Form No. CHG-2 Certificate of registration of charge. [Pursuant to sections 77(1) and 78 of the Companies Act 2013 and sub-rule (1) of 6 of the Companies (Registration of Charges) Rules, 2014 Corporate identity number (CIN) or foreign company registration number of the company(FCRN) of the company: GLN: Name of the company: Charge Identification No.: This is to certify that pursuant to the provisions contained in Chapter VI of the Companies Act, 2013, the above mentioned charge dated the ____ day of ______two thousand ______, created by the above named company/ ……………………, on behalf of the company in favour of ________ to secure the amount of _______ rupees has been registered and assigned a Charge Identification Number as mentioned above in the Register of Charges, in accordance with the provisions contained in that behalf in Chapter VI of the said Act. Given under my hand and seal, at …….(place), this ________day of _________two thousand ______. Registrar of Companies …………………….. www.taxguru.in
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Form No. CHG-2
Certificate of registration of charge.
[Pursuant to sections 77(1) and 78 of the Companies Act 2013 and
sub-rule (1) of 6 of the Companies (Registration of Charges) Rules,
2014
Corporate identity number (CIN) or foreign company registration
number of the company(FCRN) of the company:
GLN:
Name of the company:
Charge Identification No.:
This is to certify that pursuant to the provisions contained in
Chapter VI of the Companies Act, 2013, the above mentioned
charge dated the ____ day of ______two thousand ______,
created by the above named company/ ……………………, on behalf
of the company in favour of ________ to secure the amount of
_______ rupees has been registered and assigned a Charge
Identification Number as mentioned above in the Register of
Charges, in accordance with the provisions contained in that
behalf in Chapter VI of the said Act.
Given under my hand and seal, at …….(place), this ________day
of _________two thousand ______.
Registrar of Companies
……………………..
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Form No. CHG-3
Certificate of registration of modification of charge [Pursuant
to section 79(b) of the Companies Act 2013 and sub-rule (2) of rule
6 of the Companies (Registration of Charges) Rules, 2014
Corporate identity number (CIN) or foreign company registration
number (FCRN) of the company:
Name of the company:
Charge Identification No.:
This is to certify that pursuant to the provisions contained in
Chapter VI of the Companies Act 2013, the above charge dated
the……. Day of ……… 20… created in favour of …………….to secure
the amount of Rs.__________ has been modified in the following
manner:
Brief particulars of the modification: (as appearing in Form No.
6.1 filed for modification of
charge)
and the above modification has been registered and assigned a
Charge Identification Number as mentioned above in the Register
of Charges, in accordance with the provisions contained in that
behalf in Chapter VI of the said Act.
Given under my hand at …….(place), this ________day of
_________two thousand _____.
Registrar of Companies
……………………..
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Form No. CHG-5
Memorandum of satisfaction of charge
Section 82/83 of the Companies Act 2013 and sub-rule (2) of rule 8
of the Companies (Registration of Charges) Rules, 2014
1 (a) Corporate identity number (CIN) or foreign company
registration number (FCRN) of the company:
(b) GLN
2 (a) Name of the company:
(b) Charge Identification Number:
This is to certify that pursuant to the provisions contained in
Chapter VI of the Companies Act 2013, the above charge for Rs.
_______only has been satisfied in full on ……… day of ……… two
thousand ……….. in accordance with the provisions contained in
that behalf in Chapter VI of the said Act.
Given under my hand and seal at _____(place), this ________day
of _________two thousand _____.
