ANNEXURE B - AFFIDAVIT - Simplified Exit Scheme, 2005

ANNEXURE B AFFIDAVIT (to be given individually by applicant) I, Director of ___________________________________ Private/Limited, (hereinafter called the Company ), incorporated on ___/___/_____ under the Companies Act, 1956 having its Registered Office at __________________and having PAN No:___________do solemnly affirm and state as under: 1. I _______________, S/o D/o . Shri___________, holder of Passport No: ______/PAN _______ (copy of Passport/PAN duly attested by Gazetted Officer is enclosed) am Director of the company stated above since_______________ 2. My present residential address is __________________(copy of documentary evidence duly attested by Gazetted Officer is enclosed. Alternatively, an affidavit sworn before Magistrate may be enclosed) 3. My permanent address is ________________________(copy of documentary evidence duly attested by Gazetted Officer is enclosed. Alternatively, an affidavit sworn before Magistrate may be enclosed) 4 . The Company was incorporated on __________________ with the object to carry on the business of ____________________________________________________. 5. The company maintains/does not maintain any bank account as on date. 6. The Company has been inoperative from the date of its incorporation. / The company commenced business/operations/commercial activity after incorporation but has been inoperative for the past _________________ year(s) due to following reasons*. ______________ _______________ (give the reasons here) * Strike out whichever is not applicable 7. As on date, the Company does not have any dues towards Income Tax / Sales Tax /Central Excise/ Banks and Financial Institutions; any other Central or State Government Departments/Authorities or any Local Authorities. 8. Strike out whichever is not applicable :- (i) There is no litigation pending against or involving the company. (ii) There are litigations pending against the company which are mentioned as under:- (give brief particulars of litigation and state the authority, with address, where it is pending, along with case number). (iii) The litigation under Companies Act, 1956 or other Act (specify the name of the Act) pertains to an offence which is compoundable and the compounding application has been filed with the appropriate authority. ( A copy of compounding application to be enclosed). 9. I have been authorised to file this application by Board resolution dated _______/. (Copy of resolution is annexed). 10. That an application is hereby filed for action under section 560 of the Companies Act, 1956, before the Registrar of Companies with necessary fees and required Financial Statement/Statement of Account/declaration* signed by me. * Strike out whichever is not applicable. 11. In case of any loss(es) to any person or any valid claim arising from any person after the striking off of the name of the Company from the Register of Companies, , ___________, I the applicant, undertake to indemnify any person for such losses and the indemnity bond to this effect is enclosed and submitted. I solemnly state that the contents of this affidavit are true to the best of my knowledge and belief and that it conceals nothing and that no part of it is false. Signature: ____________________ (Deponent) Verification:- I verify that the contents of this affidavit are true to the best of my knowledge and belief. Place: Signature: ____________________ Date: (Deponent)