Form 4a – COMPANIES (CENTRAL GOVERNMENT’S) GENERAL RULES & FORMS

FORM No. 4A : Declaration of solvency

(See rule 5C)

Name of Company : _____________________________________________

Address (Regd. Office): _____________________________________________

_____________________________________________

_____________________________________________

Presented by : ________________________________________ (Name)

_____________________________________ (Designation)

We, _____________________________ of ______________________________ and of _______________ being all the directors of M/s. ________________________________ do solemnly affirm and declare that we have formed the opinion that the company is capable of meeting its total liabilities and that the company will not be rendered insolvent within a period of one year from the date of making this declaration.

We append a statement of company’s assets and liabilities as at ___________ being the latest date before making of this declaration (Annexure-I).

We further declare that the company’s audited annual accounts including the Balance Sheet have been filed upto date with the Registrar of Companies ___________________________

Signature ________________________

Name ___________________________

Managing Director

Signature _______________________

Name _________________________

Directors

Signature ________________________

Name ___________________________

Directors

Verification

And we make this solemn declaration believing the same to be true.

We solemnly declare that we have made a full enquiry into the affairs of the company including assets and liabilities of this company and that having done so and having noted that the shareholders by a special resolution have approved the buy-back of ……………… (…………………) (in words) number of shares / securities as per the provisions of section 77A of the Companies Act, 1956, as inserted by the Companies (Amendment) Ordinance, 1999.

Verified this day the ……………….. day of ………………….., 19……………

Signature ____________________

Name ______________________

Managing Director

Signature ____________________

Name ______________________

Directors

Signature ____________________

Name ______________________

Directors

Solemnly affirmed and declared at _______________ the __________ day of ____________ 19 _________ before me.

Commissioner for Oaths and Notary Public or Justice of the Peace

Annexure I : Statement of Assets and Liabilities

Statement as at _____________ 19 _______, showing assets at estimated realizable values and liabilities expected to rank.

Name of the Company : _____________________________________

Assets

Book Value Estimated to realize

1. Balance at Bank

2. Cash in hand

3. Marketable Securities

4. Bills Receivables

5. Trade Debtors

6. Loans and Advances

7. Unpaid Calls

8. Stock-in-trade

9. Work in Progress viz.

_______________

_______________

_______________

10. Freehold Property

11. Leasehold Property

12. Plant and Machinery

13. Furniture, fittings, utensils, etc.

14. Patents, Trade Marks, etc.

15. Investments other than Marketable Securities

16. Other property viz.

________________

________________

________________

________________

________________

Total: _______________

_______________

Liabilities

Estimated to rank for payment (to the nearest rupee)

1. Secured on specific assets viz;

_______________________

2. Secured by floating charge(s), viz;

_________________________

3. Estimated cost of liquidation and other expenses including interest accruing until payment of debts in full.

4. Unsecured creditors (amounts estimated to rank for payment)

(a) Trade accounts

(b) Bills payable

(c) Accrued expenses

(d) Other liabilities

______________________

______________________

_______________________

_______________________

(e) Contingent liabilities

_________________________

_________________________

_________________________

_________________________

_____________________

Total : _____________________

Total estimated value of assets Rs. ________________

Total Liabilities Rs. �_________________

Estimated surplus after paying debts in full Rs. _________________

Remarks ____________________

Signature ___________________

Name ______________________

Managing Director

Signature ___________________

Name _____________________

Directors

Signature ___________________

Name _____________________

Directors

Place: ________________

Date : ________________

*The period to be filled in should not exceed 3 years.

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