Annexure E
Note: To be executed in the presence of a Public Notary / Gazetted Officer
Bond of Indemnity to be furnished jointly by all Legal Heir(s) including the Claimant(s)
(To be submitted on Non-judicial Stamp Paper of appropriate value)
[For Transmission of Securities on death of Sole Securities’ Holder, where no
nomination has been registered]
The Board of Director,
ICICI Bank Limited
ICICI BANK TOWER NEAR CHAKLI CIRCLE OLDPADRA ROAD VADODARA, GUJARAT 390007
(Address)
I/We do hereby solemnly affirm and state on oath as follows:
That Mr. /Ms. Omprakash Jain was holding the
following securities:
Name of the Certificate No. Distinctive No. Folio No. No. of
Company securities held
1) ICICI Bank Limited 00082543 23497021 - 23497270 1092734 250
5831862140 -
2) ICICI Bank Limited 00968339 1092734 25
5831862164
That the aforesaid deceased holder died intestate on 27/02/2018, without registering any
nominee, leaving behind him/her the following persons as the only surviving legal heirs,
according to the laws of intestate succession applicable to him/her by which he/she was
governed at the time of his/her death.
Name of the Legal Address and Age Relationship with the
Heir(s)/Claimant(s) contact details Deceased
1. Sushil Jain 9/2 Marothiya Bazar, Bajaj khana 47 Son
chowk ,Indore
2
3
4
OR
That the aforesaid deceased holder died on , without registering any
nominee, leaving behind him/her the following persons as the only surviving legal heirs,
according to the laws of testamentary succession.
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Name of the Legal Address and Age Relationship with the
Heir(s)/Claimant(s) contact details Deceased
1
2
Therefore, I/We, the Legal Heir(s)/Claimant(s) and deponent(s) herein has/have,
approached ICICI Bank limited Kfin Tech (Name of the Company/RTA) with a request to
transmit the aforesaid securities in the name of the undersigned Mr. /Ms. Sushil Jain#, on
my/our behalf, without insisting on production of a Succession Certificate/ Probate of Will /
Letter of Administration or any Court order, for which we execute 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 my/our request to transfer/transmit the above said securities to
the name of the undersigned Mr. Sushil Jain] #,
I/We hereby jointly and severely agree and undertake to indemnify and keep indemnified,
saved, defended, harmless, [Name of the Company/ Issuer and any RTA] and its
successors and assigns for all time hereafter against all losses, costs, claims, actions,
demands, risks, charges, expenses, damages, etc., whatsoever which they may suffer
and/or incur by reason of transferring the said securities as herein above mentioned, at
my/our request to the undersigned Mr. Sushil Jain #, without
insisting on production of a Succession Certificate / Probate of Will / Letter of Administration
or any Court order.
IN WITNESS WHEREOF the said 1) Mr. Yash Jain (Name and signature of the
witness)
And 2) Mr. Tarachand Jain Name and signature of the witness #,
have hereunto set their respective hands and seals this day of _________________
. Signed and delivered by the said legal heir/s.
Name the Legal Heirs Signature of the
Legal Heirs
1) Sushil Jain X
2
X
3 X
(*) = Name of the deceased security holder (#) = Name of the claimant/s
Signed before me
at: Indore (M.P.)
on:
Signature of Notary
Official stamp & seal of the Notary & Regn. No.:
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