1. (a)     Name of Company

ii.    Address of its registered office

ii.    Address of the principal office if it is other than the registered office

ii.    Branches at

(b) (a)    Management structure (full list of directors/managing directors/manager/secretary with
        particulars of other directorships, if any held by them)

ii. Details of the existing capital structure

ii. Turnover (for each of the last three financial years)

ii. Net profits (for each of the last three financial years)

3.     (a)   The proposal for which Central Government’s approval is sought including particulars of
                remuneration payable  and the reasons therefor

 (b)   In case of appointment existing as on the date of commencement of the
               Companies(Amendment) Act, 1974 particulars of remuneration payable   as on the said date

4.     If the proposal is for appointment of former managing agents or secretaries and treasurers:

(a) Name and status (whether individual, firm or body corporate) of the former managing agents or secretaries and treasurers of the company and business being carried on by them

(a) (i)   In the case of a body corporate, name of the directors (including managing directors and 
           whole-time directors, if any)

(b)

ii.    In the case of a firm, names of partners

5. Particulars of remuneration paid to managing agents or secretaries and treasurers during the last year of appointment as such under the company and copy of relevant approval of the Central Government for the said remuneration.

6. If the proposal is for appointment of an associate of former managing agents or secretaries and treasurers:

(a) Name and status of such associate and business carried on by the said associate.

(b) (I)   In case of body corporate, name of the directors (including managing directors and
                     whole-time directors, if any)

(ii)   In case of firm, name of partners. 

©    The date since when the relationship of associate to the managing agents or secretaries and
              treasurers existed (bringing out the nature of the association )

7. Name of the office, i.e. consultant, adviser, etc.

8. Nature of services to be rendered and justification for such appointment or continuance.

9. Age, qualification and experience.

10.Has the proposal been approved by the company in general meeting ; if so, one copy of the resolution passed should be furnished.

11.Declaration: 

I/We solemnly declare that the fact stated in this application are true to the best of my/our knowledge, information and belief.

 Signature …………………………………