Annexure-7
AFFIDAVIT (FOR CHANGE OF SIGNATURE)
I/We S/o aged
years And S/o
aged years
Residing at
Solemnly affirm and declare in favour of
name of the Co.) whose regd. office is situated at
1. That I/We am/are the sole/joint holder of number of equity shares /
debentures/bonds/units in (name of the
company) as detailed below:
Folio No. No. of shares/ Certificate No. DNRs DNRs
Deb/bonds/units From To
2. That I/We am/are residing at the above address and have not changed my/our
address in the past 3 years (In case there has been a change in address the
investor should furnish details)
3. That the above shares were acquired by me/us out of my/our own
investment/funds against allotment in Public Issue / allotment in Right Issue or
acquired from the market in the year(s) .
4. That my/our signature/s might have changed/altered by passing of time and
therefore I/we request the company to treat my/our signature/s as per the records
maintained with the company as cancelled.
5. That my/our specimen signature/s given below be taken on record in respect of
my/our holdings of securities in the company as mentioned in para 1 in place of
my /our existing signature/s in the company’s record.
6. I/we hereby affirm that I/we shall not hold the company or its Agents anyway
responsible for any consequences that might occur directly or indirectly on
account of the company or its Agents acting on our request herein stated by
replacing the signature/s in the company’s records and for the consequential acts
/ deeds by the Co. / its agent.
7. I/we hereby further affirm that the Transfer Deeds for sale of securities bearing
my/our signatures as appended hereinbelow can be taken as validly executed by
me / us for all purposes, and intents of transferring the ownership of securities
held by me/ us under the folios as stated in para 1 above.
8. This Affidavit is executed in favour of the company / its agent on my/our own
volition and is in the form as required by the company / its agent forwarded to
me/us vide its letter No. dated .
VERIFICATION
I/We solemnly affirm that the statement contained in the above paragraphs are true to
the best of my/our Knowledge, information and belief and that nothing material has
been concealed from being disclosed.
Solemnly declared and affirmed on Deponents
Identification at
on this day of 199 . 1.
1.
Specimen signature of 2.
2.
Specimen signature of
3.
Specimen signature of
Executed before me
(To be executed on a non-judicial stamp of Rs. 20/-)