FORM NO. 19

FORM NO. 19

???????Registration No. of the Company ? ? ? ? ? Nominal Capital: Rs

THE COMPANIES ACT, 1956

Declaration of compliance with the provisions of section 149(1)(a), (b) and ? of the Companies Act, 1956

[pursuant to section 149(1)(d)]

[To be used by a company which issued a prospectus on or with reference to its formation]

Name of the company ? ? Limited?

Presented by

I of being a? director/the secretary of Limited do solemnly and sincerely declare:--

That the amount of the share capital of the company offered to the public for subscription is Rs..

That the amount stated in the prospectus as the minimum amount which, in the opinion of the board of directors, must be raised by the issue of share capital in order to provide for the matters specified in clause(5) of schedule II of the Companies Act, 1956, is Rs. ……………

That shares held subject held subject to the payment of the whole amount thereof in cash have been allotted to the amount of Rs. ………..

That every director of the company has paid to the company on each of the shares taken or contracted to be taken by him , and for which he is liable to pay in c ash a proportion equal to the proportion payable on application and allotment on the shares offered for public subscription except the following? directors, namely

who has/have not taken or contracted to take any shares for which he is/they are liable to pay in cash.

*That no director of the company has taken or contracted to take any shares for which he is liable to pay in cash.

That no money is, or may become liable to be repaid to applicants for any shares or debentures which have been offered for public subscription by reason of any failure to apply for, or to obtain, permission for the shares or debentures to be dealt in on any recognised stock exchange.

The statements in paragraphs ………………… above are true to my knowledge and those in the remaining paragraphs are true to the best of? my information and belief.

Dated this ? ? ? . Day of ? ? ? . 19

Signature

Designation: Director/Secretary

*Delete paragraphs not applicable.