Drafted from the Cooperative Commissioner's consultation draft of the Model Bye-laws 2026 — not yet finally notified. Verify the bye-law/rule number against the gazetted text once issued.

Form 04Share Certificates Free Download

Application for Duplicate Share Certificate — Damage / Mutilation of Original

Draft 2026 Bye-law / Rule No.: 15(b)

When to Use This Form

Use when the original Share Certificate is damaged, defaced, torn, mutilated or laminated and needs to be surrendered for a duplicate.

Information You Will Need

  • Original Share Certificate for surrender and cancellation
  • Indemnity Bond in the prescribed form
  • Self-declaration/Affidavit regarding the circumstance of loss

How to Submit

1

Generate PDF

Click "Generate This Form" → fill in your details → download the PDF.

2

Print the form

Print on plain A4 paper.

3

Sign & attach

Sign with pen at all required signature places, and attach any enclosures listed above.

4

Submit to Society

Hand over the signed form to the Society Secretary with the required enclosures listed above.

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Duplicate Share Certificate — Damage — Form 04 (2026) | SocietySeWA