Companies Act, 1956

FORM OF ANNUAL RETURN OF A COMPANY HAVING A SHARE CAPITAL

ANNUAL RETURN

The Companies Act, 1956 (1 of 1956)

Schedule V, Part II

(See section 159)

1. Registration Details

Registration No. گگگگگگ State Code گگ (Refer Code List 1)

Registration Date    گگ      گگ         گگ          Whether shares listed on گ

                          Date     Month     Year           recognized Stock Exchange(s)

                          Y __ Yes, N __ No

If Yes, Stock exchange code (Totals)        A       گگگگ         B     گگگگ

(Refer Code list 2)    

AGM Held           گ   Y __ Yes       Date of AGM/ گگ       گگ      گگ

                          N __ No         Due Date         Date    Month     Year

II. Name and Registered Office Address of Company

Company Name         گگگگگگگگگگگگگگگگگگگگگگگگ

گگگگگگگگگگگگگگگگگگگگگگگگ   گگگگگگگگگگگگگگگگگگگگگگگگ

Address گگگگگگگگگگگگگگگگگگگگگگگگگگگگگگگگگگگگگگگگگگگگگگ        گگگگگگگگگگگگگگگگگگگگگگگگ

Town/ City     گگگگگگگگگگگگگگگگگگگگگگگگ

State  گگگگگگگگگگ   Pin Code گگگگگگ

Telephone with STD  گگگگگ  گگگگگگگگ

Area Code      Number

Fax Number    گگگگگ   گگگگگگگگ

Email Address گگگگگگگگگگگگگگگگ

III. Capital Structure of the Company (Amount in Rs. Thousands)

Authorised Share Capital Break-up

Type of Shares         No. of Shares Nominal Value (in Rs.)

(i) Equity       گگگگگگگگ        گگگگگ

(ii) Preference گگگگگگگگ        گگگگگ

Total Authorised Capital       گگگگگگگگگ

Issued Share Capital Break-up       

Type of Shares         No. of Shares Nominal Value (in Rs.)

(i) Equity       گگگگگگگگ        گگگگگ

(ii) Preference گگگگگگگگ        گگگگگ

Total Issued Capital  گگگگگگگگگ

Subscribed Share Capital Break-up 

Type of Shares         No. of Shares Nominal Value (in Rs.)

(i) Equity       گگگگگگگگ        گگگگگ

(ii) Preference گگگگگگگگ        گگگگگ

Total Subscribed Capital      گگگگگگگگگ

Paid Up Share Capital Break-up      

Type of Shares         No. of Shares Amount Paid up (in Rs.)

(i) Equity       گگگگگگگگ        گگگگگ

(ii) Preference گگگگگگگگ        گگگگگ

Total Paid up Capital گگگگگگگگگ

Debentures Break-up

Type of Debenture    No. of Debentures     Nominal Value (in Rs.)

