Companies Unpaid Dividend (Transfer to General Revenue Account of The Central Government) Rules, 1978
FORM No. II
(See rule 6(1)]
PART 'A' : Application to the Central Government for an order for payment of the dividend amount out of the General Revenue Account of the Central Government pursuant to section 205B of the Companies Act, 1956
1. Name of the applicant:
2. Postal address of the applicant:
3. Name, registration number and registered address of the company from which the amount is due:
4. Number of shares held:
(i) Preference shares (with distinctive numbers)
(ii) Equity shares (with distinctive numbers).
5. Financial year to which the dividend relates;
6. Amount due:
(i) On preference shares
(ii) On equity shares
(iii) Interest, if any, payable to him pursuant to sub-section (4) of section 205A of the Act, and
(iv) Total of (i), (ii) and (iii) above:
7. Reasons for non-receipt of the amount from the company:
Place
Date
____________________________________
(Signature of the applicant or a person
holding a power of attorney, from the
applicant).
3 [Received from the Registrar of Companies _________ the sum of Rs. _______ (Rupees ____________ in words) being the amount payable to me/us from the General Revenue Account of the Central Government as unclaimed or unpaid dividend (which was originally) due from M/s. _________________
1. Signature of witness. With name, date, address and occupation. |
Signature of claimant with name, date, address and occupation. (on revenue stamp of 20 paise, if the claim is for Rs. 20 or more). |
2. Signature of witness. With name, date, address and occupation. |
Notes:
1. Indemnity bond should be furnished on a non-judicial stamp paper of the requisite value, in case the claim exceeds 4[Rs. 2,500].
2. In the case of deceased shareholder, the legal representative(s) of the deceased shareholder, who is (are) preferring the claim, is (are) required to furnish succession certificate/probate/letters of administration. In case the charge have been transmitted in the name of the claimant, a certificate in this behalf from the company be furnished.
3. Dividend warrant or a photo-copy of the share certificate should be furnished.
4. Separate applications should be made for claims in respect of each company].