Registrar of Companies
___________________
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Form No. CHG-7
Register of charges
[Pursuant to section 85 sub-rule (1) of rule 10 of the
Companies (Registration of Charges) Rules, 2014]
S.No Charge
ID
Date of creation
of charge or date
of acquisition of
property subject
to charge
Date of
registration
of creation of
charge
Short
description
of the
property
charged
(1) (2) (3) (4) (5)
Period and
amount
secured by
the charge
Names and
addresses of the
charge holder
Particulars of
the terms and
conditions of
the charge
Description
of the
instrument
creating the
charge
(6) (7) (8) (9)
Date of
modification
of charge
Date of
registration
of
modification
of charge
Description of
the
instrument
modifying the
charge
Particulars
of
modification
(10) (11) (12) (13)
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Date of
satisfaction
Date of
registration
of
satisfaction
Facts and date
of
condonation
of delay, if any
Reasons for
delay in filing
for registration
of creation,
modification or
satisfaction of
the charge, if
any
(14) (15) (16) (17)
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FORM NO. CHG.1 [Pursuant to sections 77,78 and 79 and pursuant to Section 384 read with 77,78 and 79 of the Companies Act, 2013 and Rule 3 (1) of the Companies( Registration of Charges) Rules 2014]
Application for registration of creation, modification of charge (other than those related to debentures) including particulars of modification of charge by Asset Reconstruction Company in terms of Securitization and Reconstruction of Financial Assets and Enforcement of
Securities Interest Act, 2002 (SARFAESI)
Form Language o English o Hindi
Refer the instruction kit for filing the form. 1. (a) *Corporate identity number (CIN) or foreign company
registration number (FCRN) of the company (b) Global Location Number (GLN) of company 2. (a) Name of the company
(b) Address of the registered office or principal place of business in India of the company
(c) email id of the company
3. (a) *This form is for registration of
□ Creation of charge □ Modification of charge
(b) Charge ID of the charge to be modified.
(c) SRN of form INC.28
4. *Whether the applicant is □ The company □ The charge holder
5. Whether the form is being filed
(i) *Beyond 30 days but within 300 days from the date of creation or modification □ Yes □ No
(ii) If yes, give reasons for the delay and mention the duration of delay (iii) Beyond 300 days □ Yes □ No (if yes, an application will be required to be made to Central Government for extension of further time) 6. (a) Whether charge is modified in favour of asset reconstruction company (ARC) or assignee
□ Yes □ No (b) Whether charge holder is authorised to assign the charge as per the charge agreement □ Yes □ No
7. (a) *Date of the instrument creating or modifying the charge
(b) *Nature, description and brief particulars of the instrument(s) creating or modifying the charge (c) *Whether charge is created or modified outside India □ Yes □ No 8. Type of charge
*(a) A charge on Immovable property or
any interest therein Movable property (not being
pledge)
(Hypothecation) Any property for securing the
issue of secured deposits
Licence under a patent Copyright
Book debts
Ship or any share in a ship
Solely of Property situated outside India
Others
(b) If others, specify
9. (a) *Whether consortium finance is involved □ Yes □ No
If Yes, enter Lead Banker’s name (b) *Whether joint charge is involved □ Yes □ No (c) *Number of charge holder(s) (Note: If more than one charge holder involved then attach the names of charge holders, details of extent to the charge, particulars of property charged, amount secured)
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10. Particulars of the charge holder (in case charge is modified in favour of ARC or assignee, enter the
particulars of ARC or assignee)
Category
If others, specify Name In case of others, specify CIN, if applicable *Name Address *Line I Line II *City
*State *ISO country code
Country
*Pin code
*e-mail id
11. (a) *Amount secured by the charge (in Rs.)
(In case the amount is in foreign currency, rupee equivalent to be stated) (In case of modification of charge, enter the amount secured by the charge after such modification)
(b) Amount secured by the charge in words (c) In case amount secured by the charge is in foreign currency, mention details 12. Brief particulars of the principal terms and conditions and extent and operation of the charge
(a) *Rate of interest (b) *Terms of repayment (c) *Margin (d) *Extent and operation of the charge (e) Others
13. In case of acquisition of property, subjected to charge, furnish the details relating to the existing charge on
the property so acquired
(a) Date of instrument creating or evidencing the charge (b) Description of the instrument creating or evidencing the charge (c) Date of acquisition of the property (d) Amount of the charge (in Rs.) (e) Particulars of the property charged
14. *Short particulars of the property or asset(s) charged (including complete address and location of the
property)
(i)
(ii)
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(iii)
(iv)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
15. (a) *Whether any of the property or interest therein under reference is not registered in the name of the
company □ Yes □ No
(b) If yes, name of the person in whose name it is registered
16. Date of creation/last modification prior to the present modification 17. Particulars of the present modification (please ensure that the correct particulars are entered as the same shall be displayed in the certificate of modification of charge) Attachments (1) *Instrument(s) of creation or modification of charge;
(2) Instrument(s) evidencing creation or modification of charge
in case of acquisition of property which is already subject to
charge together with the instrument evidencing such acquisitions; (3) Particulars of all joint charge holders;
(4) Optional attachments, if any
Declaration
� I am authorized by the Board of Directors of the Company vide resolution number * *dated
to sign this form and declare that all the requirements of Companies Act, 2013 and the
rules made thereunder in respect of the subject matter of this form and matters incidental thereto have been complied with. I also declare that all the information given herein above is true, correct and complete and as per the attached charge instrument(s) or document(s) and nothing material has been suppressed. A copy of the attached charge instrument(s) or document(s) is/ are available at the registered office or principal place of business in India of the company.
