Form No. 4 - Application by depositor Debenture holder under section 58A(9) 72 or section 117C(4) of the Act or section 45QA of the Reserve Bank of India Act, 1934. - Company Law Board Regulations, 1991

Form No. 4 (See regulation 37) [1] [Application by depositor 2[/Debenture holder] *under section 58A(9) [2] [or section 117C(4)] of the Act or section 45QA of the Reserve Bank of India Act, 1934] Before the Company Law Board (.................................. Bench) In the matter of the Companies Act, 1956 (1 of 1956), section 58A 2[or section 117C(4)] [3] [of the Act or section 45QA of the Reserve Bank of India Act, 1934] and In the matter of (state the name of the Depositor2[/Debenture holder]-applicant) and In the matter of .............................................................................. Limited (state the name of the company) (i) Name and address of the Depositor2[/Debenture holder]-applicant; (ii) Name of the company and address of its Registered Office; (iii) Name(s) of depositor(s)2[/debenture holder] with full address; (iv) Amount of Deposit2[/Debenture]; (v) Fixed Deposit2[/Debenture] Receipt No. and Date (Photostat copy to be enclosed); (vi) Terms and conditions of deposit as also date of maturity of deposit; (vii) Details of payment made, by the company, if any; (viii) Actual amount due as on date of application (Principal/Interest); (ix) Details of correspondence, if any, made between the company and the depositor2[/Debenture holder] (copy of correspondence to be enclosed); (x) Any other particular(s) as may be considered relevant; The Depositor2[/Debenture holder]-applicant therefore, prays: (i) that the company, above-named be directed to make repayment of the aforesaid deposit(s)2[/debenture(s)] along with interest due thereon in accordance with the terms and conditions of the deposit2[/debenture]; (ii) that such further orders be passed as the Company Law Board may deem fit in the circumstances of the case. (Signature of the Depositor2[/Debenture holder]-applicant) Place ........................ Date ......................... * Delete whichever is not applicable. Notes: 1. The application shall be accompanied by a fee of Rupees Fifty by way of Bank Draft in favour of 'The pay and Accounts Officer, Department of Company Affairs, New Delhi/Bombay/Calcutta/Madras'. 2. This application shall be made in duplicate. --------------------------------------- Notes:- [1] Substituted for "Application by depositor under section 58A(9)" by the Company Law Board (Amendment) Regulations, 1997, w.e.f. 1-8-1997. [2] Inserted by Company Law Board (Amendment) Regulations, 2001, w.e.f. 15-6-2001. [3] Inserted by the Company Law Board (Amendment) Regulations, 1997, w.e.f. 1-8-1997.