Loss of Stock Letter of Indemnity by alicejenny

VIEWS: 20 PAGES: 2

									LOSS OF STOCK
AND LETTER OF
INDEMNITY
State of _______________    )
                                     )ss.
_________County/Judicial District)



1. Shareholder. I,
    am a shareholder of Shaan-Seet, Incorporated and I own _____________ shares of the Class
    ______ stock ("my Shaan-Seet Stock"). I reside at


2. Lost Certificate. After searching, I am unable to locate the Certificate evidencing my Shaan-
Seet Stock (the "Certificate").

3. No Transfer. I have not sold, assigned, pledged, transferred, deposited under any
    agreement, or otherwise disposed of my Shaan-Seet Stock or the Certificate.

4. Request For Reissuance. I hereby request Shaan-Seet and its agents to refuse to
   recognize any person other than me as the owner of my Shaan-Seet Stock, to refuse to make
any payment, transfer, registration, delivery or exchange relative to my Shaan-Seet Stock to any
person other than me, and to refuse to take any other action relative to my Shaan-Seet Stock
pursuant to the request or demand of any person other than me. Further, I hereby request
Shaan-Seet to issue a duplicate Certificate to me or to take any action, which would otherwise
require the surrender of such Certificate, without the surrender of such Certificate.

5. Original Certificate. If I should find or recover the original Certificate, I will
immediately surrender that original Certificate to you for cancellation.

6. Indemnification. I will indemnify and hold harmless Shaan-Seet and all present and former
transfer agents, directors, employees, officers, attorneys, and accountants, from all loss and
claims relating in any way to the original Certificate (including all action taken by Shaan-Seet
pursuant to Section 4 hereof) and/or the reissuance of the new Certificate to me.

Dated this _____ day of ________________________, 20 _____.


                                      ___________________________________________
                                      Signature
AFFIDAVIT OF LOSS/LETTER OF INDEMNITY
PAGE 2




State of __________ )
                               )ss.
_________________ )



       This is to certify that on the _____day of _______________________, 20 ____, before me, the
undersigned, a Notary Public in and for the State of _______________, duly commissioned and
sworn, personally appeared ___________________________to me known to be the individual
described in and who executed the within and foregoing document and that he/she signed the
foregoing document freely and voluntarily for the uses and purposes therein mentioned.

          Given under my hand and official seal the day and year in this certificated first appearing
above.


                                        _______________________________________
                                        Notary Public for_____________________
                                        My Commission Expires_____________

								
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