Annexure ‘C’
[Refer to paragraph 4(2) of Schedule I]
Return to be filed by an Indian company
who has arranged issue of GDR/ADR| 1. | Name of the Company | : | |
| 2. | Address of Registered Office | : | |
| 3. | Address for correspondence | : | |
| 4. | Existing Business (Please give the NIC Code of the activity in which the company is predominantly engaged) | : | |
| 5. | Details of the purposes for which GDRs/ADRs have been raised.If funds are deployed for overseas investment, details thereof. | : | |
| 6. | Name and address of the Depository abroad | : | |
| 7. | Name and Address of the Lead/Manager Investment/Merchant Banker | : | |
| 8. | Name and addresses of the Sub-Managers to the issue | : | |
| 9. | Name and address of the Indian custodians | : | |
| 10. | Details of FIPB approval (Please quote the relevant NIC Code if the GDRs are being issued under the Automatic Route) | : | |
| 11. | Whether any overall sectoral cap for foreign investment is applicable. If yes, please give details. | : | |
| 12. | Details of the Equity Capital(a) Authorised Capital
(b) Issued and Paid-up Capital
(i) Held by persons Resident in India
(ii) Held by foreign Investors other than FIIs/NRIs/PIOs/OCBs (A list of foreign investors holding more than 10 per cent of the paid-up capital and number of shares held by each of them should be furnished)
(iii) Held by NRIs/PIOs/OCBs
(iv) Held by FIIs.
Total Equity held by non –residents
(c) Percentage of equity held by non-residents to total paid-up capital | : | Before Issue After Issue |
| 13. | Whether issue was on private placement basis. If yes, please give details of the investors and ADRs/GDRs issued to each of them. | : | |
| 14. | Number of GDRs/ADRs issued | : | |
| 15. | Ratio of GDRs/ADRs to underlying shares | : | |
| 16. | Issue Related Expenses:(a) Fee paid/payable to Merchant Bankers/Lead Manager
(i) Amount (in US $ etc.)
(ii) Amount as percentage to the total issue.
(b) Other Expenses | : | |
| 17. | Whether funds are kept abroad. If yes, name and address of the bank. | : | |
| 18. | Details of the listing arrangement :
Name of Stock ExchangeDate of commencement of trading | : | |
Certified that all the conditions laid down by Government of India and Reserve Bank of India have been complied with.
Sd/-
Chartered Accountant | Sd/-
Authorised Signatory of the Company |