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Issue of Shares/ Convertible debentures / Others to foreign investors - Reporting under FDI Scheme

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..... Date of issue of shares / convertible debentures/others No. Particulars (In Block Letters) 1. Name of the Investee Company Address of the Registered Office of the Investee Company with City, District and State clearly mentioned Telephone Fax e-mail State Registration No. given by Registrar of Companies and Date of Incorporation. Whether existing company or new company (strike off whichever is not applicable) Existing company / New company (Brow .....

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..... private placement 03 Rights 04 Bonus 05 Conversion of ECB 06 Conversion of royalty (including lump sum payments) 07 Conversion against import of capital goods by units in SEZ 08 ESOPs 09 Share Swap 10 Others (please specify) .....

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..... Non competition fee Others @ Total @ Please specify the nature (d) Total inflow (in Rupees) on account of issue of shares / convertible debentures/others to non-residents (including premium, if any) vide (i) Remittance through AD: (ii) Debit to NRE/FCNR/Escrow A/c with Bank_________ (iii) Others (please specify) Date of reporting of (i) and (ii) above to RBI under Para 9 (1) A of Schedule I to Notification No. FEMA 20 /2000-RB dated May 3, 2000, as amended from time to time. (e) Disclosure of fair value of shares issued** We are a listed company and the market value of a share as on date of the issue is* We are an un-listed company and the fair value of a share is* ** before issue of shares .....

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..... y) Sub Total b) Resident Total DECLARATION TO BE FILED BY THE AUTHORISED REPRESENTATIVE OF THE INDIAN COMPANY: (Delete whichever is not applicable and authenticate) We hereby declare that: 1. We comply with the procedure for issue of shares / convertible debentures as laid down under the FDI scheme as indicated in Notification No. FEMA 20/2000-RB dated 3 rd May 2000, as amended from time to time. 2. The investment is within the sectoral cap / statutory ceiling permissible under the Automatic Route of RBI and we fulfil all the conditions laid down for investments under the Automatic Route namely (strike off whichever is not applicable). a) Shar .....

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..... . R (Signature of the Applicant)* :___________________________________________ (Name in Block Letters) :___________________________________________ (Designation of the signatory) :___________________________________________ Place: Date: (* To be signed by Managing Director/Director/Secretary of the Company) CERTIFICATE TO BE FILED BY THE COMPANY SECRETARY 3 OF THE INDIAN COMPANY ACCEPTING THE INVESTMENT: (As per Para 9 (1) (B) (i) of Schedule 1 to Notification No. FEMA 20/2000-RB dated May 3, 2000) In respect of the abovementioned details, we certify the following : 1. All the requirements of the Companies Act, 1956 have been complied with. 2. Terms and conditions o .....

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..... ed Accountant indicating the manner of arriving at the price of shares issued to the persons resident outside India (as specified in para 9 B of Schedule I to Notification No. FEMA 20/2000-RB dated May 3, 2000.) PAN Number Date of issue /transfer of shares No. Particulars (In Block Letters) 1. Name Address State Registration No. given by Registrar of Companies Whether existing company or new company (strike off whichever is not applicable) If existing company, give registration number allotted by .....

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..... Existing company / New company Fax Telephone .....

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..... Percentage of FDI allowed as per FDI policy 3 Details of the foreign collaborator Name Address Country Constitution (specify whether Foreign National/Foreign Company/ FVCI / FII / NRI / PIO / others) .....

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..... 4 Particulars of Shares / Convertible Debentures Issued (a) Nature and date of issue Nature of issue Date of issue Number of shares/ convertible debentures 01 IPO / FPO 02 Preferential allotment / private placement 03 Rights 04 Bonus 05 Conversion of ECB 06 .....

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..... the issue is against conversion of ECB or royalty, a Chartered Accountant's Certificate certifying the amount of the outstanding on the date of conversion (c) Break up of premium Amount Control Premium Non competition fee Others* Total * please specify the nature (d) Total inflow (in Rupees) on account of issue of shares to non-residents (including premium, if any) vide Remittance through AD: Debit to NRE/FCNR A/c with Bank_________ Others Date of reporting of (i) above to RBI under Para 9 (1) A (i) of Notification No. FEMA 20/2000-RB dated May 3, 2000, as amended from time to time. (e) Disclosure of fair value of shares issued** We are a listed company and the market value of a share as on date of the .....

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..... y (strike off whichever is not applicable) Foreign entity(ies)-(other than individuals), to whom we have issued shares have existing joint venture or technology transfer or trade mark agreement in India in the same field. (Conditions stipulated in Press Note 1 of 2005 Series dated January 12, 2005 have been complied with). OR Foreign entity(ies)-(other than individuals), to whom we have issued shares do not have any existing joint venture or technology transfer or trade mark agreement in India in the same field. We are/ are not an SSI unit the investment limit of 24 % of paid-up capital has been observed/ requisite approvals have been obtained. Shares have been issued on rights basis and the shares are issued to non-residents at a price that is not lower than that at which shares have been issued to residents. OR Shares issued are bonus shares. OR Shares have been issued under a scheme of merger and amalgamation of two or more Indian companies or reconstruction by way of demerger or otherwise of an Indian company, duly approved by a court in India. OR Shares are issued under ESOP and the conditions regard .....

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..... Date No. Particulars (In Block Letters) 1. Name Address State Registration No. given by the Registrar of Companies .....

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..... Web site (if any): 3. Account closing date: 4. Details of changes if any, with regard to information furnished earlier (Change in name of company / Change of location, activities, etc.) FORM FC-GPR (PART-B) 5. Foreign Direct Investment (FDI) Amount in Lakhs of Rupees Foreign Liabilities In India # Foreign Assets Outside India ## Outstanding at March end of Previous Year Outstanding at March end of Current Year Outstanding at March end of Previous Year Outstanding at March end of Current Year 5.0 Equity Capital 5.1 Other Capital $ .....

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..... # Please furnish the outstanding investments of non-resident investors (Direct Investors) who were holding 10 % or more ordinary shares of your Company on the reporting date. ## Please furnish here your investments outside the country in each of which your Company held 10 per cent or more ordinary shares of that non-resident enterprise on the reporting date. Use March-end market price/exchange rate . $ Other Capital transactions between the non-resident direct investor and investee / reporting company includes: i) Short Term Borrowing from overseas investors, ii) Long Term Borrowing from overseas investors, iii) Trade Credit, iv) Suppliers Credit, v) Financial Leasing, vi) Control Premium, vii) Non-Competition Fee in case of transactions not involving issue of shares, viii) Non-cash acquisition of shares against technical transfer, plant and machinery, goodwill, business development and similar considerations and ix) investment in immovable property made during the year. @Note: As the details of the Loans availed by your company are collected through Authorised Dealers separately by Foreign Exchange Department of the RBI in ECB return .....

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