FORM II - SEIZURE MEMO OR FREEZING MEMO (INVENTORY OF ITEMS) - Prevention of Money-Laundering (Forms, Search And Seizure or Freezing And The Manner of Forwarding The Reasons And Material To The Adjudicating Authority, Impounding And Custody of Records And The Period of Retention) Rules, 2005

FORM II [See sub‐rule (2) of rule 4] SEIZURE MEMO OR FREEZING MEMO (INVENTORY OF ITEMS) Dated........... From............ [time] to........... [time] Panch Witnesses: 1. .................................. [name with complete address] 2. ................................. [name with complete address] We, the above named panchas having been called upon by Shri ..........................................[name, designation and complete address of Officer] have presented ourselves at ....................[complete address of the premises] Here we were shown an authorisation dated ........................... issued by Shri ........................ [name, designation and complete address of the Director] under section 17 of the Prevention of Money laundering Act, 2002 (15 of 2003) authorising Shri ..........................[name, designation and complete address of the officer authorized by the Director] to conduct search, seizure or freeze of the above mentioned premises. We as well as Shri .....................[name of the occupier of the premises] put our dated signatures on the authorisation in token of having seen the same. Before the actual start of search and after the conclusion of search by Shri..............................[name, designation and complete address of the authority] and the accompanying officers viz. Sarvashri/Shri/Shrimati........................offered their personal search which was declined/taken by Sarvashri/Shri/Shrimati...................[the occupier of the premises] on both the occasions in our presence. The search started at ............hours on ............and concluded at ..............hours on...........As a result of search............[specify proceeds of crime or records] were checked and verified and inventory prepared or recovered and seized or frozen as per details given in the Schedule below. The search was conducted in a peaceful and orderly manner and no damage to the person or property was caused during the course of search. [Signature] Authority [Seal] SCHEDULE [Inventory of items recovered and seized or frozen] Panch Witnesses: 1. ...................... [Signature with date] 2. ........................ [Signature with date] ..................................... [Signature of the person searched] (Authority) Signature with Seal (Received copy) [Signature of the person searched] NOTE :- Each page of the seizure memo or Freezing Memo is to be signed and dated by the Panch Witnesses, the person searched and the Authority.