ANNEXURE-A - AFFIDAVIT - Easy Exit Scheme, 2011

ANNEXURE-A AFFIDAVIT (to be given individually by every director) 1. I/, Director of ___________________________________ , (hereinafter called the Company ), incorporated on ___/___/_____ under the Companies Act, 1956 having its Registered Office at __________________and having CIN No __________________ do solemnly affirm and state as under: 2. I/ _______________, S/o/ D/o Shri/ Smt___________, holder of DIN /Income Tax PAN /Passport number: ________________(copy of Income Tax PAN /Passport duly attested by a Gazetted Officer or a whole time practicing professional (Chartered Accountant/ Company Secretary/Cost Accountant) or a Company Secretary in full time employment of the company is enclosed) am Director of the company stated above since_______________(mention date of appointment). 3. My present residential address is _____________________ (Copy of documentary evidence duly attested by a Gazetted Officer or a whole time practicing professional (Chartered Accountant/ Company Secretary/Cost Accountant) or a Company Secretary in full time employment of the company is enclosed. Alternatively, an affidavit sworn before Magistrate may be enclosed) 4. My permanent address is ____________________________ (Copy of documentary evidence duly attested by a Gazetted Officer or a whole time practicing professional (Chartered Accountant/ Company Secretary/Cost Accountant) or a Company Secretary in full time employment of the company is enclosed. Alternatively, an affidavit sworn before Magistrate may be enclosed) 5. The company maintains/does not maintain any bank account as on date (mention details of Bank Account(s) if maintained). 6. I affirm that the Company ___________________ (mention name of the company) have assets and liabilities amounting to Rs.______________ (as per annexed Statement of Accounts). -12- 7. 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) 8. 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. 9. 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, details of which are mentioned under serial number 9 of Form EES, 2011. 10. In case of any loss(es) to any person or any valid claim and liability arising from any person after the striking off the name of the Company________(mention name) from the Register of Companies, I, the director of the company, undertake to indemnify any person for such losses, valid claim and liability and the indemnity bond to this effect is being submitted separately with the application Form. 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 :________________ (Deponent) Date: __________________