<<On the letter head of Auditor>>
To whom so ever it may concern
This is to be certified that Ms. ______________________ a Company incorporate under Companies Act, 2013 and having its registered office situated at ___________________has following “outstanding receipts of money or loan, which have been taken from 1st April, 2014 and are outstanding as on 22nd January, 2019 and which are not considered as deposits, in terms of Rule 2(1)(c) of Companies (Acceptance of Deposits) Rules, 2014 read with Section 73 of the Companies Act, 2013:–
| S.No. | Particulars | Amount | Total Amount |
| a) | Amount received from: | ||
| 1) the Central Government; | 00,000 | ||
| 2) a state Government; or any amount received from any other source whose repayment is guaranteed by the Central Government or State Government; | 00,000 | ||
| 3) any amount received from a local authority; or | 00,000 | ||
| 4) any amount received from statutory authority constituted under an act of Parliament or a State Legislature. | 00,000 | 00,000 | |
| b) | Amount received from: | ||
| 1) Foreign Governments; or | 00,000 | ||
| 2) Foreign or international banks; | 00,000 | ||
| 3) Multilateral financial institutions; | 00,000 | ||
| 4) Foreign Governments owned development financial institutions | 00,000 | ||
| 5) Foreign export credit agencies; | 00,000 | ||
| 6) Foreign collaborators; | 00,000 | ||
| 7) Foreign body corporates | 00,000 | ||
| 8) Foreign citizens; | 00,000 | ||
| 9) Foreign authorities or; | 00,000 | ||
| 10) Persons residents outside India subject to the provisions of Foreign Exchange Management Act, 1999 (42 of 1999). | 00,000 | 00,000 | |
| c) | Amount received as – | ||
| 1) A loan or facility from any banking company; | 00,000 | ||
| 2) From the state Bank of India or any of its subsidiary banks; | 00,000 | ||
| 3) From a banking institution notified by the Central Government under section 45 of the Banking Regulation Act, 1949 | 00,000 | ||
| 4) A corresponding new bank as defined in clause(d)of section 2 of the Banking Companies (Acquisition and Transfer of Undertakings) Act, 1980 | 00,000 | ||
| 5) From a cooperative bank as defined in clause (b-ii) of section 2 of the Reserve Bank of India Act, 1934 | 00,000 | 00,000 | |
| d) | Amount received as loan or financial assistance from – | ||
| 1) Public Financial Institutions notified by the Central | 00,000 | ||
| 2) Government; | 00,000 | ||
| 3) Any regional financial institutions; | 00,000 | ||
| 4) Insurance companies; or | 00,000 | ||
| 5) Scheduled Banks as defined in the Reserve Bank of India Act,1934 | 00,000 | 00,000 | |
| e) | Amount received against issue of commercial paper or any other instruments issued in accordance with the guidelines or notification issued by the Reserve Bank of India. | 00,000 | 00,000 |
| f) | Amount received by the company from any other company. | 00,000 | 00,000 |
| g) | Amount received and held pursuant to an offer made in accordance with the provisions of the Act towards subscription to any securities including share application money or advance towards allotment of securities pending allotment, so long as such amount is appropriated only against the amount due on allotment of securities applied for. | 00,000 | 00,000 |
| h) | Amount received from a person who, at the time of the receipt of the amount, was a director of the company or the relative of the director of a private company. | 00,000 | 00,000 |
| i) | (A) Amount raised by the issue of bonds or debentures secured by a first charge or a charge ranking pari passu with the first charge on any assets referred to in Schedule III of the Act excluding intangible assets of the company; or | 00,000 | |
| (B) bonds or debentures compulsorily convertible into shares of the company within ten years. | 00,000 | 00,000 | |
| j) | Amount raised by the issue of non-convertible debentures not constituting a charge on the assets of the company and listed on recognized stock exchange as per applicable regulations made by Securities and Exchange Board of India. | 00,000 | 00,000 |
| k) | Amount received from an employee of the company not exceeding his annual salary under a contract of employment with the company in the nature of non-interest bearing security deposit. | 00,000 | 00,000 |
| l) | Non-interest bearing amount received and held in trust. | 00,000 | 00,000 |
| m) | Amount received in course of, or for the purposes of the business of the company- | ||
| 1) As an advance for supply of goods or provision of services accounted for in any manner whatsoever provided that such advance is appropriated against supply of goods or provision of services within a period of three hundred and sixty five days from the date of acceptance of such advance. | 00,000 | ||
| 2) As advance accounted for in any manner whatsoever, received in connection with consideration for immovable property under I I an agreement or arrangement, provided that such advance is adjusted against such property in accordance with the terms of agreement or arrangement. | 00,000 | ||
| 3) As security deposit for performance of the contract of supply of goods or provision of services. | 00,000 | ||
| 4) As advance received under long term projects for supply of capital goods except those covered under item (b) of sub-clause (xii) clause (c) of sub- rule (1) of rule (2) of the Companies (Acceptance of Deposits) Rules, 2014. | 00,000 | ||
| 5) As an advance towards consideration for providing future services in the form of a warranty or maintenance contract as per written agreement, if the period for providing such services does not exceed the period prevalent as per common business practice or five years, from the date of acceptance of such service whichever is less. | 00,000 | ||
| 6) As advance received and allowed by any sectoral regulator or in accordance with directions of Central or State Government. | 00,000 | ||
| 7) As an advance for subscription towards publication, whether in print or electronic to be adjusted against receipt of such publications. | 00,000 | ||
| 8) Any amount brought in by promoters of the company by way of unsecured loans in pursuance of the stipulation of any lending financial institution. | 00,000 | ||
| 9) Any amount received by a Nidhi company in accordance with the rules made under section 406 of the Act. | 00,000 | ||
| 10) Any amount received by way of subscription in respect of chit under the Chit Funds Act, 1982 | 00,000 | ||
| 11) Any amount received by company under any collective Investment scheme in compliance with regulations framed by the Securities and Exchange Board of India. | 00,000 | ||
| 12) Any amount of twenty five lakh rupees or more received by a startup company, by way of convertible note (convertible into equity shares or repayable within a period not exceeding five years from the date of issue) in a single tranche, from a person | 00,000 | ||
| 13) Any amount received by a company from – | |||
| (A) Alternate Investment Funds; | 00,000 | ||
| (B) Domestic venture Capital Funds; | 00,000 | ||
| (C) Infrastructure Investments Trusts; | 00,000 | ||
| (D) Real Estate Investment Trusts; | 00,000 | ||
| (E) Mutual Funds registered with the Securities and Exchange Board of India. | 00,000 | 00,000 | |
| Total | 00,000 |
For ____________________________ (Auditor name)
Chartered Accountants
ICAI Firm Registration no-XXXXX
XXXX
Partner
Membership no-
Place:
Date: