Appendix 1 - e-Form of Application for Approval for Declaration of Dividend out of Reserves - Companies (Declaration of Dividend out of Reserves) Rules, 1975

Appendix 1 e-Form of Application for Approval for Declaration of Dividend out of Reserves [Pursuant to section 205A(3) of the Companies Act, 1956 and the Companies (Declaration of Dividend out of Reserves) Rules, 1975] Note: All fields marked in * are to be mandatorily filled. 1. ( a ) *Corporate identity number (CIN) of company ( b ) Global location number (GLN) of company 2. ( a ) Name of the company ( b ) Address of the registered office of the company 3. *Capital structure (rupees in thousand) ( i ) *Paid-up capital ( ii ) Reserves and surplus ( a ) *Free reserves ( b ) *Other reserves 4. Indicate the rate and amount of proposed dividend and how it meets the condition(s) mentioned in the rule 2 of the Companies (Declaration of Dividend out of Reserves) Rules, 1975 ( a ) *Proposal of the company ( b ) *Rate of proposed dividend ( c ) *Amount of proposed dividend ( d ) *Conditions for the non-compliance of which the application is being made 5. Justification for the proposal ( a ) When the company is in loss ( b ) When the profit is inadequate for declaring dividend at the proposed rate 6. * Amount of profits for the current year and the amount proposed to be withdrawn from the general reserves ( a ) Amount proposed to be utilized ( b ) Amount proposed to be withdrawn Attachments 1. *No objection letter from the company's lead financial institution Attach 2. *Copy of board of directors resolution in support of the company's proposal. Attach 3. Optional attachment(s), if any. Declaration To the best of my knowledge and belief, the information given in this application and its attachments is correct and complete. I have been authorised by the board of directors' resolution dated * (DD/MM/YYYY) to sign and submit this application To be digitally signed by Managing director or director or manager or secretary of the company Certificate It is hereby certified that I have verified the above particulars from the books of accounts and records of M/s and found them to be true and correct. To be digitally signed by Chartered accountant or cost accountant or company secretary (in whole-time practice) For office use only Digital signature of the authorising officer This e-Form is hereby approved This e-Form is hereby rejected Instructions for filling of e-Form Sl. No. Detailed Instructions Note : Instructions are not provided for the fields which are self-explanatory Refer the relevant provisions of the Companies Act, 1956 and rules made there under with respect to the matter dealt in this e-Form 1 ( a ) Enter the 'Corporate Identity Number' (CIN) of the company, You may find CIN by entering your existing registration number in the Find CIN/GLN service at the portal www.mca.gov.in 2 ( a ), ( b ) Click the "Pre-fill" button System will automatically display the name and registered office address of the company 4 Enter the following point wise details: ( a ) Brief description for the proposal of the company. ( b ) Rate of proposed dividend. ( c ) Amount of proposed dividend. ( d ) Conditions, for the non-compliance of which the application is being made, as mentioned in the rule 2 of the Companies (Declaration of Dividend out of Reserves) Rules, 1975, 5 Enter in brief the justification for declaration of dividend out of reserves, in cases: ( a ) When the company is in loss. ( b ) When the profit is inadequate for declaring dividend at the proposed rate. 6 Enter the following amounts proposed to be utilized for declaration of dividend: ( a ) Amount of profit for the current year proposed to be utilized for declaration of dividend. ( b ) Amount proposed to be withdrawn from the general reserves for declaration of dividend including the amount for dividend tax Attachments No objection letter from the company's lead financial institution if any. Copy of Board of directors' resolution in support of the company's proposal. Declaration Enter the date of board resolution authorising the signatory to sign and submit the application. Signature The e-Form should be digitally signed by managing director or director or manager or secretary of the company duly authorised by the Board of directors. Certificate The e-Form should be certified by company secretary in whole-time practice by digitally signing the e-Form.