FORM C REPORTING FORM--WHERE NET WORTH HAS BEEN ERODED BY FIFTY PER CENT [See regulation 36(1)] (Note.--Particulars furnished below shall give the position as on the date unless otherwise directed in the questionnaire. Indicate financial figures in lakhs of rupees.) 1.
2.
Name of the industrial company and address
:
(a) Head office
:
(b) Registered office
:
(c) Factory or factories
:
(a) Number and date of registration of the company under the Companies Act, 1956, and the State in which registered. (A copy of registration certificate to be enclosed) : (b) Number and date of registration of all the factories/factory under the Factories Act, 1948, and the States/State in which registered. (A copy of registration certificate to be enclosed) : (c) The heading/sub-heading of the scheduled industry or industries under the Industries (Development and Regulation) Act, 1951, to which the article(s) manufactured or proposed to be manufactured relate(s) : (d) Number and date of registration or licence under the Industries (Development and Regulation) Act, 1951. In case the company is registered with DGTD or any other competent authority under the said Act, the number and date of registration with DGTD or any such authority should also be indicated. (A copy of registration certificate or licence to be enclosed) :
3.
(e) Whether ancillary industrial undertaking within the meaning of clause (aa) of section 3 of the Industries (Development and Regulation) Act, 1951, read with the Ministry of Industry (Department of Industrial Development) Notification No. S.O. 232(E), dated April 2, 1991, as amended/substituted from time : to time
Yes/No
(f) Whether a small scale industrial undertaking as defined in clause (j) of section 3 of the Industries (Development and Regulation) Act, 1951, read with the Ministry of Industry (Department of Industrial Development) Notification No. S.O. 232(E), dated April 2, 1991, as amended/ substituted from time to time. Please indicate investments in plant and machinery whether held on ownership terms or by lease or by hirepurchase (before depreciation) :
Yes/No
(a) Name(s) of the promoter(s) and his/their address(es)
:
(b) Shareholding pattern of all classes of shares
:
Amount % of aggregate paid-up capital Page 1 of 4
(i) Promoters
:
(ii) Associates
:
(iii) Public financial institutions (institution-wise)
:
(iv) General public
:
(c) Details of ten largest shareholders (against each, please indicate whether promoters/ associates/ holding company/group company) : 4.
Sector : private/joint
:
5.
(a) Names of directors and their latest addresses (indicating A. Chairman, B. Wholetime directors including managing director and C. Nominee directors) : (b) Name and address of chief executive by whatever name called :
6.
(a) Main line of business activity since registration of the company : (b) Other subsidiary business activity
:
7.
Whether MRTP company
:
Yes/No
8.
Whether FERA company
:
Yes/No
9.
Financial position (as per the last two audited balance-sheets)
:
Liabilities
As on
As on
......
......
Assets
A. Paid-up capital
F. Fixed assets
B. Reserves
G. Non-current assets
C. Term liabilities
H. Current assets
D. Current liabilities
I. Others
E. Others
J. Profit balance
Total
Total
and
loss
As on
As on
......
......
account
Please furnish copies of balance-sheet and profit and loss accounts for the last five years including year under reference (audited/provisional) 10. Net worth (as defined in section 3(1)(ga) of the Sick Industrial Companies (Special Provisions) Act, 1985) : (a) Peak net worth and the year
:
(b) Net worth at the end of last financial year
:
11. Whether closed or working (position of each plant/unit/division : to be specified) 12. Dues to individual banks (as on a recent date to be specified by reporting company) : Page 2 of 4
Name Working Working capital of capital term loan bank limit/ outOriginal Outstanding amount standing amount amount
Funded interest
Term loans
Original OutOriginal Outamount standing amount standing amount amount
Total Irreoutgularity standing amount
Total 13. Dues to term lending institutions (as on a recent date to be specified by reporting company) : Name of institutions
Original Amount
Outstanding Principal
Interest
Default Principal
Interest
1. I.D.B.I. 2. I.R.B.I. 3. I.F.C.I. 4. I.C.I.C.I. 5. Others--SFCs, SIDCs, etc. (specify institutions individually) Total 14. Reasons for erosion of net worth-(a) Managerial problems
:
(b) Production and technical problems
:
(c) Marketing difficulties
:
(d) Financial problems
:
(e) Lack of adequate infrastructure
:
(f) Shortage of raw material
:
(g) Government policies
:
(h) other reasons to be specified
:
Page 3 of 4
15. Date of finalisation of duly audited accounts of the company for the relevant financial year (i.e., date of annual general meeting of the company whereat duly audited accounts of the company were approved for the financial year at the end of which net worth declined at 50% or more of peak net worth during the immediately preceding four financial years.) : 16. Date on which the general meeting of the shareholders of the company is proposed to be convened for purpose of considering the erosion of net worth. Whether minimum 21 days notice given after the annual general meeting? : 17. Any other information considered relevant or useful
:
I do hereby certify that the particulars and information given above are based on information derived from records and believed to be true. ............... Signature For and on behalf of the reporting company Date.........................
.................................................................
Place........................
Name and designation of the authorised officer
To The Secretary, Board for Industrial and Financial Reconstruction, Jawahar Vyapar Bhawan, No.1, Tolstoy Marg, New Delhi - 110001.
Page 4 of 4
