s) of the Applicant(s)
N.B. : The delivery to the company of this form duly filled in shall not be
deemed in any way to affect the Company's right to insist on
production of Probate or Letter of Administration or Succession
Certificate to the estate of the deceased share/debentureholder.
