Form III - 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) - Companies (Declaration of Beneficial Interest in Shares) Rules, 1975

Form III 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) Name of the Company .................................... Registration No. of the Company.................................... Address of its Registered Office .................... Nominal Capital............................................................. Sl. No. Particulars of shares in respect of which the person whose name is entered in the register of members of the company as a hold thereof does not holder the beneficial interest in such shares Particulars of persons in whose names the above shares have been registered as holders in the register 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 Kind of shares Face value of shares Paid-up value of shares Name and Nationality Address Father's/Husbands' name Date of entry of name in register Name and Nationality Address Father's/Husband's name Occupation Date ........................ .............................................................................................. Signature of person signing on behalf of the company