FORM OF ANNUAL RETURN OF A COMPANY HAVING SHARE CAPITAL ANNUAL RETURN THE COMPANIES ACT, 1956 (1 of 1956) SCHEDULE V (See Section 159)
PART II I
Registration Details Registration No. Registartion Date
0
2 2
2 3 Date
1
0 4 Month
4 4
State Code
9 7 Year
0
Whether Shares listed on recognized Stock Exchange Y -Yes N - No
8
N
If Yes, Stock Exchange Code (Totals) A AGM Held
II
Y
Y-Yes N-No
-
-
-
-
B
Date of AGM / Due Date
-
-
2 9 Date
-
-
-
0 9 Month
0 9 Year
Name and Registered Office Address of the Company : Company Name
Address
P R I
N C E T O N
H O U S I
P R I
V A T E
M I
L I
M B E R Y A R D
M Y S O R E
L A Y O U T
R O A D
Town/City
B A N G A L O R E
State
K A R N A T A K A
Telephone with STD
0 8 Area Code
0
0 8
0
e-Mail Address
T E D
N O. 2 T I
FAX Number
N G
2
2
6
PIN Code
6 7 4 Number 7 4
0
5 0
1
4 4
9
5 6
0
0 2
6
3
[email protected]
Page 1
III
Capital Structure of the Company (Amount in Rs. Thousands) Authorized Share Capital Break-up Type of Shares i) Equity
No. of Shares 5
ii) Preference
0
0 0
N I
L
Total Authorized Capital
Nominal Value (In Rs.) 1 0 0 N I
5
0
L
0
Issued Share Capital Break-up Type of Shares i) Equity
No. of Shares 1
ii) Preference
0
0 0
N I
L
Nominal Value (In Rs.) 1 0 0 N I
Total Issued Capital
1
L
0 0
Subscribed Share Capital Break-up Type of Shares i) Equity
No. of Shares 1
ii) Preference
0
0 0
N I
L
Total Subscribed Capital
Nominal Value (In Rs.) 1 0 0 N I
1
0
L
0
Paid-up Share Capital Break-up Type of Shares i) Equity
No. of Shares 1
ii) Preference
0
0 0
N I
L
Total Paid -up Capital
Nominal Value (In Rs.) 1 0 0 N I
1
Debentures Break-up
0
L
0
Not Issued
Type of Debentures (i) Non-Convertible
-
No. of Debentures - - - - - -
-
Nominal Value (Rs.) - - - - -
(ii) Partly Convertible
-
-
-
-
-
-
-
-
-
-
-
-
-
(iii) Fully Convertible
-
-
-
-
-
-
-
-
-
-
-
-
-
Total Amount
-
-
-
-
-
-
-
-
-
-
-
-
Page 1
IV Directors / Managers/Secretary Information (Past & Present) [Refer clause 6 of Part I of Schedule V]
Name Nationality
Residential Address
J A W A H A R G O P A L Surname Middle Name First Name I I-Indian , F- Foreign Date of Birth
Dessignation
Date of Appointment
D
2 3 Date
3 0 0 1 1 9 Date Month Year C - Chairman cum Managing Director, M- Managing Director W-Wholetime Director , S-Secretary, R-Manager, D-Director
0 4 Month
Election Commission K T Indentity Card No. (If issued)
9 7 Year
1
3
0
7
Date of Ceasing 8 3
3
- Date 3 0
- Month 2
R N B R R
A O. E O O
M 2 1 N S O A D A D
Nationality
Date of Appointment
2 3 Date
District
B A N G A L O R E
State
K A R N A T A K A
3
Residential Address
2 3 0 8 1 9 Date Month Year C - Chairman cum Managing Director, M- Managing Director W-Wholetime Director , S-Secretary, R-Manager, D-Director
0 4 Month
Election Commission K T Indentity Card No. (If issued)
9 7 Year
1
3
0
7
Date of Ceasing 8 3
3
- Date 0 2
- Month
6 0
5 R N B R R
A O. E O O
M 2 1 N S O A D A D
Nationality
D H I R E N G O P A L Surname Middle Name I I-Indian , F- Foreign
Date of Appointment
D
2 5 Date
Election Commission - - Indentity Card No. (If issued)
0 3 Year -
Date of Ceasing
4
6
P A
N C R O S S M I L L E R S C R O S S
District
B A N G A L O R E
State
K A R N A T A K A
5
Residential Address
First Name
1 8 0 7 1 9 Date Month Year C - Chairman cum Managing Director, M- Managing Director W-Wholetime Director , S-Secretary, R-Manager, D-Director
