FORM OF ANNUAL RETURN OF A COMPANY HAVING A SHARE CAPITAL

ANNUAL RETURN

[See section 159]

Part II

I. Registration Details

Registration No.--------                                                                                                                                  State Code ----------(Refer Code List)

Registration date -------(dd/mm/yy)                                                                                    Whether shares listed on Recognised stock exchange(s) ----

                                                                                                                                                            Y - Yes N - No

If Yes, Stock Exchange Code (Totals)                                                                                                       A------- B-------

(Refer Code List 2)

AGM Held Y - Yes---- N - No-----

Date of AGM / Due date ---------(dd/mm/yy)

II. Name and registered office address of company :

Company Name---------------------------------------------------

Address ----------------------------------------------------------

Town/City--------------------------------------------------------

State -------------- Pin Code ----------------------------------

Telephone (with STD) Area Code ---------Number ---------------

Fax Number ------------------------------------------------------

Mail address------------------------------------------------------

III. Capital structure of the company (amount in Rs. thousand)

Authorised share capital break up

Type of Shares

No. of shares

Nominal value (in Rs.)

(i) Equity

--------------

--------------

(ii) Preference

--------------

--------------

Total authorised capital

--------------

Issued share capital break up

(i) Equity

--------------

--------------

(ii) Preference

--------------

--------------

Total authorised capital

--------------

Subscribed share capital break up

Type of Shares

No. of shares

Nominal value (in Rs.)

(i) Equity

--------------

--------------

(ii) Preference

--------------

--------------

Total authorised capital

--------------

Paid up share capital breaking

Types of shares

No. of shares

Amount paid up (in Rs.)

(i) Equity

--------------

--------------

(ii) Preference

--------------

--------------

Total Paid-up capital

--------------

Debentures break up

Type of debenture

No. of debentures

Nominal value (in Rs.)

(i) Non-convertible

--------------

--------------

(ii) Partly convertible

--------------

--------------

(iii) Fully convertible

--------------

--------------

Total Amount

--------------

IV. Directors/manager/secretary information (past and present) [Refer clause 6 of Part (I) of Schedule V]

Name: ----------(surname) --------------(Middle Name)---------------(First name)

Nationality I - Indian --------

F - Foreign-------

Date of Birth------------(dd/mm/yy)

Designation

C - Chairman-Cum-Managing Director ,W - Whole-time Director, S - Secretary, R - Manager

D - Director, M - Managing Director

Date of Date of appointment---------------(dd/mm/yy)

Date of Ceasing ---------------(dd/mm/yy)

Election Commission Identity Card No. (if issued)]

-------------------------------------------

Name: ----------(surname) --------------(Middle Name)---------------(First name)

Nationality I - Indian --------

F - Foreign-------

Date of Birth------------(dd/mm/yy)

Designation

C - Chairman-Cum-Managing Director ,W - Whole-time Director, S - Secretary, R - Manager

D - Director, M - Managing Director

Date of Date of appointment---------------(dd/mm/yy)

Date of Ceasing ---------------(dd/mm/yy)

Election Commission Identity Card No. (if issued)]

-------------------------------------------

Name: ----------(surname) --------------(Middle Name)---------------(First name)

Nationality I - Indian --------

F - Foreign-------

Date of Birth------------(dd/mm/yy)

Designation

C - Chairman-Cum-Managing Director ,W - Whole-time Director, S - Secretary, R - Manager

D - Director, M - Managing Director

Date of Date of appointment---------------(dd/mm/yy)

Date of Ceasing ---------------(dd/mm/yy)

Election Commission Identity Card No. (if issued)]

-------------------------------------------

Name: ----------(surname) --------------(Middle Name)---------------(First name)

Nationality I - Indian --------

F - Foreign-------

Date of Birth------------(dd/mm/yy)

Designation

C - Chairman-Cum-Managing Director ,W - Whole-time Director, S - Secretary, R - Manager

D - Director, M - Managing Director

Date of Date of appointment---------------(dd/mm/yy)

Date of Ceasing ---------------(dd/mm/yy)

Election Commission Identity Card No. (if issued)]

-------------------------------------------

Name: ----------(surname) --------------(Middle Name)---------------(First name)

Nationality I - Indian --------

F - Foreign-------

Date of Birth------------(dd/mm/yy)

Designation

C - Chairman-Cum-Managing Director ,W - Whole-time Director, S - Secretary, R - Manager

D - Director, M - Managing Director

Date of Date of appointment---------------(dd/mm/yy)

Date of Ceasing ---------------(dd/mm/yy)

Election Commission Identity Card No. (if issued)]

-------------------------------------------

Residential Address

-----------------------------

Town/City

-----------------------------

District

-----------------------------

State

-----------------------------

Pin Code

-----------------------------

Residential Address

-----------------------------

Town/City

-----------------------------

District

-----------------------------

State

-----------------------------

Pin Code

-----------------------------

Residential Address

-----------------------------

Town/City

-----------------------------

District

-----------------------------

State

-----------------------------

Pin Code

-----------------------------

*Note : Additional Sheets may be attached if needed.

