Form No. 04 - [See clause (c) of sub-rule (2) of rule 7 & rule 277] - Limited Liability Partnership (Winding up and Dissolution) Rules, 2010

Form No. 04 [ See clause ( c ) of sub-rule (2) of rule 7 rule 277] Name of LLP:................ LLPIN:................. Statement of Assets and Liabilities as at.......... (In Rupees........) Particulars Figures as at the end of___ Figures as at the end of the last reporting period as on...... 1 2 3 I. Contribution and liabilities (1) Partners funds ( a ) Contribution ( b ) Reserves and Surplus (Surplus being the profit/loss made during the year) (2) Liabilities ( a ) Secured Loans ( b ) Unsecured Loans ( c ) Short-term borrowings ( d ) Creditors/Trade Payables - Advance from customers ( e ) Other liabilities (to specify) ( f ) Provisions ( i ) for taxation ( ii ) for contingencies ( iii ) for insurance ( iv ) other provisions (if any) Total II Assets ( a ) Fixed Assets ( b ) Investments ( c ) Loans and Advances ( d ) Inventories ( e ) Debtors/Trade Receivables ( f ) Cash and Cash equivalents ( g ) Other assets (to specify) Total Notes: ( a ) Contingent liabilities not provided for. Dated........ Signatures Designated partners of LLP