□ I further declare that: (a) the delay in filing the particulars of creation/modification, was accidental or due to inadvertence or some
other sufficient cause and are or is not of a nature to prejudice the position of the charge holder,
shareholders or creditors of the company;
(b) no prejudice would be caused to the charge holder(s) or any other creditor(s) of the company, if the delay
is condoned;
(c) the company has not created or modified any other charge(s) whatsoever on the assets of the company,
since the creation / modification of the present charge, for which the application for condonation of delay
is being filed;
(d) the company is carrying on the business as on the date of filing this application and no
proceedings to wind-up the company have commenced or are pending against the company;
(e) there is no litigation proceedings pending before any court of law for which condonation of delay is being
filed;
(f) the company has not applied for striking off the name of the company from the register of
Registrar of Companies
To be digitally signed by
Director or manager or secretary or CEO or CFO (In case of an Indian company) or an authorised representative (In case of a foreign company) Designation
DSC
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DIN of the director; DIN or PAN of the manager or CEO or CFO or authorised representative; or membership number of company secretary
Declaration I/we confirm that the attached charge instrument(s) or document(s) is/are true copies of the original which is/are available with the charge holder and/or assignee and all the information and particulars mentioned above are derived there from are concisely and correctly stated. I/we am/are duly authorised to sign this form. To be digitally signed by Charge Holder PAN of the charge holder To be digitally signed by ARC or assignee PAN of the ARC or assignee To be digitally signed by
Designation PAN Note: Attention is also drawn to provisions of Section 447, section 448 and 449 of the Companies Act, 2013 which provide for punishment for fraud, punishment for false statement and punishment for false evidence respectively.
DSC
DSC
DSC
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FORM NO. CHG.4
[Pursuant to section 82(1) of the Companies Act, 2013 and Rule 8(1) of the Companies (Registration of charges)Rules 2014]
Particulars for satisfaction of charge
thereof
Form Language o English o Hindi
Refer the instruction kit for filing the form
1. (a) *Corporate identity number (CIN) or
foreign company registration number (FCRN) of the company (b) Global location number (GLN) of company 2. (a) Name of the company
(b) Address of the registered office or principal place of business in India of the company
(c) email ID of the company
3. *This form is for registration of O Satisfaction of charge
4. (a) (i) *Whether the form is being filed beyond 30 days □ Yes □ No
If yes, give reasons for the delay and mention the duration of delay (ii) *Whether the applicant is o Company o Charge holder (b) *SRN of Form CHG.4 filed for satisfaction of charge (c) *SRN of Form INC.28
Pre-fill
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7. *Date of Satisfaction of charge in full Attachments 1. *Letter of the charge holder stating that the amount
has been satisfied;
2. Order of the Central Government;
3. Optional attachment(s)
Declaration
� I am authorized by the Board of Directors of the Company vide resolution no.* dated*
to sign this form and declare that all the requirements of Companies Act, 2013 and the rules made thereunder in respect of the subject matter of this form and matters incidental thereto have been complied with. I also declare that all the information given herein above is true, correct and complete and as per the attached charge instrument(s) or document(s) and nothing material has been suppressed.