V. Details of shares/debentures held at date of AGM*

Ledger Folio of share/debenture holder----------------------

Share/debenture

holder's name----------(surname) --------------(Middle Name)---------------(First name)

Father's name/ Husband' name -----------------------------------------------------------

Type of share/ debentures 1 - Equity, 2 - Preference shares 3 - Debentures, 4 - Stock

Number of shares/ debentures held/stock, if any

Amount per share (in Rs.) ----------

Ledger Folio of share/debenture holder----------------------

Share/debenture

holder's name----------(surname) --------------(Middle Name)---------------(First name)

Father's name/ Husband' name -----------------------------------------------------------

Type of share/ debentures 1 - Equity, 2 - Preference shares 3 - Debentures, 4 - Stock

Number of shares/ debentures held/stock, if any

Amount per share (in Rs.) ----------

Ledger Folio of share/debenture holder----------------------

Share/debenture

holder's name----------(surname) --------------(Middle Name)---------------(First name)

Father's name/ Husband' name -----------------------------------------------------------

Type of share/ debentures 1 - Equity, 2 - Preference shares 3 - Debentures, 4 - Stock

Number of shares/ debentures held/stock, if any

Amount per share (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

-----------------------------

Town/City

-----------------------------

District

-----------------------------

State

-----------------------------

Pin Code

-----------------------------

Address

-----------------------------

Town/City

-----------------------------

District

-----------------------------

State

-----------------------------

Pin Code

-----------------------------

Address

-----------------------------

Town/City

-----------------------------

District

-----------------------------

State

-----------------------------

Pin Code

-----------------------------

VI. Details of shares/debentures transfers since date of last AGM (or in the case of the first return at any time since the incorporation of the company)*

Date of Previous AGM ---------------(dd/mm/yy)

Date of registration of transfer of shares---------------(dd/mm/yy)

Type of Transfer 1- Equity, 2 - Preference shares, 3 - Debentures, 4 - Stock

Number of shares/ debentures transferred

Amount per share (in Rs.)

Ledger folio of transferor ------------------------------

Transferor's name ----------(surname) --------------(Middle Name)---------------(First name)

Ledger folio transferee --------------------------------

Transferee's name ----------(surname) --------------(Middle Name)---------------(First name)

Date of registration of transfer of shares---------------(dd/mm/yy)

Type of Transfer 1- Equity, 2 - Preference shares, 3 - Debentures, 4 - Stock

Number of shares/ debentures transferred

Amount per share (in Rs.)

Ledger folio of transferor ------------------------------

Transferor's name ----------(surname) --------------(Middle Name)---------------(First name)

Ledger folio transferee --------------------------------

Transferee's name ----------(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 --------------------------

VIII. Equity share capital break up (Percentage of total equity)

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

(ii) Government Companies ---------

(iii) Public financial institutions---------

(iv) Nationalised/Other banks---------

(v) Mutual funds ---------

(vi) Venture capital ---------

(vii) Foreign holdings(FIIs/FCs/FFIs/NRIs/OCBs)---------

(viii) Bodies corporate (not mentioned above) ---------

(ix) Directors/relatives of directors---------

(x) Other top 50 shareholders(Other than those listed above)--------- We;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 amounts envisaged in clause (a) to (e) of sub section (2) of section 205C of the Companies Act, 1956 remaining unpaid or unclaimed for a period of seven years from the date they become payable by a company have been credited to the Investor Education and Protection Fund ;

(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) of 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. 10 crore orr 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

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 Cochinn will fill in the exchange codes as follows :

ANNEXURE III

SHARES/DEBENTURES HELD : (FORMAT FOR FLOPPIES)

I. Registration Details :

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

V. Shares held by Shareholders :

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

The files may be submitted 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)

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

The files ma be sumitted in 5.25" or 3.5" floppies (preferably 3.5") or 60/150 MB Normal Cartridge Tapes (mini Cartridge not acceptable).