Annexure-C - Statement of Account - Easy Exit Scheme, 2010

Annexure-C Statement of Account Name of the Company : CIN No. Statement of Account as on date : Particulars : (Brief break up in respect of each item needs to be given) Amount (Rs.) I. Sources of Funds (1) Capital (2) Reserves Surplus (including balance in Profit and Loss Account) (3) Loan Funds Secured loans from Financial Institutions Secured loans from Banks Secured loans from Govt. Others Secured loans Debentures Unsecured Loans Deposits interest thereon Total Loan Funds Total of (1) to (3) II. Application of Funds (1) Fixed Assets (2) Investments (3) ( i ) Current Assets, Loans and Advances Less : ( ii ) Current Liabilities provisions Creditors Unpaid Dividend Payables Others Total Current Liabilities provisions Net Current assets ( i - ii ) (4) Miscellaneous expenditure to the extent not written off or adjusted (5) Profit Loss Account (Debit balance) Total of 1 to 5 Name and Date : Signature of Place : (Managing Director)* Name and Name and Signature of Signature (Directors) (Secretary)* ................................................................... *Applicable only if there is MD/Secretary Duly certified by Statutory Auditor or Chartered Accountant in whole-time practice. Membership No./Certificate of Practice Number with seal.