FORM NO.10
     Registration  No. of the company 				        Nominal Capital Rs
THE COMPANIES ACT, 1956

Particulars of a series of debentures, containing or giving by reference to any other instruments, any charge, to the benefit of which  the debenture-holders of the said series, are entitled pari passu, created by a company registered in India and also of any issue of debenture in a series
[pursuant to section 128 and 129]

THIS FORM IS TO BE USED FOR REGISTRATION OF PARTICULARS OF THE ENTIRE SERIES AND ALSO FOR ANY ISSUE IN A SERIES.
Name of the company 					 Limited/Private Limited.
Presented by 

Total amount secured by whole series	Amount of the percent issue of series	Date of the resolution authorising the issue of the series	Date of the covering deed (if any ) by which the security is created or defined or if there is no such deed, the first execution of any debenture of the series	
1		1		1		1		

				

General description of the property charged	Gist of the terms and conditions and extent and operations of the charge	Names and addresses of the trustees (if any) for the debenture-holders 	Date of registration of the series(c)	
5		5		5		5		

				

Date of present issue 	Amount of present issue	Gist of the terms and conditions and extent and operation of  the charge	Particular as to the amount or rate per cent of the commission, allowance or discount (if any), paid or made either, directly or indirectly by the company to any person in consideration of subscribing or agreeing to subscribe, whether absolutely or conditionally  or procuring or agreeing to procure subscription whether absolute or conditional for any of the debentures included in this return.	
9		9		9		9		

				

Dated the			     day of			    19 .

Signature

Designation 

Note :
(a)	A description of the instrument e.g. “Trust Deed”, ‘Mortgage’, ‘Debenture’ etc. as the case may be should be given.
(b)	‘Charge’ includes ‘mortgage’ see section 124.
(c)	The date of registration may be confirmed from the certificate of registration.
(d)	The rate of interest under the terms of the debenture should not be entered.
(e)	State position in relation to the company.