ANNE:XURE - A (See rule 4l

ANNE:XURE - A (See rule 4l 

FORIU NO. NCLT. 

1 [see rules 3,4, 64, 66, 67, 68, 69, 70, 7 t, 73, 74, 75, 77, 78, 79, 80, 81, 83, 86 and 8{ 

 FORM NCLT.

4l Columns required for filing of Original Application / Reply / Rejoinder / Interlocutory Application or liling of addltlonal documents under directions of the Bench 

1. Details of Original Applicatlon / Reply / Rejoinder / Interlocutory Appllcation Particulars of the Petitioner / Applicant / Respondent and state whether company, whether petitioner or not. (Name, description, father's / husband's name, occupation, capacity, i.e. qua shareholder, qua depositor and address) 

2. Juriedlction of the Bench: The petitioner declares that the subject-matter of the petition is within the jurisdiction of the Bench. 

iii. Limltation: (If applicablef The petitioner / applicant further declares that the petition is within the limitation laid down in section ....... Of the Companies Act, 2013 (where applicable) 

iv. Facts ofthe case are glven below: (Give here a concise statement of facts in a chronological order, each paragraph containing as nearly as possible a separate issue, fact or otherwise. ) 

v. Relieflsf sought. In view ofthe facts mentioned above, the petitioner/ applicant / respondent prays for the following relief(s): (Speciff below the relief(s) sought explaining the ground for relief(s) and the legal provisions (if any) relied upon) 71 lPage 

vi. Particulars of Bank draft evidencing payment of fee for the petition or application made: Branch of the Bank on which drawn: 

Name of the issuing branch: 

Demand Draft No......... 

Date.............. 

Amount Rs...........

 (Signature/ Signature of Authorised signatory)

 Date: Place:

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