FORM NO.CAA.15

[Pursuant to section 238(1)(a)  and rule 28]

Information to be furnished along with circular in relation to any scheme or contract involving the transfer of shares or any class of shares in the transferor company to the transferee company

Details of the transferee company

1.(a) Corporate Identity Number :

   (b) Global Location Number :

2. (a) Name of the company:

    (b) Registered office address:

(c) E-mail id:

3. Whether the company is

?     Public company

?     Private company

?     OPC

4. (a) Whether the shares of the company are listed on a recognized stock exchange:

?     Yes

?     No

    (b) If yes, name of the stock exchanges where shares are listed:

5.Main objects/ principal business of the company:

6.Capital structure of the company:

   Authorized share capital:

   Issued share capital:

   Subscribed share capital:

   Paid up share capital:

7.Debt structure of the company:

8.Details of the promoters, key managerial personnel, directors of the company:

9.Material interest and effect of the scheme on such interest of:

(i)                  Key Managerial Personnel

(ii)                 Promoters

(iii)                Directors

(iv)               Debenture trustees

(v)                Deposit trustees

(vi)               Auditors

10.(a) Extent of shareholding of directors, Key Managerial Personnel, promoters, managers, managing directors of the transferee company

Shareholder’s name -    

Status (whether a director, Key Managerial Personnel, etc.) - 

Share type-

Number of shares-         

Value per share (Rs.)-                       

(b) Extent of shareholding of directors, Key Managerial Personnel, promoters, managers, managing director in the transferor company

Shareholder’s name-     

Status (whether a director, Key Managerial Personnel, etc.)-  

Share type  -

Number of shares -

Value per share (Rs.)-    

11.(a) Offer made by any other person on behalf of the company:

?     Yes

?     No

       (b) State the interest of the other person in the company:

Details of the transferor company

12. (a) Corporate Identity Number :

      (b) Global Location Number :

13. (a) Name of the company:

      (b) Registered office address:

  (c) E-mail id:

14. Whether the company is

?     Public company

?     Private company

?     One Person Company

15. (a) Whether the shares of the company is listed on a recognized stock exchange:

?     Yes

?     No

     (b) If yes, name of the stock exchanges where shares are listed:

16.      Main objects/ principal business of the company:

17.    Capital structure of the company:

        Authorized share capital:

        Issued share capital:

        Subscribed share capital:

        Paid up share capital:

18.      Debt structure of the company:

19.      Details of the promoters, key managerial personnel, directors of the company:

20.      Material interest and effect of the scheme on such interest of:

(i)                   Key Managerial Personnel

(ii)                 Promoters

(iii)                Directors

(iv)               Debenture trustees

(v)                Deposit trustees

(vi)               Auditors

21.    (a) Extent of shareholding of directors, Key Managerial Personnel, promoters, managers, managing directors of the transferee company

Shareholder’s name-     

Status (whether a director, Key Managerial Personnel, etc.)-  

Share type  -

Number of shares -

Value per share (Rs.)-

(b) Extent of shareholding of directors, Key Managerial Personnel, promoters, managers, managing director in the transferor company

Shareholder’s name-     

Status (whether a director, Key Managerial Personnel, etc.)-  

Share type-

Number of shares-         

Value per share (Rs.)-             

22.    Any relation that subsists between transferor and transferee company:

Details of the scheme

23.    Reasons for which the offer has been recommended by director of the transferor company:

24.    Form of consideration

                 Total consideration                                  ……………………..

?           Cash                                          ………………………

?           Other than cash                         …….………………..

25.    if consideration is other than cash, particulars thereof:

26.    if consideration involves the allotment of shares in the transferee company, 

         (a) Share exchange ratio:

(b) basis of valuation of shares of transferee company:

 (c) Full particulars of the shares and the rights attached thereto:

27.    Sources from which the transferee company proposes to pay for the acquisition of the said shares, if the consideration is cash:

Declaration

I/We, ………….., directors of the transferor company do solemnly declare that the information given in this statement and enclosures is correct and complete to the best of my/our knowledge.

Date:

Place:

Signature

Enclosures:

1.   Details of transfer of shares in the transferor company by its directors, Key Managerial Personnel, promoters, manager, managing director in the two years preceding the offer;

2.   Statement of valuation of shares by a registered valuer;

3.   Auditor’s certificate regarding the offer;

4.   Offer document shall contain a statement by or on behalf of transferee

      company disclosing the steps it has taken to ensure that necessary cash will be available;

5. Details of change of name, registered office and objects of the transferee

     company;

6. Details of change of name, registered office and objects of the transferor

     company.