� I further declare that:
1. the delay in filing the particulars of satisfaction, was accidental or due to inadvertence or some other sufficient
cause and are or is not of a nature to prejudice the position of the charge holder, shareholders or creditors
of the company;
2. no prejudice would be caused to the charge holder(s) or any other creditor(s) of the company, if the delay is
condoned;
3. the company has not created or modified any other charge(s) whatsoever on the assets of the company, since
the satisfaction of the present charge, for which the application for condonation of delay is being filed;
4. the company is carrying on the business as on the date of filing this application and no
proceedings to wind-up the company have commenced or are pending against the company;
5. there is no litigation proceedings pending before any court of law for which condonation of delay is being filed;
6. the company has not applied for striking off the name of the company from the register of
Registrar of Companies
To be digitally signed by Director or manager or company secretary or CEO or CFO (in case of an Indian company) or an authorised representative (in case of a foreign company) Designation
DIN of the director; or DIN or PAN of the manager or CEO or CFO or authorised representative; or Membership number of the company secretary
Declaration I/we confirm that the attached charge instrument(s) or document(s) is/are true copies of the original which is/are available with the charge holder and/or assignee and all the information and particulars mentioned above are derived there from are concisely and correctly stated. I/we am/are duly authorised to sign this form. To be digitally signed by
DSC Box
DSC Box
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Charge Holder (financial institution or bank or debenture holder etc.) PAN Email ID To be digitally signed by ARC or assignee PAN Email ID To be digitally signed by PAN Designation Email ID
Note: Attention is also drawn to provisions of Section 447, section 448 and 449 of the Companies Act, 2013 which provide for punishment for fraud, punishment for false statement and punishment for false evidence respectively.
DSC Box
DSC Box
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FORM NO. CHG.6
[Pursuant to section 84(1) and pursuant to Section 384 of the Companies Act, 2013 and Rule 9 of the Companies (Registration of charges) Rules 2014]
Notice of appointment or cessation of receiver or
manager
Form Language o English o Hindi
Refer the instruction kit for filing the form.
3. (a) *This notice is being filed by O Person appointing receiver or manager O Person appointed as receiver or manager (b) *Type of Notice O Appointment O Cessation
5. *Date of appointment (DD/MM/YYYY) 6. *Date of Cessation (DD/MM/YYYY) 7. * Whether the appointment or cessation is O Pursuance to an order of court O Pursuance to any instrument 8. (a) Number of charges (b) Pursuance to an order of court
Court reference Date of Court order (DD/MM/YYYY)
Charge ID Appointment relating to whole of the property of the company
Appointment relating to income arising from whole of the property of the company
O Yes O No O Yes O No
(c) Pursuance to any instrument
Description of instrument
Date of instrument (DD/MM/YYYY)
Charge ID Appointment relating to whole of the property of the company
Appointment relating to income arising from whole
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of the property of the company
O Yes O No O Yes O No
Attachments
1. *Copy of instrument appointing receiver/ manager;
2. *Copy of court order;
3. List of specified property of the company in case the
appointment relates to specified property of the
company;
4. List of specified property of the company in case the
appointment relates to income arising from
specified property of the company;
5. Optional attachment(s), if any
Declaration
I declare that whatever stated above is true correct and complete and nothing material has been suppressed including the attachments to this form. I am duly authorised to sign this form. To be digitally signed by
Person appointing receiver or manager PAN
To be digitally signed by Receiver or manager
PAN
Note: Attention is also drawn to provisions of Section 447, section 448 and 449 of the Companies Act, 2013 which provide for punishment for fraud, punishment for false statement and punishment for false evidence respectively
DSC Box
DSC Box
Attachment
Attachment
Attachment
Attachment
Attachment
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FO
RM
NO
. C
HG
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reg
istr
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on
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tem
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Fo
rm
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En
gli
sh
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ind
i
Refe
r t
he in
str
ucti
on
kit
fo
r f
ilin
g t
he f
orm
.
16
. (
a)
*Corp
ora
te identity
num
ber
(CIN
) or
fore
ign c
om
pany
r
egis
tration n
um
ber
(FCRN
) of th
e c
om
pany
(
b)
Glo
bal Location N
um
ber
(GLN
) of com
pany
17
. (a
) N
am
e o
f th
e c
om
pany
(b)
Addre
ss o
f th
e r
egis
tere
d o
ffic
e o
r princip
al pla
ce o
f busin
ess in I
ndia
of th
e c
om
pany
(
c)
em
ail I
D o
f th
e c
om
pany
18
. *This
form
is for
condonation o
f
�
Dela
y in r
egis
tration o
f
�
Cre
ation o
f Charg
e
�
Modific
ation o
f Charg
e
�
Satisfa
ction o
f Charg
e
�
Om
issio
n o
r m
issta
tem
ent
of any p
art
icula
r in
respect
of
�
Cre
ation o
f Charg
e
�
Modific
ation o
f Charg
e
�
Satisfa
ction o
f Charg
e
Pre-F
ill
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4.
