Form of return to be filed with the Registrar pursuant to sub-section (4) of section 187C of the Companies Act, 1956 (1 of 1956)

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....nt to sub-section (4) of section 187C of the Companies Act, 1956 (1 of 1956) Name of the Company ....................................                                            ....

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.................................. Address of its Registered Office ....................                                                    &....

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.... of members Particulars of persons who hold beneficial interest in such shares Nature of the beneficial interest Dates of declarations under sub-sections (1), (2) and (3) received in respect of the said shares together with names of declarants Dates of receipt of the said declarations by the company 1 2 3 4 5 6 7 No. of shares Distinctive Nos. of shares Ki....

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....sp;                                                                  &....