1 2 Month
K R I
0 0
- Year
Date of Birth
Dessignation
6
Town / City B A N G A L O R E
PIN Code
Name
N C R O S S M I L L E R S C R O S S
Town / City B A N G A L O R E
M A N O H A R G O P A L Surname Middle Name I I-Indian , F- Foreign
D
P A
- Year
Date of Birth
Dessignation
R I
5 5
PIN Code Name
K
- Date
- Month
6 5
5
0 F N R E
2A - F O R T O. 2 0 O A D X T E N
A R M A 1 ST J A S I
6
0 0
4
6
A H N O R M A I N Y A M A L O N
Town / City B A N G A L O R E District
B A N G A L O R E
State
K A R N A T A K A
- Year
PIN Code
5
6
0 0
4
6
Page 1
v Details of Shares /Debentures held on date of AGM Ledger Folio of Share / Debenture Holder Share /Debenture Holder's Name
J
0
A W A H A R
Father's / Husband's name
G O P A L
G O P A L
R A M N A R A Y A N
Type of 1 1- Equity, 2-Preference 3-Debenture, 4-Stock Share Number of Shares / Debentures 3 4 0 Amount
held in stock
1
M A N O H A R
Father's / Husband's name G O P
A
L
G O P
R
A
held in stock
M N
A
R
A
Y
M K R I P A N O. 2 1 N S O N C R O S S R O A D L L E R S R O A D C R O S S N G A L O R E
B A N G A L O R E
State
K A R N A T A K A
0
PIN Code
0
2
Residential Address
A
1
5
6
0
0 4
6
N
R B M Town /City B
A E I A
M K R I P A N O. 2 1 N S O N C R O S S R O A D L L E R S R O A D C R O S S N G A L O R E
District
B A N G A L O R E
State
K A R N A T A K A
0
0
PIN Code
0
3
Residential Address
5
6
0
0 4
6
per share
Ledger Folio of Share / Debenture Holder D H I
R E
Father's / Husband's name G O P
N
G O P
A L
02- A N O. 2
F A R A H F O R T M A N O R 1S T M A I N R O A D A Y A M A Y A L E X T E N S I O N
J
A L
0
Town /City
B A N G A L O R E
District
B A N G A L O R E
State
K A R N A T A K A
R A M N A R Y A N
Type of 1 1- Equity, 2-Preference 3-Debenture, 4-Stock Share Number of Shares / Debentures 3 2 0 Amount
held in stock
A E I A
District
0
A L
Type of 1 1- Equity, 2-Preference 3-Debenture, 4-Stock Share Number of Shares / Debentures 3 4 0 Amount
Share /Debenture Holder's Name
R B M Town /City B Residential Address
per share
Ledger Folio of Share / Debenture Holder Share /Debenture Holder's Name
1
per share
1
0
0 PIN Code
5
6
0
0 4
6 Page 1
VI
Details of Shares / Debentures transfers since the date of the last AGM. Date of Previous AGM Date of Registration of Transfer of Shares Type of Transfer
2 9 Date
0 9 Month
2 0 0 Year
Date
Month
Year
1- Equity
No. of Shares/Debentures Transferred
2-Preference
8
3- Debentures 4- Stock
Amount per Share (Rs.)
Ledger Folio of Transferor Transferor's Name Surname
Middle Name
Name
Surname
Middle Name
Name
Ledger Folio of Transferee Transferee's Name
Date of Registration of Transfer of Shares Type of Transfer
Date
Month
1- Equity
No. of Shares/Debentures Transferred
Year 2-Preference
3- Debentures 4- Stock
Amount per Share (Rs.)
Ledger Folio of Transferor Transferor's Name Surname
Middle Name
Name
Surname
Middle Name
Name
Ledger Folio of Transferee Transferee's Name
Date of Registration of Transfer of Shares Type of Transfer
Date
Month
1- Equity
No. of Shares/Debentures Transferred
Year 2-Preference
3- Debentures 4- Stock
Amount per Share (Rs.)
Ledger Folio of Transferor Transferor's Name Surname
Middle Name
Name
Surname
Middle Name
Name
Ledger Folio of Transferee Transferee's Name
Page 1