Company Law Board, ) Haryana, Himachal Pradesh,

Northern Region Bench, ) Jammu and Kashmir, Punjab,

3rd floor, "B" Block, ) Rajasthan, Uttar Pradesh, and
Paryavaran Bhawan, ) Union Territories of Delhi and
C.G.O. Complex, , ) Chandigarh.
Lodhi Road, )
New Delhi – 110 003. )

Company Law Board, ) Arunachal Pradesh, Assam, Bihar,

Eastern Region Bench, ) Manipur, Meghalaya, Nagaland,
9, Old Post Office Street, ) Orissa, Sikkim, Tripura, West
6th floor, ) Bengal, and Union Territories of
Calcutta – 700 001. ) Anadaman and Nicobar Islands
) and Mizoram

Company Law Board, ) Andhra Pradesh, Karnataka, Kerela,

Southern Region Bench, ) Tamil Nadu, and Union Territories
Shastri Bhavan, 5th floor, ) of Pondecherry and Lakshadweep
Block – I, ) Island.
No. 26, Haddows Road, )
Chennai (Madras) – 600 006. )
Tel.: 044 - 827 3639 )

Company Law Board, ) Goa, Gujarat, Madhya Pradesh,

Western Region Bench, ) Maharashtra, and Union Territories
NTC House, 2nd floor, ) of Dadra and Nagar Haveli and
16, Narottam Morarjee Marg, ) Damman and Diu.
Ballard Estate, )
Mumbai – 400 038. )
Tel.: 261 1456 (Bench Officer) & 261 9636 )

Note 1: The application shall be accompanied by a fee of Rupees Fifty by way of a

Challan evidencing remittance of cash into PNB under the Head of A/c.
1475 - OGES. Fees realized by the Central Govt. and Company Law
Board on application made to it under the Companies Act, 1956" OR by
way of Bank Draft in favour of "The Pay and Accounts Officer,
Department of Company Affairs, Mumbai."

2. This application shall be made in triplicate.

 FORM NO. 11

(See Rule 36A)

*APPLICATION BY DEPOSITOR UNDER SECTION 58A(9)

OF THE COMPANIES ACT, 1956
(for manufacturing companies)
or
APPLICATION BY DEPOSITOR UNDER SECTION 45QA(2)
OF THE RESERVE BANK OF INDIA ACT, 1934
(for non-banking financial companies)

BEFORE THE COMPANY LAW BOARD (WESTERN REGION BENCH)

(Change address as required)

NTC House, 2nd floor, 16, Narottam Morarjee Marg,
Ballard Estate, Mumbai - 400 038.

APPLICATION NO. OF 2002

In the matter of the Companies Act, 1956 (1 of 1956), Sec.58A

AND

In the matter of (state the name of the :

Depositor-Applicant :

AND

In the matter of (state the name of the :

company) :

Name and address of the :

Depositor-applicant :

Name of the company and address of its :

Registered Office :
Name(s) of Depositor(s) with full address :

Amount of Deposit :

Fixed Deposit Receipt No. and date :

(photostat copy to be enclosed) :

Terms and conditions of Deposit as also :

date of Maturity of Deposit :

Details of payment made by the company, :

if any :

Actual amount due as on date of :

application (principal + interest) :

Details of correspondence, if any, made :

between the company and the Depositor :
(copies of correspondence :
to be enclosed) :

Any other particular(s) as may be :

considered relevant :

P R A Y E R S :-

The Depositor-applicant, therefore, prays:-

(a). that the company abovenamed be directed to make repayment of the aforesaid
deposit(s) along with interest due thereon in accordance with the terms and
conditions of the deposit;

(b). that such further orders be passed as the Company Law Board may deem fit in the
circumstances of the case.

Dated at Mumbai, this ________ day of __________________ 2002.

(Signature of the Depositor-applicant)

 NAME
Address
Tel.:

Thursday, 31st October, 2002.

To:

The Company Law Board,

(Change address as required)
Western Region Bench,
NTC House, 2nd floor,
16, Narottam Morarjee Marg,
Ballard Estate,
Mumbai - 400 038.

Respected Sir,

Re: New Complaint

__________________ ... COMPLAINANT.
v/s
__________________ ... RESPONDENTS.
___________________________________________

Enclosed herewith please find the above captioned new complaint which is being filed in
triplicate (1 original + 2 extra sets).

I am also enclosing herewith the prescribed fees of Rs.50/-, paid through Pay Order
bearing cheque no. ________________ dated ___________________________ drawn on
__________________________________________________, payable to "The Pay and
Accounts Officer, Department of Company Affairs, Mumbai".

I request appropriate action to be taken on my compliant. The date of hearing and the
order may kindly be communicated to me at the above address.

Thanking you,

Yours faithfully,

Encl.: As above. (Signature of the Depositor-applicant)