*The a
pplication is m
ade b
y
□
Com
pany □
Any o
ther
inte
reste
d p
ers
on
5.
*SRN
of re
levant
form
O
Form
CH
G.1
O
Form
CH
G.4
O
Form
CH
G.9
6.
Charg
e identification n
um
ber(
ID)
7.
(a)
*D
ate
of
cre
ation/m
odific
ation/s
atisfa
ction o
f charg
e e
nte
red in t
he r
ele
vant
form
(
b)
*Am
ount
of charg
e c
reate
d/m
odifie
d/s
atisfied
(
c)
*N
am
e(s
) of th
e c
harg
e h
old
er(
s)
(
d)
*Part
icula
rs o
f th
e p
ropert
y o
r asset(
s)
charg
ed (
inclu
din
g c
om
ple
te a
ddre
ss a
nd location o
f th
e p
ropert
y)
8.
*Reasons for
dela
y/o
mis
sio
n/m
issta
tem
ent
in f
ilin
g
9.
*D
eta
ils o
f om
issio
n/m
issta
tem
ent
and t
he r
elief re
quired
Att
ach
men
t(s)
L
ist
of
att
ach
men
ts
1.
*In
str
um
ent
cre
ating/m
odifyin
g/s
atisfy
ing t
he c
harg
e;
2.
Lett
er
of
auth
orisation (
in c
ase o
f Auth
orised
R
epre
senta
tive o
f a fore
ign c
om
pany);
3
. Copy o
f re
solu
tion o
f th
e B
oard
auth
orisin
g t
he filin
g
o
f th
e a
pplication a
nd a
ppoin
ting t
he a
uth
orized
r
epre
senta
tive, if a
ny;
4. Affid
avit;
5. Confirm
ation fro
m t
he C
harg
e-h
old
er;
Att
ach
men
t
Att
ach
men
t
Att
ach
men
t
Att
ach
men
t
Att
ach
men
t
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6. Bala
nce S
heet
and A
nnual Retu
rn o
f financia
l year
in
whic
h form
was filed for
whic
h r
ectification is d
one (
if
com
ple
ted);
7. O
ptional att
achm
ent,
(if a
ny)
Decla
rati
on
(if a
pplicant
is c
om
pany)
I
�
do s
ole
mnly
decla
re t
hat
I am
the (
Dro
p d
ow
n:
valu
es-
directo
r or
manager
or
com
pany s
ecre
tary
or
CEO
or
CFO
or
an
auth
orised r
epre
senta
tive);
�
and it
is furt
her
decla
red t
hat
1.
the d
ela
y in f
ilin
g t
he p
art
icula
rs o
f cre
ation/m
odific
ation/s
atisfa
ction o
r om
issio
n o
r m
issta
tem
ent,
was a
ccid
enta
l or
due t
o inadvert
ence o
r som
e o
ther
suffic
ient
cause a
nd a
re o
r is
not
of a n
atu
re t
o p
reju
dic
e t
he p
ositio
n o
f th
e charg
e
hold
er,
share
hold
ers
or
cre
ditors
of th
e c
om
pany;
2.
no p
reju
dic
e w
ould
be c
aused to the c
harg
e h
old
er(
s)
or
any o
ther
cre
ditor(
s)
of th
e c
om
pany, if the d
ela
y is
condoned
or
om
issio
n o
r m
issta
tem
ent
is r
ectified;
3.
the c
om
pany h
as n
ot
cre
ate
d o
r m
odifie
d a
ny o
ther
charg
e(s
) w
hats
oever
on t
he a
ssets
of
the c
om
pany,
sin
ce t
he
cre
ation /
modific
ation o
f th
e p
resent
charg
e, fo
r w
hic
h t
he a
pplication for
condonation o
f dela
y is b
ein
g filed;
4.
the
com
pany
is
carr
yin
g
on
the
busin
ess
as
on
the
date
of
filing
this
application
and
no
pro
ceedin
gs t
o w
ind-u
p t
he c
om
pany h
ave c
om
menced o
r are
pendin
g a
gain
st
the c
om
pany;
5.
there
is n
o litig
ation p
roceedin
gs is p
endin
g b
efo
re a
ny c
ourt
of
law
for
whic
h c
ondonation o
f dela
y is b
ein
g filed;
6.
the
com
pany
has
not
applied
for
str
ikin
g
off
the
nam
e
of
the
com
pany
from
th
e
Regis
ter
of
Regis
trar
of Com
panie
s.
