FORM No. III - Form of Indemnity Bond - Companies Unpaid Dividend (Transfer to General Revenue Account of the Central Government) Rules, 1978

FORM No. III [See rule 6(3)] Form of Indemnity Bond To The Registrar of Companies, In consideration of your agreeing to pay me the sum of Rs. .............................. (Rupees ...............................................) only, being the amount due to me on dividend for the year ................. from M/s. ...................................... out of the (Name of the company) General Revenue Account of the Central Government, I .................................... son/daughter/wife of ........................... do hereby agree to indemnify you to the extent of any claim not exceeding the amount hereinbefore mentioned which may be preferred against you, and which you may have to lawfully discharge Date .............................. Place ............................. (Signature) Witneses 1. (Signature) Address 2. (Signature) Address