FORM
No. II
(See rule 6(1)
PART 'A' : Application to the Central Government
for an order for payment of the dividend amount out of the
General Revenue Account of the Central Government pursuant
to section 205B of the Companies Act, 1956
1. Name of the applicant:
2. Postal address of the applicant:
3. Name, registration number and registered
address of the company from which the amount is due:
4. Number of shares held:
(i) Preference shares (with distinctive
numbers)
(ii) Equity shares (with distinctive numbers).
5. Financial year to which the dividend
relates;
6. Amount due:
(i) On preference shares
(ii) On equity shares
(iii) Interest, if any, payable to him pursuant
to sub-section (4) of section 205A of the Act, and
(iv) Total of (i), (ii) and (iii) above:
7. Reasons for non-receipt of the amount
from the company:
Place
Date
____________________________________
(Signature of the applicant or a person
holding a power of attorney, from the applicant).
Received from the Registrar of Companies
_________ the sum of Rs. _______ (Rupees ____________ in words)
being the amount payable to me/us from the General Revenue
Account of the Central Government as unclaimed or unpaid dividend
(which was originally) due from M/s. _________________
1. Signature of witness.
With name, date, address and occupation. |
Signature of claimant with
name, date, address and occupation. (on revenue stamp
of 20 paise, if the claim is for Rs. 20 or more). |
2. Signature of witness.
With name, date, address and occupation. |
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Notes:
1. Indemnity bond should be furnished on
a non-judicial stamp paper of the requisite value, in case
the claim exceeds Rs. 2,500.
2. In the case of deceased shareholder,
the legal representative(s) of the deceased shareholder, who
is (are) preferring the claim, is (are) required to furnish
succession certificate/probate/letters of administration.
In case the charge have been transmitted in the name of the
claimant, a certificate in this behalf from the company be
furnished.
3. Dividend warrant or a photo-copy of
the share certificate should be furnished.
4. Separate applications should be made
for claims in respect of each company.
PART 'B' : Payment Order by the Registrar
Classification
"068-Miscellaneous General Services-Unpaid Dividends
of Companies-Deduct Refund". |
Certified that the amount claimed, namely,
Rs. ______________ has actually been deposited by the company
to the General Revenue Account of the Central Government under
Major Head "068-Miscellaneous General Services-Unpaid Dividends
of Companies" on _________________ (date) Necessary note for
refund has been kept in the accounts maintained by me.
________________
(Registrar)
Passed for payment for Rs. _____________
in favour of Shri __________ . The cheque/demand draft may
please be issued in favour of Shri ___________
____________
(Registrar)
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