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

FORM No. 4C : Return in Respect of Buy-back of Securities

COMPANIES ACT, 1956

(Pursuant to section 77A(10)]

(See rule 5C also)

(Please attach separate sheets, if necessary)

1. Name of the Company :

___________________

2. Address of Registered Office of Company :

___________________

3. Registration number of the company allotted by the Registrar of Companies :

___________________

4. Income-tax Permanent Account Number, under Income-tax Act, 1961:

___________________

5. Whether the Company is listed (Indicate Yes or No) :Yes/No

___________________

6. If listed, give the names of stock exchanges where listed and also indicate the date and other details of listing of securities with each stock exchange :

___________________

7. If listed, name of merchant banker appointed by the company in terms of Securities and Exchange Board of India (Buy-back of Securities) Regulation, 1998 made under the Securities and Exchange Board of India Act, 1992:

___________________

8. Details of capital as on (as per latest audited balance sheet):

Sl. No.

Details of Capital

Authorized Capital (Rs.)

Subscribed Capital (Rs.)

Paid-up Capital (Rs.)

(1)

(2)

(3)

(4)

(5)

1.

Equity

2.

Preference:

(a) Redeemable

(b) Convertible

3.

Others, if any

Total

9. Free Reserves :

(as defined in clause (b) of Explanation to section 372A of Companies Act, 1956) As on _______________

(as per latest audited balance sheet)

___________________

10. Securities Premium Account :

As on ___________________

(as per the latest audited balance sheet)

___________________

11. Proceeds of any shares or other specified securities :

As on ________________________

(as per the latest audited balance sheet)

___________________

12. Debts:

As on ___________________________

(as per the latest audited balance sheet)

A. Secured :

B. Unsecured :

C. Total (A+B)

___________________

___________________

___________________

___________________

13. Date of special resolution of members authorizing buy-back of securities:

___________________

14. Amount of securities authorized to be bought back:

___________________

15. Date up to which buy-back of securities to be completed:

___________________

16. Date of which earlier buy-back was authorized (give details of each earlier buy-back) :

___________________

17. Date on which the earlier buy-back was completed:

___________________

18. Debt to capital and free reserve ration allowed for the company:

___________________

19. Details of Government approval for the ratio at serial number ’18’ above higher than 2:1

___________________

20. Whether there is any default in the following:

(a) Repayment of deposit

(b) Repayment of interest payable on deposit referred to “(a)” above

(c) Repayment of debentures

(d) Repayment of Preference shares

(e) Payment of dividend to shareholders

(f) Repayment of term loans to any financial institution /bank

(g) Repayment of interest on the term loans referred to “(f)” above

*Yes/No

Yes/No

Yes/No

Yes/No

Yes/No

Yes/No

Yes/No

21. Whether there is any default in complying with the provisions of following sections:

A. Section 159 (relating to Annual Return)

B. Section 207 (relating to payment of dividend)

C. Section 211 (relating to balance sheet/Profit and loss account)

*Yes/No

*Yes/No

*Yes/No

*Strike whichever is not applicable.

22. Depreciation of securities bought-back by the company :

( Please attach separate sheets if necessary)

Sl. No.

Folio number / Certificate number of securities bought back

Date of buy-back of securities

Number of securities bought back

Category to which they belong (Preference/ Equity/ Employees Stock Option Sweat equity, etc.)

Name of the last holder of security

Reference to entry in register of members

*Mode of buy-back of securities

(1)

(2
)

(3)

(4)

(5)

(6)

(7)

(8)

Face value of a Security (Rs.)

Buy-back value paid for a security (Rs.)

Total Consideration paid for buy-back of securities Rs.

Cumulative total of column 11

Date of cancellation of securities bought back

Date of Extinguishment of securities bought back

Date of physical destruction of securities bought back

Remarks

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

*Indicate whether the securities have been bought back

from the existing security-holders on a proportionate basis or

from the open marker or

from odd-lots of listed securities or

from Employees’ Stock Option or

from Sweat Equity or

from any other mode, if so, indicate the mode.

23. Particulars relating to holders of securities before buy-back :

Sl. No.

Date of Buy-back

Folio Number and Certificate Number of security bought back

Name of the last holder of security

Reference to entry in Register of members

(1)

(2)

(3)

(4)

(5)

(please attach separate sheets, if necessary)

24. Date of payment of consideration to all the shareholders from whom securities have been bought back, (Give details in respect of all such shareholders).

25. The shareholding pattern after buy-back of securities :

(Please attach separate sheets, if necessary)

Sl. No.

Category of security holders

# Shareholding pattern

Securities held before buy-back as on …….

Security held after buy-back as on ……..

1.

Central Government

2.

State Government

3.

Government Companies

4.

Public Financial Institutions

5.

Banks

6.

Mutual Funds

7.

Venture Capital

8.

Foreign Holding

(FIIs/FCs/FFIs/NRIs/OCBs)

9.

Bodies Corporates

(Not mentioned above)

10.

Employees Stock Option

11.

Directors/Relatives of Directors

12.

Sweat Equity

13.

Others

Indicate details in respect of each category of security bought back.

Place

Signature ___________

Date

Name ____________

Designation __________

Company seal]

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