ANNEXURE A - APPLICATION FORM FOR STRIKING OF NAME OF COMPANY UNDER SECTION 560 OF THE COMPANIES ACT, 1956 - Simplified Exit Scheme, 2005

ANNEXURE A APPLICATION FORM FOR STRIKING OF NAME OF COMPANY UNDER SECTION 560 OF THE COMPANIES ACT, 1956 Affix Affix PP size Photo PP size Photo No. of Company Name of Company Address of the Company:: To The Registrar of Companies, --------------- (Name of the State) Sir, The Company after carefully considering all aspects has duly resolved in the Board meeting held on___________ to make an application for striking the name of our company off the Register u/s 560 of the Companies Act, 1956. We, the directors of the company make an application for striking the name of our company off the Register u/s 560 of the Companies Act, 1956. (2) I/We furnish the following details and documents for considering my/our application. (i) Audited Financial Statements for the year ending _____ showing no assets and liabilities. Or (ii) A Statement of Account for the period from _____ to ______ being the latest period applicable for the company. It is declared that due to __________________________________________________________________ _____________ (give here reasons) the Balance Sheet and Profit and Loss Account can not be prepared, hence a Statement of Accounts is submitted. (iii) Affidavits as per Annexure B of this Circular No. 17/78/2001-CL.V dated 28-01-2005 of M/o Company Affairs. (iv) Indemnity Bonds as per Annexure C of the General Circular No. 17/78/2001-CL.V dated 28-01-2005 of M/o Company Affairs. (v) Demand Draft/Pay Order/Banker s Cheque No. _______ dated________ drawn in favour of Registrar of Companies ________ (name of State in which registered office of the company is situated) payable at _________. (vi) NOC from RBI/SEBI as the case may be, in case an NBFC/Collective Investment Management Company is registered with RBI/SEBI. (vii) Copy of Board Resolution and/or other document showing authorization given to us for filing of this application. (3) Now, therefore, the undersigned request you to strike off the name of the company from the Register. (4) I shall be liable under section 628 of the Companies Act, 1956 and under relevant provisions of the Indian Penal Code if I make any statement pursuant to this circular:- (a) which is false in any material particular, knowing it to be false; or (b) which omits any material fact knowing it to be material (5) * Ours is a Collective Investment Management Company (CIMC)/NBFC* registered/not registered* with SEBI/RBI*. For CIMC/NBFC (6) (a) Ours is a CIMC /NBFC company registered with SEBI/RBI. Our registration number with SEBI/RBI is ________________ and we had Head Office at ____________and branches at ____________(indicate places of Branch Offices). We have been issued a No Objection Certificate by SEBI/RBI* to exit from the Register of Companies. (b) Ours is a CIMC /NBFC company not registered with SEBI/RBI. We declare that we had not commenced business or carried out any business or operations or commercial activity at any time. * Clauses 5 and 6 applicable only in case of an CIMC/NBFC * Strike out which-ever is not applicable Yours faithfully, Names and addresses of Applicants 1. Signature Date : 2. Signature