Indemnity from Holder of Lost Share Certificate to Corporation in Exchange for a new Stock Certificate.

Form Outline:

Indemnity Regarding Lost Stock Certificate

WHEREAS Name of Person to Whom Lost Stock Certificate... ;

AND WHEREAS the Holder has not...;

AND WHEREAS a certificate representing the Shares has...

NOW THEREFORE in consideration of the Corporation agreeing to... as follows:

DATED: Date of Signing of Indemnity

Witness		Full Name of Person to whom Cheque was made out to

Corporation Forms