(i) Non-Convertible    گگگگگگگگ        گگگگگ

(ii) Partly Convertible گگگگگگگگ        گگگگگ

(iii) Fully Convertible  گگگگگگگگ        گگگگگ

Total amount  گگگگگگگگگ

Name  گگگگگگگگگگگگگگگگگگگگگگگگگگگگ

Surname                  Middle Name                First Name

Nationality     گ   I - Indian Date of birth    گگ گگ گگ

                   F - Foreign              Date Month Year

Designation گ C - Chairman-cum-Managing Director

W - Whole Time Director, S - Secretary, R - Manager

          D - Director, M - Managing director

Date of Appointment Election Commission   گگ     گگ    گگ

Date   Month Year    Date of Ceasing        گگ     گگ    گگ

Date   Month Year

Identity Card No. (if issued) گگگگگگگگگگگگگگگگگگگگگگگگ

Name  گگگگگگگگگگگگگگگگگگگگگگگگگگگگ

Surname                  Middle Name                First Name

Nationality گ  I - Indian       Date of birth    گگ گگ گگ

F - Foreign              Date Month Year

Designation گ C - Chairman-cum-Managing Director

W - Whole Time Director, S - Secretary, R - Manager

D - Director, M - Managing director

Date of Appointment Election Commission   گگ     گگ    گگ

Date   Month Year    Date of Ceasing        گگ     گگ    گگ

Date   Month Year

Identity Card No. (if issued) گگگگگگگگگگگگگگگگگگگگگگگگ

Name  گگگگگگگگگگگگگگگگگگگگگگگگگگگگ

Surname                  Middle Name                First Name

Nationality گ  I - Indian       Date of birth    گگ گگ گگ

F - Foreign              Date Month Year

Designation گ C - Chairman-cum-Managing Director

W - Whole Time Director, S - Secretary, R - Manager

D - Director, M - Managing director

Date of Appointment Election Commission   گگ     گگ    گگ

Date   Month Year    Date of Ceasing        گگ     گگ    گگ

Date   Month Year

Identity Card No. (if issued) گگگگگگگگگگگگگگگگگگگگگگگگ

Residential Address   گگگگگگگگگگگگگگگگگگگگگگگگ             گگگگگگگگگگگگگگگگگگگگگگگگ

Town/ City     گگگگگگگگگگگگگگگگگگگگگگگگ

District          گگگگگگگگگگگگگگگگگگگگگگگگ

State  گگگگگگگگگگگگگگگگگگگگگگگگ

Pin Code        گگگگگگ

Residential Address   گگگگگگگگگگگگگگگگگگگگگگگگ             گگگگگگگگگگگگگگگگگگگگگگگگ

Town/City      گگگگگگگگگگگگگگگگگگگگگگگگ

District          گگگگگگگگگگگگگگگگگگگگگگگگ

State  گگگگگگگگگگگگگگگگگگگگگگگگ

Pin Code        گگگگگگ

Residential Address   گگگگگگگگگگگگگگگگگگگگگگگگ             گگگگگگگگگگگگگگگگگگگگگگگگ

Town/ City     گگگگگگگگگگگگگگگگگگگگگگگگ

District          گگگگگگگگگگگگگگگگگگگگگگگگ

State  گگگگگگگگگگگگگگگگگگگگگگگگ

Pin Code        گگگگگگ

*Note: Additional Sheets may be attached if needed.

V. Details of Shares/ Debentures Held at Date of AGM*

Ledger Folio of Share/ Debenture Holder گگگگگگگگ

Share/ Debenture Holder's Name     گگگگگگگگگگگگگگگگگگگگگگگگگگگگ

Surname                  Middle Name                First Name

Father's/ Husband's Name    گگگگگگگگگگگگگگگگگگگگگگگگگگگ

Types of Share/ Debenture گ        1-Equity, 2-Preference Shares,

3 - Debentures, 4 - Stock

Number of Shares/ Debentures Held/        

Stock, if any  گگگگگگ                      Amount per share گگگگگگ

                                                         (in Rs.)

Ledger Folio of Share/ Debenture Holder گگگگگگگگ

Share/ Debenture Holder's Name     گگگگگگگگگگگگگگگگگگگگگگگگگگگگ

Surname                  Middle Name                First Name

Father's/ Husband's Name    گگگگگگگگگگگگگگگگگگگگگگگگگگگ

Types of Share/ Debenture گ        1-Equity, 2-Preference Shares,

3 - Debentures, 4 - Stock

Number of Shares/ Debentures Held/        

Stock, if any  گگگگگگ                Amount per share گگگگگگ

                                           (in Rs.)

*Note: Separate sheet may be attached if needed. If number of such shareholders exceed 10, if so desired, a text file may be submitted on a floppy or a cartridge tape in the format given in Annexure III.

         

Address   گگگگگگگگگگگگگگگگگگگگگگگگ   گگگگگگگگگگگگگگگگگگگگگگگگ

Town/ City     گگگگگگگگگگگگگگگگگگگگگگگگ

District          گگگگگگگگگگگگگگگگگگگگگگگگ

State  گگگگگگگگگگگگگگگگگگگگگگگگ

Pin Code        گگگگگگ

Address گگگگگگگگگگگگگگگگگگگگگگگگ             گگگگگگگگگگگگگگگگگگگگگگگگ

Town/ City     گگگگگگگگگگگگگگگگگگگگگگگگ

District          گگگگگگگگگگگگگگگگگگگگگگگگ

State  گگگگگگگگگگگگگگگگگگگگگگگگ

Pin Code        گگگگگگ

         

Address  گگگگگگگگگگگگگگگگگگگگگگگگ             گگگگگگگگگگگگگگگگگگگگگگگگ

Town/ City     گگگگگگگگگگگگگگگگگگگگگگگگ

District          گگگگگگگگگگگگگگگگگگگگگگگگ

State  گگگگگگگگگگگگگگگگگگگگگگگگ

Pin Code        گگگگگگ       

VI. Details of Shares/ Debentures Transfers since date of last AGM (or in the case of the first return at the time since the incorporation of the company)*

Date of Previous AGM          گگ     گگ    گگ

Date   Month Year

Date of Registration of      Transfer of shares       گگ     گگ    گگ

Date   Month Year

Type of transfer  گ   1- Equity, 2 - Preference Shares, 3 - Debentures, 4 - Stock

Number of Shares/ Debentures transferred گگگگ  Amount per share گگگگگگ

              (in Rs.)

