FORM-G

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.

Description

Par

ticu lars

(1)

(2)

(3)

1

Name of the Corporate Person

2

Identification Number of Corporate Person (CIN/LLPIN)

3

Voluntary Liquidation Commencement Date

4

Date of Deposit into the Corporate Voluntary Liquidation Accoun

t

5

Amount deposited into the Corporate Voluntary Liquidation Acco

unt (Rs.)

6

Bank Account from which the amount is transferred to Corporate Voluntary Liquidation Account

1. Account No:
2. Name of Bank:
3. IFSC:
4. MICR:
5. Address of Branch of the Bank:

7

Details of the Amount (Rs.) deposited into Corporate Voluntary L iquidation Account

1. Unclaimed dividends
2. Undistributed proceeds
3. Income earned till the due date of deposit
4. Interest at the rate of twelve per cent on the amount retained bey ond due date (Please show computation of interest amount)

Total

Sl. No.

Name          of stakeholder entitled        to receive unclaimed dividends or undistributed proceeds

Address, phone number and email address     of the stakeholder

Identification Number    of    the stakeholder (PAN, CIN/LLPIN/DIN,

Aadhaar        No.)

(Please        attach

Identification proof.)

Amount due to the stakeholder (Rs.)

Nature of Amount due

Remarks

(1)

(2)

(3)

(4)

(5)

(6)

(7)

1

2