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.