Form I - Declaration by the person referred to in section 187C(1) of the Companies Act, 1956 (1 of 1956) - Companies (Declaration of Beneficial Interest in Shares) Rules, 1975

FORM I [See rule 3(1)] Declaration by the person referred to in section 187C(1) of the Companies Act, 1956 (1 of 1956) To ............................................. (Name of the company) ............................................. (Address of the registered office) In pursuance of sub-section (1) of section 187C of the Companies Act, 1956 (1 of 1956), I hereby declare that ............................................... hold(s) the beneficial interest in ......................................................................... shares bearing Nos. .... (number) (kind) ................ which are entered in my name in the register of members of the company as the holder of such shares. The particulars of such person(s) who hold the beneficial interest in the said shares are given below: 1. Sl. No. Name Father's/Husband's Name Age Occupation Address Nationality 2. Nature of the beneficial interest: 3. Date of acquisition of the beneficial interest: 4. Reasons why the shares have not been registered in the name of the person(s) holding the beneficial interest in the register of the company: 5. Paid-up value of such share(s): Place ............ ................................. Date ............. Signature of the person making the declaration .................................. Name and address