Ledger Folio of Transferor    گگگگگگگگگ

Transferor's Name     گگگگگگگگگگگگگگگگگگگگگگگگگگگگ

Surname                  Middle Name                First Name

Ledger Folio of Transferee    گگگگگگگگگ

Transferee's Name    گگگگگگگگگگگگگگگگگگگگگگگگگگگگ

Surname                  Middle Name                First Name

Date of Registration of       Transfer of shares      گگ     گگ    گگ

Date   Month Year

Type of transfer گ    1- Equity, 2 - Preference Shares, 3 - Debentures, 4 - Stock

Number of Shares/ Debentures transferred گگگگگگ Amount per share گگگگگگ

                 (in Rs.)

Ledger Folio of Transferor    گگگگگگگگگ

Transferor's Name     گگگگگگگگگگگگگگگگگگگگگگگگگگگگ

Surname                  Middle Name                First Name

Ledger Folio of Transferee    گگگگگگگگگ

Transferee's Name    گگگگگگگگگگگگگگگگگگگگگگگگگگگگ

Surname                  Middle Name                First Name

*Note: Separate sheet may be attached if needed. If number of such transactions exceed 10, if so desired, a text file may be submitted on a floppy or cartridge in the format given in Annexure IV.

VII. Indebtedness of the Company (Amount in Rs. Thousands) [Secured Loans including interest outstanding/ accrued but not due for payment]

Amount         گگگگگگگگگگ

VIII. Equity Share Capital Break-up (Percentage of Total Equity)

(i) Government [Central & State(s)]

گگگ 

(ii) Government Companies

گگگ 

(iii) Public Financial Institutions

گگگ 

(iv) Nationalized/Other Banks

گگگ 

(v) Mutual Funds

گگگ 

(vi) Venture Capital  

گگگ 

(vii) Foreign Holdings (FIIs/ FCs/ FFIs/ NRIs/ OCBs)

گگگ 

(viii) Bodies Corporate (Not Mentioned Above)

گگگ 

(ix) Directors/ Relatives of Directors

گگگ 

(x) Other top 50 Share Holders [Other than those listed above]

گگگ 

We certify that:

(a) the return states the facts as they stood on the date of the annual general meeting aforesaid, correctly and completely;

(b) since the date of the last annual return the transfer of all shares, debentures, the issue of all further certificates of shares and debentures have been appropriately recorded in the books maintained for the purpose;

(c) the whole of the amount of dividend remaining unpaid or unclaimed for a period of three years from the date of transfer to the special account has been transferred to the General Revenue Account of the Central Government as required under sub-section (5) of section 205A;

(d) the company has not, since the date of the annual general meeting with reference to which the last return was submitted, or in the case of a first return, since the date of the incorporation of the company, issued any invitation to the public to subscribe for any shares or debentures of the company;

(e) where the annual return discloses the fact that the number of members of the company exceeds fifty, the excess consists wholly of persons who under sub-clause (1) section 3 are not to be included in reckoning the number of fifty;

(f) since the date of annual general meeting with reference to which the first return was submitted or in the case of a first return since the date of the incorporation of the private company, no public company or deemed public company has or have held twenty-five per cent, or more of its paid up share capital;

(g) the company did not have an average turnover of Rs. ten crores or more during the relevant period;

(h) since the date of the annual general meeting with reference to which the last annual return was submitted or since the date of incorporation of the company, if it is first return, the company did not hold twenty-five per cent or more of the paid up share capital of one or more public companies; and

(i) the private company did not accept or renew or invite deposits from the public.

Signed

Director: __________________________

Director/ Managing Director/ Manager/ Secretary: ___________________________

Secretary in whole time practice: ________________________

CP No.: ______________________

Note: Certificates to be given by a Director and Manager/ Secretary or by two Directors where there is no manager or secretary. In the case of a company whose shares are listed on a recognized stock exchange, the certificates shall also be signed by a secretary in whole time practice.

