1. I, Shri/Shrimati .................................................. residing at ....................................... an Indian inhabitant state as under:

2. Shri/Shrimati ................................. residing at was the member of the ................................... Co-operative Housing Society Ltd, having address at ................................... She/he was holding Share Certificate No ................................. for ten fully paid up shares of rupees fifty each, bearing distinct numbers from ............... to .......................(both inclusive).

3. The said Shri/Shrimati.................................. was holding the flat / tenement No. ................ on ..................... floor, in the building known as; or in the building No. of the society constructed on the plot of land, bearing No situated at ...............................

4. The said Shri/Shrimati............................... had nominated the following persons under Rule 25 of the Maharashtra Co-op Societies Rules, 1961

5. I am duly authorised by the above nominees to make an application *':-membership of the society. My name appears first in the said nomination Letter.

6. The said Shri/Shrimati died on or about .................................................

7. According to the Bye-law No. 34 of the said Society, I am entitled to make ar application for membership of the said society and for transfer of the said shares and interest of the said deceased member in the said flat / tenement to my names Accordingly, I have made an application for membership of the said society and for transfer of the shares and the interest of the said deceased member in the said, flat tenement to my name.

8. I hereby indemnify and keep indemnified the said society and its office-bearers -against any claim, demand, suit or other legal proceedings by other nominee/nominees claiming either lawfully and/or equitably through the said deceased Shri/Shrimati ..............................................and shall see that the said society and its office bearers are not put to losses.
I further declare and undertake to bear all expenses, costs, charges in respect of any such claim, demand, suit and/or legal proceedings which may be filed by other nominee/ nominees either lawfully and/or equitably claiming through the said deceased member of the society.

9. I am fully aware of the fact that the society admits me as its member in place of the said deceased member of the society only on the basis of the indemnity and undertaking furnished by me.

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Witnesses:-
1) Name .........................................	1) Signature of the Witness
Address .........................................
2) Name ........................................	2) Signature of the Witness
Address .........................................

Place:
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