To
be d
igit
ally s
ign
ed
by
Directo
r or
manager
or
com
pany s
ecre
tary
or
CEO
or
CFO
(In
case o
f an I
ndia
n
com
pany)
or
an a
uth
orised r
epre
senta
tive (
In c
ase o
f a f
ore
ign c
om
pany)
Desig
nation
DIN
of th
e d
irecto
r; o
r D
IN o
r PAN
of th
e m
anager
or
CEO
or
CFO
or
or
auth
orised r
epre
senta
tive;
or
Mem
bers
hip
num
ber
of
the c
om
pany s
ecre
tary
D
ecla
rati
on
(if a
pplicant
is a
ny p
ers
on o
ther
than t
he c
om
pany)
I confirm
that th
e d
ela
y in filin
g the p
art
icula
rs o
f cre
ation/m
odific
ation/s
atisfa
ction o
r om
issio
n o
r m
issta
tem
ent,
was a
ccid
enta
l or
due to inadvert
ence o
r som
e o
ther
suff
icie
nt cause a
nd a
re o
r is
not of a n
atu
re to p
reju
dic
e t
he p
ositio
n o
f th
e c
harg
e h
old
er,
share
hold
ers
or
cre
ditors
of
the c
om
pany a
nd a
ll t
he info
rmation a
nd p
art
icula
rs m
entioned a
bove a
re c
oncis
ely
and c
orr
ectly
sta
ted.
T
o b
e d
igit
ally s
ign
ed
by
Charg
e H
old
er
PAN
DS
C
DS
C
Att
ach
men
t
Rem
ove a
tta
ch
men
t A
tta
ch
men
t
www.taxguru.in
To
be d
igit
ally s
ign
ed
by
ARC o
r assig
nee
PA
N
To
be d
igit
ally s
ign
ed
by
Desig
nation
P
AN
No
te:
Att
en
tion
is a
lso
draw
n t
o p
rovis
ion
s o
f S
ecti
on
44
7,
secti
on
44
8 a
nd
44
9 o
f th
e C
om
pan
ies A
ct,
20
13
w
hic
h p
rovid
e f
or p
un
ish
men
t fo
r f
rau
d,
pu
nis
hm
en
t fo
r f
als
e s
tate
men
t an
d p
un
ish
men
t fo
r f
als
e e
vid
en
ce
resp
ecti
vely
D
SC
DS
C
www.taxguru.in
FO
RM
NO
. C
HG
.9
[P
ursu
an
t to
secti
on
s 7
1(3
),
77
,78
& 7
9
an
d p
urs
uan
t to
Secti
on
38
4 r
ead
wit
h
71
(3
),
77
,78
an
d 7
9 o
f T
he C
om
pan
ies A
ct,
2
01
3 a
nd
Ru
le 3
of
Th
e C
om
pan
ies(
Reg
istr
ati
on
of
ch
arg
es) R
ule
s 2
01
4]
Ap
plicati
on
fo
r r
eg
istr
ati
on
of
creati
on
or m
od
ific
ati
on
of
ch
arg
e
for d
eb
en
tures o
r
recti
ficati
on
of
parti
cu
lars f
iled
in
resp
ect
of
creati
on
or m
od
ific
ati
on
of
ch
arg
e
for d
eb
en
tures
Fo
rm
Lan
gu
ag
e o
En
glish
o H
ind
i
Refe
r t
he in
str
ucti
on
kit
fo
r f
ilin
g t
he f
orm
.
3.
