Company Law Board Regulations, 1991

FORM NO.4

(See Regulation 37)

APPLICATION BY DEPOSITOR UNDER SECTION 58A (9) OF THE ACT OR SECTION 45QAOF THE RESERVE BANK OF INDIA ACT, 1934 (*delete whichever is not applicable)

BEFORE THE COMPANY LAW BOARD (……………BENCH)

IN THE MATTER OFN THE COMPANIES ACT, 1956 ( 1 OF 1956), (SECTION 58A OF THE ACT OR SECTION 45QA OF THE RESERVE BANK

OF INDIA ACT, 1934)

AND

IN THE MATTER OF (State the name of the Depositor-applicant)

AND

IN THE MATTER OF …………… LIMITED (State the name of the company)

      i.         Name and address of the Depositor-applicant:

     ii.         Name of the company and address of its Registered Office:

    iii.         Name(s)of Depositor (s)with full address:

    iv.         Amount of Deposits\:

     v.         Fixed Deposit Receipt No. & date (Photostat copy to be enclosed):

    vi.         Terms and Conditions of Deposit as also date of Maturity of Deposit:

   vii.         Details of payment made, by the company, if any:

  viii.         Actual amount due as on date of application (Principal/interest)

    ix.         Details of correspondence, if any, made between the company and the Depositor (copy of correspondence to be enclosed):

     x.         Any other particular (s)as may be considered relevant:

The Depositor-applicant, therefore, prays:-

      i.         that the company, abovenamed be directed to make repayment of the aforesaid Deposit(s)along with interest due thereon in accordance with the Terms and Conditions of the Deposit:

     ii.         (ii)that such further orders be passed as the Company Law Board may deed fit in the circumstances of the case.

(Signature of the Depositor-applicant)

Place: ……………..

Date: ……………...

Note :

1.      The application shall be accompanied by a fee of Rupees Fifty, by way of Bank Draft in favour of “The Pay and Accounts Officer, Department of Company Affairs, New Delhi/ Bombay/ Calcutta/ Madras”

2.      This application shall be made in duplicate.