IMPORTANT: Please submit separate forms for SHARES and each series of

DEBENTURES along with relative certificate(s) to Karvy Computer share Pvt Ltd
Registered office: 46,Avenue 4,Street No. 1, Banjara Hills, Hyderabad – 500034.

To,
Karvy Computer share Pvt Ltd
46, avenue 4 Street no 1
Banjara Hills
Hyderabad
500034

Company Name /Unit

Dear Sir, Date : ____________

Re: TRANMISSION OF SHARES/DEBENTURES

I/We, undersigned being the Executor(s) of the will Administrator(s) of the
Estate/Successor(s) to the Estate/Legal heir of Mr./Mrs./Miss
_____________________________________________________________ (deceased) of
which Probate/letters of Administration/Succession Certificate was dully granted to me/us on
company in respect of _________ Shares/Debentures in your company, now standing in the
name of the said deceased in the Register of Members/ Debenture holders of your Company.
I/We, hereby agree and bind myself/ourselves to hold the said shares/debenture subject to
the provisions of the Memorandam & Articles of Association of your Company.
I/We given hereunder such other particulars/information as would be required by you for
your records.

FULL NAME Occupation Father’s/Husband’s

Name
1.

2.

3.

4.

ADDRESS OF THE FIRST HOLDER Yours faithfully

1.

2.

3.

4.
S-F No.Of Distinctive Number Certificate B-F
Shares/ No.
Debentures From To

Document Registration Specimen Signature(s)

No. _______ Date ___________ 1._______________________________

Internal 2. ______________________________

Transfer No._________________ 3.______________________________

Date 4._______________________________
 AFFIDAVIT

Address of the Deceased

Share Holder

To,

The Director, _______________________________

REG :( Full name of the deceased)

________________________________

________________________________
Dear Sir,

I/We regret to inform you that Mr./Mrs. _______________________________________

who was a registered Share/Debenture holder in your Company holding _________________
Equity Share/Debentures bearing distinctive Nos.(from)________________ to
____________ under Share/Debenture Certificate No.________________________ died
without leaving a will (Intestate)/ leaving his last will and Testament dated
________________________where of I/We am/are the only legal heirs/executors at
_________________________________ on __________________________________
leaving behind the within mentioned person(s) as the only surviving legal heirs according to
the Law of Inestate by which he/she was governed at the time of his/her death.

I/We beg to give here below the information required by you and shall thank you to
transfer the said Share/Debentures bearing distinctive Nos.(from) ______________________
in favour of ________________________ without insisting on production of legal
representation to the estate of the Deceased Share/Debenture holder:

1. Full Name of the Deceased Share / Debenture holder

and address.
2. Share/Debenture held singly/jointly.
3. No. of Shares and Debentures bearing distinctive
Nos. From To
Share/Debenture certificate No.
4. Face Value of the Shares/Debentures and Present
Market Values.
5. In whose custody Share/Debenture Certificate are ?
and reason for the same.
6. (a) Had the Deceased Share/Debenture holder left
any will.
(b) Has the Estate duty & discharge certificate been
obtained
 (c ) Has any Probate/Letter of Administration/
Succession Certificate to the Estate of the
Deceased has been obtained.
(d) Legal heirs/Executors/Administrators/
Successors to the Estate of the Deceased.

ClaimantName Occupation
1) __________________________________ ______________________________________
2) __________________________________ ______________________________________
3) __________________________________ ______________________________________

7. Documents enclosed for registration and return :

(Please furnish originals along with one copy)
(a) Municipal Death Certificate.
(b) Estate duly despatch certificate.
8. Date and place of Death.
9. Full details of surviving legal heirs.
Husband/wife/children/parents/brothes/sisters (if Hindu Joint Family, the names and address
of the karta and Do-parcehers with their respective ages).

Full Name/Address Relationship with Deceased Age

(1)
(2)
(3)
(4)
(5)
10. Name(s) of the guardian of the Minor children of the share/Debenture holder.
(In case Minor is Claimant)

(a) Whether natural Guardian.

(b) Whether Guardian appointed under the Guardians and Ward Act. If so attach a certified
true copy or duly attested copy of such order.
(c) In whose custody the minor is/minors are?
11. The following persons have agreed to sign the Indemnity bond as sureties jointly and
severally with all the surviving legal heirs of the deceased Share/Debenture holder.

(1) Name & Signature

(2) Address
(3) Occupation

Bank A/c No:

Banker’s Name & Address:

I/We hereby solemnly affirm that the above statements are true, that none of them or any part of
them is false and that nothing has been concealed therein and that I am/we are the only executors
and benefits under the said Share/Debentures/

Yours faithfully,

1)
 2)
3)
4)
Executed this day of 200

NOTE: THIS AFFIDAVIT TO BE EXECUTED ON NON JUDICIAL STAMP PAPER OF

RS.10/- BEFORE A NOTARY PUBLIC DATH OFFICER MAGISTRATE.
 LETTER OF INDEMNITY

To,
Karvy Computer share Pvt Ltd
46, avenue 4 Street no 1
Banjara Hills
Hyderabad
500034

Company Name/Unit

Dear Sir,

Re : Registered Share/Debenture holder holding _______________________________________

Equity Share/Debenture Certificate No. _______________________________ and bearing
distinctive Nos. From ________________________________ To _________________________

We regret to inform you that Mr./Mrs. ___________________________________________ who

was a registered Share/Debenture holder holding ______________________ Equity
Shares/Debentures of the company bearing distinctive Nos. ___________________________
under Share Certificate No. ___________________________________ in his/her
Name(Jointly/single) died intestate without leaving a will on the _____________________ day of
____________________ 200 ____________

We further inform you that he/she left behind him/her as his/her only surviving heirs and next of
kin the following persons according to the law of intestate Succession applicable to him/her by
which he/she was governed at the time of his/her death.
(a)
(b)
(c)
(d)
We have to state that the said Shares/Debentures bearing distinctive Nos.From _____________ to
______________________________ were registered in the name of _____________________
We have, therefore, approached you with a request to transfer the aforesaid shares as mentioned
above in the name of the undersigned Mr./Mrs./Messers._________________________________
on my/our behalf without insisting on production of legal representations and you have kindly
agreed to do so on my/our executed an indemnity as is herein contained and on relying on the
information herein given by us believing the same to be true.

In consideration therefore of your having at our request to transfer Shares/Debentures to

the name of the undersigned ___________________________________________________ we,
the undersigned _______________________________ and ______________________________
hereby jointly and severally agree and undertake to indemnity and keep indemnified, saved,
defended harmless you and your Successors and assigns for all time hereafter against all losses,
costs, claims, actions, demands, risks, charges, expenses, damages etc. Whatsoever which you
may suffer and or incur by reason of your, at our request, transferring the said shares as herein
above mentioned to the undersigned ___________________________________ without insisting
on production of legal representations.

Yours faithfully
Legal heris
Surities : 1)

(Name, Address & Signature) 2)

1) 3)

4)

2) 5)

NOTE: THIS INDEMNITY IS TO BE EXECUTED ON NON JUDICAL STAMP PAPER OF

RS 100/- BEFORE A NOTARY PUBLIC/MAGISTRATE/OATH OFFICER.

Please Ensure That :

1) Claimant has Signed the Indemnity

2) All surities are mentioned
3) Surities mentioned are different from each other.
4) Claimant name is written wherever necessary
5) Certificate Details are properely written
6) Company Name is mentioned wherever needed.
7) All Legal Heirs have signed wherever needed.
8) Full Addresses/Bank Mandate wherever needed is duly filled.