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..... claration is situated as and when shares/convertible debentures/others are issued to the foreign investor, along with the documents mentioned in item No. 4 of the undertaking enclosed to this form) Permanent Account Number (PAN) of the investee company given by the Income-tax Department Date of issue of shares/ convertible debentures/others No. Particulars (In Block Letters) 1. Name Address of the Registered Office State Registration No. given by Registrar of Companies Whether existing company or new company (strike off whichever is not applicable) Existing company/New company If existing company, give registration number allotted by RBI for FDI, if any Telephone Fax e-mail 2. Description of the main business activity NIC Code Location of t .....

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..... y or against import of capital goods units in SEZ, a Chartered Accountant's Certificate certifying the amount outstanding on the date of conversion (c) Break up of premium Amount Control Premium Non-competition fee Others Total please specify the nature (d) Total inflow (in Rupees) on account of issue of shares/convertible debentures/others to non-residents (including premium, if any) vide (i) Remittance through AD: (ii) Debit to NRE/FCNR/Escrow A/c with Bank _________ (iii) Others (please specify) http://www.taxmanagementindia.com/visitor/detail_act.asp?ID=2074 Date of reporting of (i) and (ii) above to RBI under Para 9(1) A of Schedule I to Notification No. FEMA 20 /2000-RB dated May 3, 2000 , as amended from time to time. (e) Disclos .....

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..... ded from time to time. OR (b) Shares issued are bonus. OR (c) Shares have been issued under a scheme of merger and amalgamation of two or more Indian companies or reconstruction by way of demerger or otherwise of an Indian company, duly approved by a court in India. OR (d) Shares are issued under ESOP and the conditions regarding this issue have been satisfied 3. Shares have been issued in terms of SIA /FIPB approval No.__________________ Dated __________________ 4. The foreign investment received and reported now will be utilized in compliance with the provision of a Prevention of Money Laundering Act, 2002 (PMLA) and Unlawful Activities (Prevention) Act, 1967 (UAPA). We confirm that the investment complies with the provisions of all appli .....

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..... 00 ) In respect of the abovementioned details, we certify the following: 1. All the requirements of the Companies Act, 1956 have been complied with. 2. Terms and conditions of the Government approval, if any, have been complied with. 3. The company is eligible to issue shares/convertible debentures/others under these Regulations. 4. The company has all original certificate issued by AD Category-I banks in India, evidencing receipt of amount of consideration in accordance with paragraph 8 of Schedule 1 to Notification No. FEMA 20/2000-RB dated May 3, 2000. (Name Signature of the Company Secretary) (Seal) FOR USE OF THE RESERVE BANK ONLY: Registration Number for the FC-GPR: Unique Identification Number allotted to the Company at the time of r .....

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