Application for approval of issue of public companies under Paragraph 1(z)(i) of Schedule XV to the Act

Part - A

1.

Details of the company

(i)

Name

(refer note 1)

(ii)

Address

(refer note 2)

(iii)

Permanent Account Number

(iv)

Company Identification Number

(v)

Date of formation or incorporation

dd/mm/yyyy

(vi)

Place of formation or incorporation

(refer note 2)

(vii)

Nature of business

(viii)

Number of years in this business

2.

Tax year

Part - B

3.

(A)

(i)

Name of the Banker

(refer note 1)

(ii)

Address of the Banker

(refer note 2)

(B)

Repeat, if required

4.

(A)

(i)

Name of the auditor

(refer note 1)

(ii)

Address of the auditor

(refer note 2)

(iii)

Membership number

(B)

Repeat, if required

Part - C

5.

Net worth of the applicant (company) (as on the end of the previous financial year)

6.

Proposed total capital to be raised through the present equity/ debenture issue

7.

Whether the present equity/debenture issue conform to the definition of ‘infrastructure facility’ (refer note 3)?

(i) Yes

(ii) No (select one)

8.

Details of the eligible issue of capital

Number

Face

Value

Premium or Discount

(i)

Equity Shares

(ii)

Preferential Shares

(iii)

Debentures

9.

Details of approval of Securities and Exchange Board of India (SEBI) for the eligible issue of capital

(i)

Date of approval

(ii)

Order number

(refer note 4)

10.

Details of proposed infrastructure facility or power project

(i)

Nature

(ii)

Location

(iii)

Estimated project cost

11.

Approximate year-wise investment required

Financial

Year

Amount of investment

12.

Sources of proposed investment:

(i)

Eligible issue of the capital

(ii)

Other sources

13.

Schedule of development of infrastructure facility or power project

(i)

Planned date of commencement of the project

dd/mm/yyyy

(ii)

Planned date of commencement of operation of the project

dd/mm/yyyy

14.

Other details to be provided as separate enclosure

(Attach as per note. 5)

I certify that the information furnished above is true to the best of my knowledge and belief.

Signatures ofthe authorised signatory

Annexure

Particulars

A-1

Copy of certificate of incorporation under Companies Act, 2013 (18 of 2013)

A-2

Copy of the latest audited financial statement along with last three years audited balance sheet

A-3

Description of significant accounting policies

A-4

Details of management–

(a) Names of directors with their experience, qualifications and profession;

(b) Names of the key personnel;

(c) Organisational structure

(d) Details of Board of directors of associate organisations, companies and their subsidiaries

A-5

Detailed objects of the present equity/debenture issue

A-6

If response to row No. 7 is yes, then give details of the same.

A-7

Approval of SEBI with regard to eligible issue of capital (row No.9)

A-8

Clearance of the concerned authorities and agreement executed with the Government or Government bodies (row No.10)

A-9

Copy of the project report, if any