Company form No. 55

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812

Registration No. of Company F…………………………………………………………….

THE COMPANIES ACT, 1956

Particulars of charge’ on property in India created by a foreign company after the

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15th January, 1937

[Pursuant to section 600 read with section 1251

Name of Company…………………………………………….

Presented by……………………………………………………..

Particulars of mortgage or charge created by …………………………………a company incorporated in

and which has established a principal place of business in India

at……………………………………………………. ……………………………………………………………………………………

………………………………………………………….

Date and description of the instrument creating or evidencing the charge

Amount secured by the charge

Short particulars of the charged

Gist of the terms and conditions and extent and operation of the charge

Names, adresses descriptions of the. persons entitled to the charge

Amount or rate percent of the commission, allowances or discount (if any) paid or made either directly or indirectly by the company to any person in consideration of his subscribing, or agreeing to sub-scribe,whether absolutely or conditionally, or procuring or agreeing to procure sub-scriptions,whether absolute or conditional, for any of the debentures included in this return

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Signature or signatures of one or more persons…………………………………………………….

authorised under section 592@l)(d) of the…………………………………………………………..

Companies Act, 1956 or of some other person……………………………………………………..

in India, duly authorised by the company…………………………………………………………….

Dated the ………………………..day of …. ………. 19…………………..

1 “Charge” includes “mortgage”. [See section 1241

2 Country of origin.

3 A description of the instrument e.g. “Trust Deed”, “Mortgage”, “Debentures”, etc. as the case may be should be given.

4 Persons entitled to the charge will include mortgagees.

5 The rate of interest payable under the terms of the debentures should not be entered.

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