ANNEXURE-A
AFFIDAVIT
(to be given individually by every director) 

1.	I,                                       Managing Director of                                (hereinafter called “the Company”), incorporated on                      under  the    Companies    Act, 1956    having    its    Registered    Office    at                                     and  having     CIN  No U                               do solemnly affirm and state as under : 

2.	 I,                                                     ,  S/o Shri                                   , holder of DIN number:                                    (copy of Income Tax PAN /Passport   duly attested by a Gazetted Officer or a whole time practicing  professional (Chartered  Accountant/  Company  Secretary/Cost  Accountant)  or  a  Company  Secretary  in  full  time  employment  of  the company  is  enclosed)  am  Director  of  the  company  stated  above since                      (mention date of appointment).  

3.	 My present residential address is                                                                  (Copy of 

4.	documentary evidence duly attested by a Gazetted Officer or a whole  time  practicing  professional (Chartered  Accountant/  Company Secretary/Cost   Accountant) or a Company    Secretary   in   full   time employment of the company is enclosed. Alternatively, an affidavit sworn before Magistrate may be enclosed)  

5.	My permanent address is                                                                 (Copy of documentary evidence duly attested by a Gazetted Officer or a whole  time  practicing  professional (Chartered  Accountant/  Company Secretary/Cost   Accountant)   or   a   Company   Secretary   in   full   time employment of the company is enclosed. Alternatively, an affidavit sworn before Magistrate may be enclosed)  

6.	The company maintains/does not maintain any bank account as on date (mention details of Bank Account(s) if maintained). 

7.	I affirm that the Company                                                                       (mention name of the company) have assets and liabilities amounting to Rs.                 /-  (as per annexed Statement of Accounts). 

8.	The Company has been inoperative from the date of its incorporation /The company  commenced   usiness/operations/commercial  activity  after incorporation but has been inoperative for the past   ________________ year(s) due to following reasons*._______________  (Give the reasons here) 

9.	As on date, the Company does not have any dues towards Income Tax / Sales Tax  / Central Excise/ Banks and Financial Institutions; any other Central  or  State  Government  Departments/Authorities  or  any  Local Authorities.

10.	Strike out whichever is not applicable:-
	(i) There  is  no  litigation  pending  against  or  involving  the company.
         (ii) There are litigations pending against the company, details of which are
              Mentioned under serial number 9 of Form EES 2010. 

11.	In case of any loss(es) to any person or any valid claim and liability  arising  from  any person  after     the  striking  off     the  name  of  the  Company         (mention name) from the Register of Companies,  I,                                       ,  the Managing Director of the company, undertake to indemnify any person for such losses, valid claim and liability and the indemnity bond to this effect is being submitted separately with the  application Form. 

I solemnly state that the contents of this affidavit are true to the best of my knowledge and belief and that it conceals nothing and that no part of it is false. 

               Signature: ________________
                                                                                                             (Deponent)
Verification:-
I verify that the contents of this affidavit are true to the best of my knowledge and belief. 

Place :	        Signature :________________
                                                                                                                        (Deponent) 
  Date: 

                                             ANNEXURE-B 
INDEMNITY BOND 
(to be given individually or collectively by every director ) 
To 
The Registrar of Companies, 
Andhra Pradesh,
HYDERABAD

1.	I,                                                             the Managing Director (s) of               .                                                         (mention name of the company), incorporated on                          under the Companies Act,  1956, having its Registered Office at                                                           . 
AND
	I                                                       the director (s) of                        (mention name of the company), incorporated on                        under the Companies Act, 1956, having its Registered Office at                                                   do hereby declare that: 
2.	I,                                                       S/o Shri                                       and  .                                 s/o                                                are Directors of this company. 
3.	That We have  made  an  affidavit  dated  the  _________, duly sworn before  First Class Judicial  Magistrate  or  Executive  Magistrate  or  Oath Commissioner Notary, affirming that the Company                                  have   assets   and   liabilities amounting to Rs.                    /- 
 
4.	Further,  the  Company  has  been  inoperative  from  the  date  of  its incorporation. / The company commenced  Business/ operations/commercial activity  after  incorporation  but  has  been  inoperative  for  the  past _________________ year(s)*. And the Company is not intending to do any  business or commercial activity. Thus the Company is defunct and I request the Registrar of Companies,                                             to strike off the name of the Company  from  the  Register  of  Companies  under  Section 560  of  the Companies Act, 1956. 

	* Strike out whichever is not applicable. 
5.   I /We do hereby undertake and indemnify in writing: 
(a) to pay and settle all lawful claims arising in future after the 	striking off the name of the Company. 

(b) to indemnify any person for any losses that may arise pursuant to  striking off the name of the Company.                        
(c) to settle all lawful claims and liabilities which have not come to 	our notice up to this stage, even after the name of the Company 	has been struck off in terms of Section 560 of the Companies 	Act, 1956. 

Place:	           (Name, Father’s name, Address & Signature)
Date: 	               (To be given by every director)
WITNESSES: 
		
1																1.
Name: 	                      Signature:
Father’s name: 
Address: 							

Occupation: 

																																																														2.
2.	                     Signature:
Name: 
Father’s name: 
 Address: 
Occupation: 

ANNEXURE -C 
STATEMENT OF ACCOUNT

Name of the Company:                                                                                .
CIN No.                                                     .     
Statement of Account as on date:                      .
Particulars : (Brief break up in respect of each item                Amount (Rs.)
needs to be given).
I. Sources of Funds 

	

	

	
 (1) Capital 																																																																		       
(2) Reserves & Surplus (including balance in Profit and Loss Account)                                                                       
(3) Loan Funds 

	
	
Secured loans from Financial 
Institutions                                         
Secured loans from Banks 
Secured loans from Govt. 
Others Secured loans 
Debentures 
Unsecured Loans 
Deposits & interest thereon 
Total Loan Funds 

Total of   (1) to (3) 

					                                                                                                       
II. Application of Funds 																							

	

	
 (1) Fixed Assets 																																										
(2) Investments 

	

 (3) (i) Current Assets, loans and Advances
 Less : (ii) Current Liabilities & provisions 
 Creditors 
Unpaid Dividends
Payables
Others
Total Current Liabilities & Provisions
Net Current Assets (i-ii)
(4) Miscellaneous expenditure to the extent of not written off or adjusted
(5) Profit & Loss Account (Debit balance)

Total of   (1) to (5)
                              Name and  Signature of
Date : 	                              	(Managing Director)*
Place:                                  

Name and Signature	     	     Name and Signature  of                                    
   (Secretary)																 (Directors)

* Applicable only if there is MD/Secretary 

Duly certified by Statutory Auditor or Chartered Accountant in whole time practice. 
Membership No/Certificate of Practice Number with seal.