ANNEXURE I - Statement of unclaimed dividends or undistributed assets, paid under sections 555(1) and (2) into the Company's Liquidation Account in the Reserve Bank of India to be furnished under section 555(3) - Company’s Liquidation Accounts Rules, 1965

ANNEXURE I (See rule 7) Statement of unclaimed dividends or undistributed assets, paid under sections 555(1) and (2) into the Company's Liquidation Account in the Reserve Bank of India to be furnished under section 555(3) Name of the company.......................................... Nature of the proceeding [1] .......................................... Date of commencement of winding-up............................ Date of payment into the Company's Liquidation Account..................... I. Particulars of the unclaimed dividends paid into the Company's Liquidation Account in the Reserve Bank of India Number on list of creditors Name of the creditor to whom the dividend is due Last known address of creditor Date of declaration and rate of dividend Date Rate Total amount of dividend payable Last date when payable Amount paid into Company's Liquidation Account Remarks 1 2 3 4 5 6 7 8 9 TOTAL Rs. P. II. Particulars of undistributed assets paid into the Company's Liquidation Account in the Reserve Bank of India Number on list of contributories Name of contributory Last known address of contributory Date of declaration and rates of return Date Rate Total amount of return payable Last date when payable Account Amount paid into Company's Liquidation Remarks 1 2 3 4 5 6 7 8 9 TOTAL Rs. P. Total amount of unclaimed dividends paid into the Company's Liquidation Account Total amount of undistributed assets paid into the Company's Liquidation Account Total amount paid under both heads (Sd.) Dated the .............. day of ............. 19....... Liquidator(s) -------------------------------------- Notes:- [1] Here state whether it is a winding-up by or subject to the supervision of the court, or member's voluntary winding-up or creditors' voluntary winding-up. If a winding-up by court, state the number of the petition and the date of the order.