[Omitted] FC-GPR

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....king the declaration 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             &....

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....corporation   4 Particulars of Shares/Convertible Debentures/others Issued (a) Nature and date of issue   Nature of issue Date of issue Number of shares/convertible debentures/others 01 IPO/FPO     02 Preferential allotment/private placement     03 Rights     04 Bonus     05 Conversion of ECB     06 Conversion of royalty (including lump sum payments)     07 Conversion against import of capital goods by units in SEZ     08 ESOPs     09 Share Swap     10 Others (please specify)       Total     (b) Type of security issued No. Nature of security Number Maturity F....

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....; We are a listed company and the market value of a share as on date of the issue is*     We are an unlisted company and the fair value of a share is*     **Before issue of shares *(Please indicate as applicable)   5. Post issue pattern of shareholding   Equity Compulsorily convertible Preference Shares/Debentures/others Investor category No. of shares Amount (Face Value) Rs. % No. of shares Amount (Face Value) Rs. % (a) Non-Resident 01 Individuals             02 Companies             03 Flls             04 FVCIs             05 Foreign Tr....

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....0-RB dated 3rd May 2000, as amended 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 invest....