FORM NO. III: Form of Indemnity Bond

See rule 6(3)

To

The Registrar of Companies,

__________________

__________________

In consideration of your agreeing to pay me the sum of Rs. ____________ (Rupees _________________) only, being the amount due to me on dividend for the year _____________ from M/s. __________________________ out of the

(Name of the company)

General Revenue Account of the Central Government,I ________________ son/daughter/wife of _________________ do hereby agree to indemnity you to the extent of any claim not exceeding the amount hereinbefore mentioned which may be preferred against you, and which you may have to lawfully discharge

Date _____________

Place ____________

____________________

(Signature)

Witnesses

1. _________________________________________

(Signature)

Address _____________________________________

2. __________________________________________

(Signature)

Address ________________________________________________

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z