(a)
*This
form
is for
o C
reation o
f charg
e o
Modific
ation o
f charg
e o R
ectification o
f charg
e
(b)
*Type o
f debentu
res
o D
ebentu
res o D
ebentu
re S
tock
o B
ond
o A
ny o
ther
instr
um
ent
(c)
SRN
of
the form
for
whic
h r
ectification is b
ein
g filed
(d)
Charg
e I
D o
f th
e c
harg
e t
o b
e m
odifie
d o
r re
ctified
(e)
SRN
of fo
rm I
NC.2
8
(f)
Rectification t
o b
e m
ade in r
egard
to
□ T
ype o
f debentu
res
□
Num
ber
of
truste
es o
r debentu
re h
old
ers
□ P
art
icula
rs r
ela
ted t
o s
eries o
f debentu
res □
Part
icula
rs r
ela
ted t
o p
resent
issue o
f series
□ A
mount
secure
d b
y c
harg
e
□ D
escription /
Part
icula
rs o
f pro
pert
y c
harg
ed
□ P
rincip
al te
rms a
nd c
onditio
ns,
exte
nt
and o
pera
tion o
f charg
e □ E
xte
nt
of
charg
e
□ P
art
icula
rs o
f com
mis
sio
ns,
allow
ances o
r dis
count
4.
(a)
*w
heth
er
applicant
is □ C
om
pany □ T
ruste
e o
f debentu
re h
old
ers
or
charg
e h
old
er
(b)
Wheth
er
the form
is b
ein
g f
iled
(
i) *
Beyond 3
0 d
ays b
ut
within
300 d
ays fro
m t
he d
ate
of
cre
ation o
r m
odific
ation
□ Y
es
□ N
o
(ii)
If y
es, giv
e r
easons for
the d
ela
y a
nd m
ention t
he d
ura
tion o
f dela
y
www.taxguru.in
(i
ii)
Beyond 3
00 d
ays □ Y
es □
No
(
if y
es,
an a
pplication w
ill be r
equired t
o b
e m
ade t
o C
entr
al G
overn
ment
for
exte
nsio
n o
f fu
rther
tim
e)
5. * N
um
ber
of tr
uste
e(s
) of debentu
rehold
ers
or
charg
ehold
er(
s)
Part
icula
rs o
f th
e t
ruste
e o
f debentu
re h
old
ers
or
charg
e h
old
er
(in c
ase c
harg
e is m
odifie
d in favour
of ARC o
r assig
nee,
ente
r th
e p
art
icula
rs o
f ARC o
r assig
nee)
Nam
e
I
n c
ase o
f oth
ers
, specify
CIN
, if a
pplicable
*N
am
e
Addre
ss *
Lin
e I
Lin
e I
I *City
*Sta
te *
ISO
countr
y c
ode
*Countr
y
*Pin
code
*e-m
ail id
Get
Lis
t of
Ch
arg
e h
old
ers
Pre-f
ill
www.taxguru.in
I
mm
ovable
pro
pert
y o
r any
inte
rest
there
in
Movable
pro
pert
y (
not
bein
g
ple
dge)
(H
ypoth
ecation)
Any p
ropert
y for
securing t
he
issue o
f secure
d d
eposits
Lic
ence u
nder
a p
ate
nt
C
opyright
Book d
ebts
Ship
or
any s
hare
in a
ship
Sole
ly o
f Pro
pert
y s
ituate
d
outs
ide I
ndia
O
thers
www.taxguru.in
www.taxguru.in
A
ttach
men
t(s)
L
ist
of
att
ach
men
ts
(5)
Copy o
f re
solu
tion a
uth
orisin
g t
he issue o
f debentu
re s
eries;
(6)
Instr
um
ent(
s)
of cre
ation o
r m
odific
ation o
f charg
e;
(7)
Ord
er
of th
e C
entr
al G
overn
ment
for
rectification o
f charg
e;
(8)
Optional att
achm
ents
, if a
ny
A
tta
ch
men
t
Att
ach
men
t
Att
ach
men
t
Att
ach
men
t
Rem
ove a
tta
ch
men
t
www.taxguru.in
D
ecla
rati
on
�
I
am
auth
orized b
y t
he B
oard
of D
irecto
rs o
f th
e C
om
pany v
ide r
esolu
tion n
um
ber.
* *date
d t
o s
ign t
his
form
and d
ecla
re t
hat
all t
he
requirem
ents
of Com
panie
s A
ct,
2013 a
nd t
he r
ule
s m
ade t
here
under
in r
espect
of th
e s
ubje
ct
matt
er
of th
is form
and m
att
ers
incid
enta
l th
ere
to h
ave b
een c
om
plied
with.
I als
o d
ecla
re t
hat
all t
he info
rmation g
iven h
ere
in a
bove is t
rue,
corr
ect
and c
om
ple
te a
nd a
s p
er
the a
ttached c
harg
e instr
um
ent(
s)
or
docum
ent(
s)
and n
oth
ing
mate
rial has b
een s
uppre
ssed.
