Application for registration of creation or modification of charge for debentures or rectification of particulars filed in respect of creation or modification of charge for debentures

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....le 3 and 13 of The Companies (Registration of charges) Rules 2014] Refer instruction kit for filing the form All fields marked in * are mandatory Entity's Details 1 *Corporate Identity Number (CIN) or Foreign Company Registration Number (FCRN) 2(a) *Name of the Company (b) *Address of the registered office or principal place of business in India of the company (c) *e-mail ID of the company 3(a) *This form is for registration of ○ Creation of charge (b) *Rectification to be made in regard to Type of debentures Extent of charge ☐ Particulars related to present issue of series Description / Particulars of property charged ☐ Particulars of commissions, allowances or discount (c) *Type of debentures Modification of charge ○ Rectification of charge Number of trustees or debentures holders Particulars related to series of debentures Amount secured by charge Principal terms and conditions, extent and operation of charge Particulars of modification Debentures Debenture Stock (d) *SRN of the form for which rectification is being filed (e) Charge ID of the charge to be modified or rectified (f)* SRN of form CHG-8 Bond Any other instrument....

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.... Dwelling Unit ID Number Floor No. Building Name & Society Name Street Name/No. Sector/Block Number Locality Landmark Taluka Pin Code District Village/Town Name State Latitude Longitude Area of dwelling (Sq. feet, Sq. Meter) (iii) Bounded by By North By South By East By West *Survey number, GAT number, Khesra number; khweta number, Mouza number, Phase number or any other such similar representation in various states or union territories can be captured in this field. (All the fields should be captured as appearing in the revenue record, flat no, house no, Municipal Office/Municipal Corporation / Grampanchayat are to be specified and also the area of the immovable property as well as boundaries) Details of charge holder 8 Number of trustee(s) of debenture holders or charge holder(s) 9 Particulars of the charge holder or the trustee of debenture holders (in case charge is modified in favour of ARC or assignee, enter the particulars of ARC or assignee) *Category (Nationalised bank/Scheduled bank/Private Sector Bank/Financial institution/ Non banking financial company/Co-operative bank/Foreign bank/Individual/Others) If others, please specify *Name of th....

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....ale deed/Lease deed/Award/Other Document s) Number Sub registrar Taluka Country Pin Code/Zip code City/Sub- State District /UT Attachments (List of Attachments) (a) *Instrument(s) of creation or modification of charge Max 2 MB Choose File Remove Download (b) Copy of the resolution authorising the issue of the debenture series Max 2 MB Choose File Remove Download (c) Optional attachment(s)- if any Max 2 MB Choose File Remove Download Declaration I am authorised by the Board of Directors of the Company vide resolution no dated to sign this is form and declare that all the requirements of Companies Act, 2013 and the rules made thereunder in respect of the subject matter of this form and matters incidental thereto have been complied with. I also declare that all the information given herein above is true, correct and complete and as per the attached charge instrument(s) or document(s) and nothing material has been suppressed. A copy of the attached charge instrument(s) or document(s) is/are available at the registered office or principal place of business in India of the company. I further declare that: 1 the delay in filing the particulars of creat....

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....s form and matters incidental thereto and I have verified the above particulars (including attachment(s)) from the original/certified records maintained by the Company/applicant which is subject matter of this form and found them to be true, correct and complete and no information material to this form has been suppressed. I further certify that: iii. iv. The said records have been properly prepared, signed by the required officers of the Company and maintained as per the relevant provisions of the Companies Act, 2013 and were found to be in order; All the required attachments have been completely and legibly attached to this form. To be digitally signed by Chartered accountant (in whole-time practice) or Cost accountant (in whole-time practice) or Company secretary (in whole-time practice) DSC BOX Whether associate or fellow: â—‹ Associate Membership number â—‹ Fellow Certificate of practice number Save Submit Note: Attention is drawn to provisions of Section 447, section 448 and 449 of the Companies Act, 2013 which provide for punishment for fraud, punishment for false statement/ certificate and punishment for false evidence respectively. For offi....

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....lder is having a valid Income Tax PAN Income tax-Permanent Account Number (PAN) BSR Code / Branch Code 6.* Date of creation of charge Yes □ No (DD/MM/YYYY) 7. Whether the charge is for Entire series of debentures Any issue in a series of debentures 8. (a) Whether the series of debentures are registered with the Registrar of Companies (ROC) Yes ☐ No (b) If yes, (i) The total amount secured by the whole series (in Rs.) (ii) Date of registration of series 9. (a) Date of present issue of series (b) "Amount of present issue of series (amount secured by the charge) (DD/MM/YYYY) (in Rs.) (DD/MM/YYYY) (In case of modification of charge, enter the amount secured by the charge after such modification) (c) Amount secured by the charge in words 10. Date of resolution authorising the issue of the series 11.(a) "Description of the property charged indicating whether it is a charge on Uncalled share capital Calls made but not paid Movable property Any property for securing the issue of secured deposits Licence under a patent Floating charge Goodwill Trade mark (DD/MM/YYYY) Immovable property or any interest therein Motor Vehicle (Hypothecation) Patent....

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....eeing to procure subscriptions, whether absolute or conditional, for any of the debentures included in this return. Modification of charge 14.(a) "Whether charge is modified in favour of asset reconstruction company(ARC) or assignee Yes No (b) Whether trustee of debenture holders or charge holder is authorised to assign the charge 15.(a) Description of the instrument modifying the charge Yes No (b) Date of instrument modifying the charge (DD/MM/YYYY) MCA 21 Page 4 of 8 16. Particulars of the present modification (Please ensure that correct particulars are entered as the same shall be displayed in the certificate of modification of charge) 17. Description of the document by which the company acquired the title Number of title documents deposited by customer I Document type Document Number Sub-registrar Taluka District State Country code Pin Code Attachment(s) List of attachments Attachment (1) Copy of resolution authorising the issue of debenture series; (2) *Instrument(s) of creation or modification of charge; Attachment (3) (4) Order of the Central Government for rectification of charge; Optional attachments, if any Attachment Attachment Re....