KINDLY ENSURE THE FOLLOWING INSTRUCTIONS WHILE EXECUTING

FORMALITIES FOR ISSUE OF DUPLICATE SHARE CERTIFICATES.

1. Kindly execute and forward us an Indemnity agreement and an affidavit on Non-judicial

Stamp paper of Rs. 500.00 & Rs.100.00 respectively (NJSP’s) or affix special adhesive
stamps (SAS) , as per the enclosed format.

2. The NJSP’s should be purchased in the name of first registered holder.

3. If adhesive stamps are affixed, the same should be cancelled by the issuing authority
under their official seal.

4. Separate Indemnity and affidavit should be executed for two or more folios having joint
names in different order.

5. Execution dates on Indemnity and affidavit should be after the date of purchase of
NJSP/SAS’s and the same within 6 months from date of purchase.

6. Name, address and Signatures of the Two different witnesses should be furnished on the
Indemnity and the witnesses should be other than registered holders. Self attested
copies of PAN card & proof of address of the 2 Witnesses are also required.

7. The signatures of the all registered holders, including joint holders(s), if any, appear on
the indemnity and affidavit, should be tallied with the specimen recorded with the
Company.

8. Corrections made on the Indemnity and affidavit should be authenticated (signature at

the place of correction) by the registered holder(s).

9. The duly executed Indemnity bond and affidavit should be attested by Notary Public
under their official seal.

10. Forward us a copy of FIR (First Information Report) lodged with local police station
(having National Emblem Stamp) with General Dairy no. (GDE. No.) for lost/Stolen/Theft
of share certificate (s) mentioning details of the shares i.e. folio \ dist. \ cert. nos. (In
Case Total value of the shares for which duplicate certificates are being applied
exceeds… Rs.5 lakhs.)

11. In case of Limited Cos. Banks & FI’s the Indemnity and affidavit should be accompanied
by a certified copy of Memorandum & Articles of association along with a certified copy
of Board Resolution having a list of authorized signatories with attested by Company
Secretary or Director. (IB and Affidavit duly attested by Notary)

12. In case of N R I ‘s, forward us plain Indemnity, Affidavit duly filled in all respects, along
with attested copy of Passport, Indemnity Bond and Affidavit the same should be
attested by Consular / Embassy/ Competent Authority. Please also forward us a
Demand Draft for Rs. 970/-, drawn in favour of KFin Technologies Limited, payable
at Hyderabad, towards cost of NJSPs.

On receipt of the documents executed as above and found in order, the same will be
placed before the Board of Directors of the Company for its approval, provided no
claim has been received against the said shares.
 AFFIDAVIT (FORM-A)

[For issuance of duplicate securities]

(To be executed on non-judicial stamp paper of Rs.100/- by the registered holder)

To
RELIANCE INDUSTRIES LIMITED
Third Floor, Maker Chambers IV,
222, Nariman Point, Mumbai-400021.

I/We,_______________________________________________________
Son / daughter/spouse of ____________________________________________________
residing at
_________________________________________________________________________
_________________________________________________________________________
__________________, having Permanent Account No (s)
______________________________do hereby solemnly affirm and state on oath as
follows.

That I/We, _________________________________________ (“all the shareholders ”)

hold the following (number of) securities under Folio no. _____ in (name of the
company) in my/ our name as single holder / joint holder:

No. of securities Security Distinctive Nos.

Folio No.
held Certificate No. From To

I/We_____________________________________________________________________
further swear / solemnly declare that I/ we am/are applying for issue of duplicate
certificate(s) to me/us on the ground that the original security(i.es) certificate(s) has/have
been misplaced / not found by me/us, despite a diligent search made by me/us in this behalf.

I/
We_______________________________________________________________________
further swear /solemnly declare that the said securities are not sold or pledged or deposited
by way of security to any person/company.

