FORM XII

(See Section 20(3) and Rule 20)

APPLICATION FOR SUBSTITUTION OF THE SECURITY

Place :
The Registrar of Chits, Date :

Dear Sir,

I / We propose to give the ~~undernoted~~under noted security in substitution of the original security for proper conduct of the chit for the commencement of which a certificate had been granted by you (vide No ___________ Dt. ___________ ) certain other particulars are also given below.

1. Name of foreman.

2. Age & occupation if the foreman is
not a firm or acompany.

3. The office in which the chit agreement of
the chit has been registered and the
number and year of registration.

4. Chit amount.

5. Details of the original security given.

6. Whether the applicant has any debt and
if so, the amount of any such debt and to
whom they are due.

7. Details of Government security / other
securities offered as substituted security.

I / We hereby declare that the information and particulars furnished herein are true and correct to the best of my / our knowledge, information and belief.

Yours faithfully
Chairman
Secretary
for and on behalf of

----------------------------------------------------------------------------------------------------------------------------------~~-------------------------------------------~~
Strike out / delete whatever is not applicable. Insert the designation(s) as may be appropriate to the applicant.

Decision of the Registrar

(Seal) Signature of the Registrar.