Indemnity Regarding Lost Stock Certificate
TO: Name of Corporation Issuing Stock Certificate
WHEREAS Name of Person to Whom Lost Stock Certificate was Issued (the “Holder”) is the holder of Number of Shares Held by Holder of Lost Stock Certificate Type of Shares Held by Holder of Lost Stock Certificate (ie. Common, Preference, etc.) shares (the "Shares") in the capital of Name of Corporation Issuing Stock Certificate (the “Corporation”); AND WHEREAS the Holder has not sold, transferred, assigned, pledged, hypothecated or otherwise encumbered the Shares in any manner; AND WHEREAS a certificate representing the Shares has either never been prepared, or has been mislaid, stolen or destroyed so that the same cannot be found or produced;
NOW THEREFORE in consideration of the Corporation agreeing to issue or causing to be issued a new stock certificate representing the Shares, the Holder covenants and agrees with the Corporation as follows: 1. 2. The Holder represents and warrants that the recitals to this Indemnity are true and correct. The Holder agrees to indemnify and save harmless the Corporation from and against all claims, actions, suits, liabilities, losses, damages, costs, charges and expenses (including legal fees) of every nature and character arising out of or in consequence of the issuance of a new certificate representing the Shares in the name of the Holder. If at any time a previous certificate representing the Shares should be found or come into the possession of or under the control of the Holder, the Holder will forthwith obtain and surrender such previous certificate to the Corporation for cancellation.
3.
This Indemnity shall be binding upon the Holder and its successors and assigns and shall enure to the benefit of the Corporation and its successors and assigns.
DATED: Date of Signing of Indemnity
Witness
Full Name of Person to whom Cheque was made out to