FORM NO. 22

FORM NO. 22

Registration No. of Company ………………. Nominal Capital Rs. …………………

THE COMPANIES ACT, 19567

Statutory report

[pursuant to section 165]

Name of company ………………………………………………………….Limited

Statutory report of the ……………………………… certified and field pursuant to section 165(5).

Date of notice for holding statutory meeting ………………………………………………………….

Date of meeting …………………………………………………………………………………………

Place where the meeting is to be held …………………………………………………………………

Presented by ……………………………………………………………………………………………

The board of directors submit this statutory report to the members in pursuance of section 165.

1. Shares allotted and cash received up to ……………………………………….. .

No. of shares

Nominal value of each share

Cash received up to?

(a)

Allotted subject to payment thereof in cash.

(i) ? Equity?

(ii)? Redeemable preference shares.?

(iii) Preference shares other than redeemable?

? ? ? preference? shares.

(b)

Allotted as fully paid up otherwise than in cash and the consideration for which they have been allotted.

(i)? Equity

(ii)? Redeemable preference shares

(iii) Preference shares other than redeemable

? ? ? preference shares.

?

Allotted as party paid up to the extent of Rs. ………..? per share and the consideration for which they have been so allotted.

(i) ? Equity?

(ii)? Redeemable preference shares?

(iii) Preference shares other than redeemable preference shares

2.? Abstract of receipts and payments upto:--

Receipts? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? Rs.

Payments ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? Rs.

Shares?

Preliminary expenses

? ? ? ? ? Equity

? ? ? ? Commission on issue or

? ? ? ? ? Redeemable preference shares.

? ? ? ? ? Sale of shares…………………….

? ? ? ? ? Preference shares other than.

? ? ? ? ? Discount on issue or

? ? ? ? ? redeemable preference shares.

? ? ? ? ? Sale of shares……………………..

Advance payment for shares.

Capital expenditure?

Debentures …………………………….

? ? ? ? ? Land ……………………………..

Loans ………………………………….

? ? ? ? ? Building ………………………….

Deposits ……………………………….

? ? ? ? ? Plant ……………………………..

Other sources ………………………….

? ? ? ? ? ? Machinery……………………….

(to be specified) ……………………….

Other items to be specified?

Balances………………………………….

? ? ? ? ? In hand ……………………………

? ? ? ? ? At banks …………………………..

? ? ? ? ? At post Office …………………….

? ? ? ? ? Saving Bank ………………………

Total

Total

3.? Preliminary expense as estimated in the prospectus or statement in the lieu of ? ? ? prospectus …………………………………..?

preliminary expenses actually incurred up to aforesaid date Rs.?

Preliminary expenses estimated to be incurred after the aforesaid date Rs.

Law carges……………………………………

Other charges in connection with the preparation of the Memorandum?

Articles of Association ………………………

printing expenses ……………………………

Registration charges …………………………

Advertisement charges ………………………

Commission on issue or sale of shares?

……………………………………………..

Discount on issue or sale of shares……………

Other initial expenses.(To be specified as far as possible ).

Total Rs. ………………………………………

4. ? ? Names, addresses and occupation of the company’s Directors, Auditors, Manager and? Secretary.?

Name(s)

Address(es)

Occupation(s)

Particulars of change(s) if any, in entries in columns (1), (2) and (3) since the date of incorporation??

Date of the change

1

2

3

4

5

A.

Directors

B.

Auditors

C.

[***]

D.

Manager

E.

Secretary

These Particulars must include dates of changes.

5.? Particulars of any contract which is to be submitted to the statutory meting for approval. (If any modification or proposed modification of a contract is? to be submitted for such approval, brief particulars of contract and particulars of modification or proposed modification should be given).

6.? Underwriting contracts.

? ? Brief description of each contract.

? ? If contract not carried out fully, extent to which it has not been carried out and reason thereby.

7. ? The arrears, if any, due on calls from Directors, [***]

Names

? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? Amount due?????

Directors

Manager

?

?

8.Particularts of any commission or brokerage paid or to be paid in connection with the issue or sale of shares to any director or Manager.

Names

Commission or brokerage paid or to be paid

On shares

On debentures

Directors

Manager.

We hereby certify that the above report is correct.

Dated the ………………………….. day of ………………….. 19 …………..

Signature of two or more Directors

We hereby certify as correct so much of the report as relates to the shares allotted by the company and to the cash received in respect of such shares and to the receipts and payments.

…………………………….

Auditors

Dated the ………………….. day of ……………… 19

1. The date should be a date within 7 days of the report.
2. Strike out the portion which does not apply.
3. Where there is a managing director, he shall be one of the signatories.