I/
We_______________________________________________________________________
________hereby further swear / solemnly declare that if, after the duplicate share
certificate(s) is / are issued to us as aforesaid, the original security(i.es) certificate(s) is / are
at any time subsequently, found, recovered or traced by us or by anyone on our behalf, then,
we unconditionally undertake not to deal with the said original share certificate(s) in any
manner whatsoever (whether by physical transfer or dematerialization or as security or
pledge) and further unconditionally undertake to promptly surrender the original share
certificate(s) to the RTA / Company, for cancellation.
 (Page 1 of 4)

I/We _________________________________________________________am/are making

the above solemn declaration on oath with full knowledge of the fact that in the event the
original security (i.es) certificate(s) issued is /are found, recovered and traced by
me/us and instead of surrendering the same is / are dealt with by me/us as aforesaid, the
Company will be at liberty to adopt civil and / or criminal proceedings against me/us for
my/our failure to promptly surrender the original security (i.es) certificate(s), for cancellation
and for breach of my/our solemn declaration and undertaking not to deal with the original
security (i.es) certificate(s) in any manner whatsoever as aforesaid at my/our entire risk as to
cost and consequences.

Signature of all Deponents :

X________________
____
____________
____
____________

VERIFICATION

We hereby solemnly affirm and state that what is stated herein above is true to our
knowledge and nothing has been concealed therein and that we are competent to contract
and entitled to rights and benefits of the above mentioned securities.

Deponent(s) (1) ____________(2) __________________(3) ____________________

Solemnly affirmed at ______________________

Signature of the Deponent(s):

1._________________________2.________________________3.___________________

Signed before me

Place: __________________________
Date : ___________________________

X --------------------------------------------------

(The Affidavit should be attested by Notary Magistrate/ Notary & Regn. No.: )

(Page 2 of 4)
 DRAFT FOR THE INDEMNITY (Form-B)

[For issuance of duplicate securities]

(To be executed on non-judicial stamp paper of Rs.500/- by the registered holder)

To
RELIANCE INDUSTRIES LIMITED
Third Floor, Maker Chambers IV,
222, Nariman Point,
Mumbai – 400021.

WHEREAS

I/We,______________________________________________________________Son /
daughter / spouse / of ______________________________________ residing at
__________________________________________________________________________
__________ having Permanent Account No (s) ______________________________do
hereby solemnly affirm and state on oath as follows.

1. That I/we, am/are the sole/joint holder/s of the Securities in following folios. I/We request you
to issue duplicate certificate(s) for securities, as detailed below in my/our name(s):

Ledger Folio No. No. of Shares. Certificate No. Distinctive Nos.

(s)

2. That the above securities were acquired by me/us for valuable consideration out of my/our
own investment/funds against allotment in Public Issue/allotment in Right Issue or acquired
from the market/through inheritance in the year(s) ………….

3. I/We hereby jointly and severely agree and undertake to indemnify and keep indemnified,
saved, defended, harmless, the aforesaid (Name of the Company/RTA) and its 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 my/our request, issuing the said Duplicate Securities as herein above mentioned,
to the undersigned.

(Page 3 of 4)

IN WITNESS WHEREOF the said

 1) WITNESS ( Name, Address & Signature)

________________________________________.

________________________________________.

________________________________________.

________________________________________.

2) WITNESS ( Name, Address & Signature)

________________________________________.

________________________________________.

________________________________________.

________________________________________.

have hereunto set their respective hands and seals this day of

_____________________________

Address of First holder /Applicant: Signature of All holder(s) / Applicant(s) :

_________________________________________ ________________________________________

_________________________________________ ________________________________________

_________________________________________ ________________________________________

_________________________________________
Pincode :
FOR OFFICE USE ONLY
Tel. No.
Signature checked by:
Email id
Date

Signed before me
at: __________________________

on:: ___________________________

(The Indemnity Bond should be attested by Notary Magistrate/ Notary & Regn. No.:)

(Page 4 of 4)