A c
opy o
f th
e a
ttached c
harg
e instr
um
ent(
s)
or
docum
ent(
s)
is/
are
available
at
the r
egis
tere
d o
ffic
e o
r princip
al pla
ce o
f busin
ess in
India
of
the c
om
pany.
□
I f
urt
her
decla
re t
hat:
(g)
the d
ela
y in filin
g the p
art
icula
rs o
f cre
ation/m
odific
ation, w
as a
ccid
enta
l or
due to inadvert
ence o
r som
e o
ther
suff
icie
nt cause a
nd a
re o
r is
not of a n
atu
re to p
reju
dic
e
the p
ositio
n o
f th
e charg
e h
old
er,
share
hold
ers
or
cre
ditors
of th
e c
om
pany;
(h)
no p
reju
dic
e w
ould
be c
aused t
o t
he c
harg
e h
old
er(
s)
or
any o
ther
cre
ditor(
s)
of th
e c
om
pany,
if t
he d
ela
y is
condoned;
(i)
the c
om
pany h
as n
ot
cre
ate
d o
r m
odifie
d a
ny o
ther
charg
e(s
) w
hats
oever
on t
he a
ssets
of
the c
om
pany,
sin
ce t
he c
reation /
modific
ation o
f th
e p
resent
charg
e, fo
r
whic
h t
he a
pplication for
condonation o
f dela
y is b
ein
g f
iled;
(j)
the
com
pany
is
carr
yin
g
on
the
busin
ess
as
on
the
date
of
filing
this
application
and
no
pro
ceedin
gs t
o w
ind-u
p t
he c
om
pany h
ave c
om
menced o
r are
pendin
g a
gain
st
the c
om
pany;
(k)
there
is n
o litig
ation p
roceedin
gs p
endin
g b
efo
re a
ny c
ourt
of
law
for
whic
h c
ondonation o
f dela
y is b
ein
g f
iled;
(l)
the
com
pany
has
not
applied
for
str
ikin
g
off
the
nam
e
of
the
com
pany
from
th
e
regis
ter
of
Regis
trar
of Com
panie
s
To
be d
igit
ally s
ign
ed
by
Directo
r or
manager
or
secre
tary
or
CEO
or
CFO
(In
case o
f an I
ndia
n c
om
pany)
or
an a
uth
orised r
epre
senta
tive (
In c
ase o
f a fore
ign c
om
pany)
Desig
nation
DIN
of th
e d
irecto
r; D
IN o
r PAN
of
the m
anager
or
CEO
or
CFO
or
Auth
orised r
epre
senta
tive;
or
mem
bers
hip
num
ber
of com
pany s
ecre
tary
Decla
rati
on
I/
we
confirm
th
at
the
att
ached
charg
e
instr
um
ent(
s)
or
docum
ent(
s)
is/a
re
true
copie
s
of
the
origin
al
whic
h
is/a
re
available
w
ith
the
charg
e
hold
er
and/o
r assig
nee
and
all
the
info
rmation
and
part
icula
rs
mentioned
above
are
derived t
here
fro
m a
re c
oncis
ely
and c
orr
ectly s
tate
d. I/
we a
m/a
re d
uly
auth
orised t
o s
ign t
his
form
. T
o b
e d
igit
ally s
ign
ed
by
Tru
ste
e o
f debentu
re h
old
ers
or
Charg
e H
old
er
PAN
DS
C
DS
C
www.taxguru.in
To
be d
igit
ally s
ign
ed
by
ARC o
r assig
nee
PAN
T
o b
e d
igit
ally s
ign
ed
by
Desig
nation
PAN
No
te:
Att
en
tion
is a
lso
draw
n t
o p
rovis
ion
s o
f S
ecti
on
44
7,
secti
on
44
8 a
nd
44
9 o
f th
e C
om
pan
ies A
ct,
20
13
wh
ich
provid
e f
or
pu
nis
hm
en
t fo
r f
rau
d,
pu
nis
hm
en
t fo
r f
als
e s
tate
men
t an
d p
un
ish
men
t fo
r f
als
e e
vid
en
ce r
esp
ecti
vely
DS
C
DS
C
www.taxguru.in
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