FORM NO. 21A

             Registration No. of company
THE COMPANIES ACT, 1956
[pursuant to section 160] 
1.	Name of the company 
2.	Presented for filling by
3.	Annual Return of the company made up to the			day of 				19		being the date of the last Annual General Meeting of the company.!
4.	Address of the registered office of the made of the company
5.	List of *past and present members

[Note:- The companies holding a licence under section 25 of the Companies Act, 1956 exempting them from using the word “Limited “ as the last word of their names, do not have fill in this item as they are exempt from this under Order No. SO 1578, dated 1st July, 1961 of the former Department of Company Law administration and published in the Gazette of India 1961, Section 3(ii), Part II, 1547]

Folio in Register of Members	Names, addresses and accupation, if any	Name if father or husband 	Date on which they became members	Date on which they ceased to be members	Remarks, if any	
1	2	3	4	5	6	

						

Notes:	

1.	Name of persons who ceased to be the members since the date of the last annual general meeting or of the lastest due date thereof and the respective dates on which they so ceased, are also to be given.
6	If the name in the list are not arranged in alphabetical order, an index sufficient to enable the name of nay person to be readily found must be annexed.
6.	Particulars of Directors, Managing Directors, [***] Manager and Secretary. !1
(A)	Particulars of person who are Directors, Managing Director of the Company on the day of the last annual general meeting or the latest due date thereof viz. The 		day of 			19.

Present name(s) and surname(s) in full and whether director or managing director	Any former name(s) or surname(s) in full	Father’s/husband’s name and surname	Nationality and nationality of origin, if the different from present nationality	Usual residential address	Business occupation and particulars of directorships, Managerships and secretaryships held in other companies/bodies corporate	Date of birth and age!!!	Date if appointment 	Date of cessation if any	
1		1		1		1		1		1		1		1		1		

Notes :
(a)	The expression “managing director”, “ director” , etc., inclueds a  member of managing/executive commitee.
(b)	The information under column (7) need not be given in respect of private companies which are not subsidiaries of public companies.

(B)	[***]
(C)	Particulars of the person(s) who is Manager/Secretary of the company on the day of the latest annual general meeting, or the latest due date thereof, namely, the …………. Day of ……………. 19 ……………

Present name(s) and surname(s) in full and whether Manager/Secretary	Any former name(s) or surname(s) in full	Father’s/husband’s name and surname	Nationality and nationality of origin, if the different from present nationality	Usual residential address	Business occupation and particulars of directorships, Managerships and secretaryships held in other companies/bodies corporate	Date if appointment 	Date of cessation if any	
1	2	3	4					

7	Particulars of indebtedness:
A statement is annexed to this return duly signed by the signatories to this return and containing particulars of the total amount of indebtedness as on the day of the aforesaid annual general meeting in respect of all charges which are or were required under the companies Act, 1956, or under any previous company law or, which would have been required to be registered under the aforesaid Act, they had been created after the commencement of the said Act.
Certificates to be given by a director and manager/Secretary or by two directors one of whom shall be managing director where there is one.
We certify that the return states the facts as they stood on the date of two directors general meeting aforesaid correctly and completely.
We certify that since the date of last annual return the transfer of all debentures and the issue of all further certificates of debentures have been appropriately recorded in the books maintained for the purpose.
In the case of private companies only:
	We certify that the company has not since the date of the annual general meeting with reference to which the last return was submitted or in the case of first return , since the date of the incorporation of the company, issued by any invitation to the public to subscribe for any debentures of the company.
	We certify that the excess of the number of members of the company over fifty consists wholly of persons, who under sub-clause(b) of clause (iii) of section 3 of the Companies Act, 1956, are not to be included in reckoning the number of fifty.
Place ……………………………..				Singed………………………Director
Date ………………………………				Singed ………………………Director
Managing Director/
Manager /Secretary]