Annexure I

Code List 1: State Codes

State Code    State Name               State Code                State Name

01                          Andhra Pradesh            02                      Assam

03                          Bihar                          04                      Gujarat

05                          Haryana                      06                      Himachal Pradesh

07                          Jammu & Kashmir          08                      Karnataka

09                          Kerala                         10                      Madhya Pradesh

11                          Maharashtra                 12                      Manipur

13                         Meghalaya                    14                      Nagaland

15                         Orissa                          16                      Punjab

17                         Rajasthan                     18                     Tamil Nadu

20                         Uttar Pradesh                21                     West Bengal

22                         Sikkim                          23                     Arunachal Pradesh

24                         Goa                             52                     Andaman Islands

53                         Chandigarh                    54                    Dadra Islands

55                         Delhi                            56                    Daman & Diu

57                         Lakshadweep                 58                    Mizoram

59                         Pondicherry            

Annexure II

Code List 2: Stock Exchange Codes

Exchange Code        Stock Exchange       Exchange Code        Stock Exchange

A1   Bombay                               B1      OTCEI

A2    Delhi                                  B2      Nagpur

A4    Calcutta                             B4      Coimbatore

A8    Madras                               B8      Cochin

A16  Bangalore                            B16     MP

A32  Hyderabad                           B32     Jaipur

A64  Ahmedabad                          B64     Rajkot

A128 Pune                                  B128   GauhatI

A256 Kanpur                               B256 Bhubaneshwar

A512 Ludhiana                             B512   Magadh

A1024 National Stock Exchange      B1024  Vadodra

                    B2048  Rajkot

Note: If listed in more than one exchange, add the respective codes to arrive at the Totals under the same category. For example a company listed in Bombay, Pune, Nagpur and Cochin will fill the exchange codes as follows:

Annexure III

Shares/ Debentures held: (format for floppies)

1. Registration Details

Field    Type   Length Format/ Value

State Code              Number                  

Registration No.        Number                   6

Date of AGM   Date                                8        (DD/ MM/ YY)

Date of last AGM      Date                       8        (DD/ MM/ YY)

Note: The first text file cid.txt will contain the data for above field for company identification.

V. Shares held by Share Holders

Field    Type   Length Format/ Value

Ledger folio of Shareholder   Character      8

Name of shareholder  Character                20      Surname Middle name First name

Father's/ Husband's Name    Character      2        Surname Middle name First name

Residential Address   Character                40     

Town/ City     Character                         20     

State  Character                                   20     

Pin Code        Number                                      6       

Type of Share/Debenture     Number         1        1. Equity, 2. Preference.3. Debentures, 4. Stock

Number of shares/Debenture Number         6       

Amount per Share/Debenture         Number         6       

Note: The second text file shh.txt will contain the data for above fields for the shareholders/debenture holders.

The files may be submitted in 5.25" or 3.5" floppies (preferably 3.5") or 60/150 MB Normal Cartridge Tapes (mini Cartridges not acceptable). The Floppies/ Cartridges may be formatted in DOS/ Unix.

Annexure IV

Shares transferred: (format for floppies)

I. Registration Details

Field    Type   Length Format/ Value

State Code              Number                   2       

Registration No.        Number                   6       

Date of AGM            Date                       8        (DD/ MM/ YY)

Date of last AGM      Date                       8        (DD/ MM/ YY)

Note: The first text file cid.txt will contain the data for above field for company identification.

VI. Transactions after the last AGM

Field    Type   Length Format/ Value

Date of Transfer of Shares   Date   8        (DD/ MM/ YY)

Type of Share/Debenture     Number 1 1. Equity, 2. Preference.

3. Debentures, 4. Stock

Number of Shares/ Debenture         Number                   6       

Amount per Share/ Debenture        Number                   6       

Ledger folio of Transferor               Character                8       

Name of Transferor   Character                         20      Surname Middle name First name

Ledger Folio of Transferee    Character                8       

Name of Transferee   Character                         20      Surname Middle name First name

Note: The second text file sht.txt will contain the data for above fields for each such share transfer.

The files may be submitted in 5.25" or 3.5" floppies (preferably 3.5") or 60/150 MB Normal Cartridge Tapes (mini Cartridges not acceptable). The Floppies/ Cartridges may be formatted in DOS/ Unix.]

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