Form II - Declaration to be made by a person referred to in sub-section (2) or sub-section (3) of section 187C of the Companies Act, 1956 (1 of 1956) - Companies (Declaration of Beneficial Interest in Shares) Rules, 1975

FORM II [See rule 3(2)] Declaration to be made by a person referred to in sub-section (2) or sub-section (3) of section 187C of the Companies Act, 1956 (1 of 1956) To ............................................ (Name of the company) .............................................. (Address of the registered office) In pursuance of sub-section (2)/sub-section (3) of section 187C of the Companies Act, 1956 (1 of 1956), I hereby declare that I hold/have obtained the beneficial interest in ............................................................ shares bearing Nos .................... and (number) (kind) specify the following particulars, namely: 1. Sl. No. Name Father's/Husband's Name Age Occupation Address Nationality 2. Date of allotment/transfer of the shares in the name of the person or persons referred to above: 3. Date of acquisition of the beneficial interest: 4. Particulars of the person from whom the beneficial interest is acquired; if the transferor of the beneficial interest is also a person who held only a beneficial interest, state whether any declaration under sub-section (2) of section 187C had been made by him to the company. If so, the date of the declaration(s) made by him: 5. Nature of the beneficial interest: 6. Circumstances under which the shares were not registered in my name: Place................... .................................... Date.................... Signature of the person making the declaration .................................. Name and address CERTIFICATE I hereby certify that the beneficial interest in the shares mentioned above has been transferred by me on ........................................... (date) ......................................................... Signature of the person who has transferred the beneficial interest in the shares