Company Law Board Regulations, 1991

Form No.

4 : 25[Application by depositor *under section 58A(9) of the Act or section 45QA of the Reserve Bank of India Act, 1934]

(See regulation 37)

Before the Company Law Board ( _________________________ Bench)

In the matter of the Companies Act, 1956, section 58A 5[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 Deposit;

(v) Fixed Deposit Receipt No. and 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, above-named 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) that such further orders be passed as the Company Law Board may deem fit in the circumstances of the case.

(Signature of the Depositor-applicant)

Place _______________

Date _______________

*Delete whichever is not applicable.

Notes:

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

2. This application shall be made in duplicate.