This Indemnity Regarding Lost Share Certificate will indemnify a corporation from any action or claim in the event a shareholder has lost or misplaced a share certificate. This indemnity contains the name of corporation issuing the certificate, name of individual to whom the certificate was issued and number of shares. It also sets forth that if the certificate is located, the shareholder will surrender it to the corporation for cancellation. A written Indemnity Regarding Lost Share Certificate will prove invaluable in the event of misunderstandings or disagreements.

This Indemnity Regarding Lost Share Certificate includes the following:

• Parties: Names of corporation issuing the shares and the shareholder to whom the shares were issued;
• Declaration: Shareholder declares that the shares have not been transferred or sold and that the certificate was lost, misplaced or destroyed;
• Indemnity: Shareholder warrants that all statements are true and indemnifies the corporation from any claims or actions arising from the loss of the certificate;
• Signatures: The shareholder must sign and date this document in the presence of a witness.

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This attorney-prepared packet contains:

1. General Information
2. Indemnity Regarding Lost Share Certificate

State Law Compliance: This form complies with the laws of all states