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Share/ Debenture Holder’s Name  

Surname

Middle Name

First Name

Father’s/ Husband’s Name  

Type of Share/ Debenture  

1 – Equity, 2- Preference Shares,3 – Debentures, 4 - Stock  

Number of Shares/ Debentures Held/ Stock, if any  

Amount per Share (in Rs.)  

Note: Separate sheet may be attached if needed. If number of such share holders exceed 10, if so desired a text file may be submitted on a floppy or a cartridge tape in the format given in Annexure – III.

Details of shares/ Debentures Held at Date of AGM (Contd.)

Address  

Town/City  

District  

State  

Pin Code  

Address  

Town/City  

District  

State  

Pin Code  

Address  

Town/City  

District  

State  

Pin Code  

Details of Shares/ Debentures Transfers since Date of last AGM (or in the case of the first return at any time since the incorporation of the company) *

Date of Previous AGM  

Date

Month

Year

Date of Registration of Transfer of

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