FORM NO. 22
Registration No. of Company ……………….		Nominal Capital Rs. …………………

THE COMPANIES ACT, 19567
Statutory report
[pursuant to section 165]
Name of company ………………………………………………………….Limited
Statutory report of the ……………………………… certified and field pursuant to section 165(5).
Date of notice for holding statutory meeting ………………………………………………………….
Date of meeting …………………………………………………………………………………………
Place where the meeting is to be held …………………………………………………………………
Presented by ……………………………………………………………………………………………
	The board of directors submit this statutory report to the members in pursuance of section 165.
1	Shares allotted and cash received up to ……………………………………….. .

No. of shares	Nominal value of each share	Cash received up to 	
(a)	Allotted subject to payment thereof in cash.			
	(i)   Equity 			
	(ii)  Redeemable preference shares. 			
	(iii) Preference shares other than redeemable 			
	       preference  shares.			
(b)	Allotted as fully paid up otherwise than in cash and the consideration for which they have been allotted.			
	(i)  Equity			
	(ii)  Redeemable preference shares			
	(iii) Preference shares other than redeemable			
	       preference shares.			
©	Allotted as party paid up to the extent of Rs. ………..  per share and the consideration for which they have been so allotted.			
	(i)   Equity 			
	(ii)  Redeemable preference shares 			
	(iii) Preference shares other than redeemable preference shares			
				
2.  Abstract of receipts and payments upto:--	
Receipts                                                      Rs.	Payments                                                         Rs.	
Shares 	Preliminary expenses	
          Equity	         Commission on issue or	
          Redeemable preference shares.	          Sale of shares…………………….	
           Preference shares other than.	          Discount on issue or	
          redeemable preference shares.	           Sale of shares……………………..	
Advance payment for shares.	Capital expenditure 	
Debentures …………………………….	           Land ……………………………..	
Loans ………………………………….	           Building ………………………….	
Deposits ……………………………….	           Plant ……………………………..	
Other sources ………………………….	            Machinery……………………….	
(to be specified) ……………………….	Other items to be specified 	
	Balances………………………………….	
	           In hand ……………………………	
	           At banks …………………………..	
	           At post Office …………………….	
	           Saving Bank ………………………	
 Total	Total	

3.  Preliminary expense as estimated in the prospectus or statement in the lieu of 
      prospectus ………………………………….. 	
			
	preliminary expenses actually incurred up to aforesaid date Rs. 	Preliminary expenses estimated to be incurred after the aforesaid date Rs.	
Law carges……………………………………			
Other charges in connection with the preparation of the Memorandum 			
Articles of Association ………………………			
printing expenses ……………………………			
Registration charges …………………………			
Advertisement charges ………………………			
Commission on issue or sale of shares 			
……………………………………………..			
Discount on issue or sale of shares……………			
Other initial expenses.(To be specified as far as possible ).	Total Rs. ………………………………………

4.     Names, addresses and occupation of the company’s Directors, Auditors, Manager and  Secretary. 	
					
Name(s)	Address(es)	Occupation(s)	Particulars of change(s) if any, in entries in columns (1), (2) and (3) since the date of incorporation  	Date of the change	
1	2	3	4	5	
A.	Directors				
B.	Auditors				
C.	[***]				
D.	Manager				
E.	Secretary				
					
These Particulars must include dates of changes.	
5.  Particulars of any contract which is to be submitted to the statutory meting for approval. (If any modification or proposed modification of a contract is  to be submitted for such approval, brief particulars of contract and particulars of modification or proposed modification should be given).	
6.  Underwriting contracts.	
     Brief description of each contract.	
     If contract not carried out fully, extent to which it has not been carried out and reason thereby.	
7.   The arrears, if any, due on calls from Directors, [***]	
	
Names	                                     Amount due     	
Directors		
Manager		

 	
8.Particularts of any commission or brokerage paid or to be paid in connection with the issue or sale of shares to any director or Manager.	
Names	Commission or brokerage paid or to be paid	
	On shares	On debentures	
Directors		
Manager.		

	We hereby certify that the above report is correct.
Dated the ………………………….. day of ………………….. 19 …………..
Signature of two or more Directors
	We hereby certify as correct so much of the report as relates to the shares allotted by the company and to the cash received in respect of such shares and to the receipts and payments.
…………………………….
Auditors
Dated the ………………….. day of ……………… 19
1	The date should be a date within 7 days of the report.
2	Strike out the portion which does not apply.
3	Where there is a managing director, he shall be one of the signatories.