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Application for striking off the name of company under the Easy Exit Scheme (EES), 2010

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..... I, hereby make an application for striking the name of the company off the Register under section 560 of the Companies Act, 1956. I furnish the following details for consideration of the application 1. ( a ) Corporate identity number (CIN) of the company Pre-fill ( b ) Global location number (GLN) of company ( c ) Name of the company ( d ) Address of the registered office of the company ( e ) e-mail ID of the company ( f ) Date of incorporation of the company (DD/MM/YYYY) .....

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..... Name Present residential address Line I Line II City State ISO country code Country Pin code II. DIN or Income-tax PAN or Passport number Pre-fill Designation Name Present residential addre .....

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..... ntry Pin code 7. Brief description of main objects of the company as per Memorandum of Association (MoA) 8. Brief description of main business last carried out by the company 9. Whether there are litigation(s) pending against or involving the company Yes No If yes, provide details 10. Whether the application is being digitally signed by Managing Director, director, manager or secretary of the company. If No, attachment at serial number 5 is mandatory Yes No 11. I hereby confirm that : o there is no inspe .....

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..... as given in the statement of accounts (As per annexure C of the Scheme) Statement of account as on (DD/MM/YYYY) Particulars Amount (in Rs.) I. Source of funds ( a ) Share capital ( b ) Reserves and surplus (including balance in Profit and Loss Account) ( c ) Secured loans ( d ) Debentures ( e ) Unsecured loans ( f ) Public deposits ( g ) Total loan funds (Sum of ( c ) to ( f ) ( h ) Others (Please specify) ( i ) Total o .....

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..... 4. Indemnity bond (to be given individually or collectively by director(s) (As per annexure B of the Scheme) Attach 5. In case application is not digitally signed by the company representative, copy of application duly signed by the director, Managing Director, manager or secretary Attach 6. Copy of no objection certificate (NOC) from concerned administrative Ministry/Department State Government (in case of a Government company) Attach Remove attachment 7. Optional attachment(s) Attach Verification To the best of my knowledge and belief, the information given in this app .....

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..... Modify Check Form Pre-scrutiny Submit For office use only: (Affix filing details) e-Form Service Request Number (SRN): e-Form Filing Date: (DD/MM/YYYY) Digital signature of the authorising officer This e-Form is hereby approved This e-Form is hereby rejected Confirm submi .....

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