| Form languageEnglishHindiRefer the instruction kit for filing the form.|- |
Before the Regional Director|- |
In the matter of the Companies Act, 2013|- |
And|- |
In the matter of appeal against the order made ob by| | |- |
1.| *Category of Appellant| |- |
2.| *Corporate identity number (CIN) or Foreign Company registration number (FCRN)| | |- |
3.| (a) Name of the Company| |- |
| (b) Address of the registered office or principal place of business in India|- |
| |- |
| (c) email id of the company| |- |
4.| Details of appellant|- |
| (a) *DIN/PAN/Passport number| | |- |
| (b) *Name| |- |
| (c) Address *Line I| |- |
| *Line II |
|- |
| (d) *City| |- |
| (e) *State| | (f) *ISO Country Code| |- |
| (g) Country| |- |
| (h) *Pin Code| | | |- |
| (i) *email id| |- |
5.| Details of respondent|- |
| (a) Adjudicating Officer| | |- |
| Specify 'Others'| |- |
| (b) Address| |- |
6.| *Section under which penalty was imposed| |- |
7.| *Penalty imposed (Amount in Rupees)| |- |
8.| *Reason for Penalty|- |
| |- |
9.| Details of imprisonment (if any)|- |
| |- |
10.| Specify the relevant Form number (if any)| |- |
11.| SRN of the form specified above| |- |
12.| *Synopsis of case|- |
| |- |
13.| *Grounds of appeal|- |
| |- |
14.| *Relief sought|- |
| |- |
15.| *Interim relief sought (if any)|- |
| |- |
16.| *Date of issuing certified copy of Penalty order|- |
17.| Due date by which the order has to be filed| |- |
18.| Delay in days| |- |
19.| Reason for delay in filing the order|- |
| |- |
20.| Details of the Condonation given (if any)|- |
| |- |
21.| *Jurisdiction of Regional Director| |- |
The appellant declares that the subject matter of appeal falls within the jurisdiction of the Regional Director.|- |
Attachments|- |
|- |
1. *Certified copy of the order against which appeal is sought;| |- |
2. Copy of authorization in favour of authorized representative;| |- |
3. Order of condonation of delay;| |- |
4. Optional attachment(s), if any.| |- |
Declaration|- |
| I am authorized by the Board of Directors of the Company vide resolution numberDatedto sign this form and declare that all the requirements of The companies Act, 2013 and the rules made thereunder.|- |
| I am filing this form in my individual capacity as Officer in default in the captioned matter and hereby certify that all the requirements of The Companies Act, 2013 and rules made there under have been complied within respect of subject matter of this form.|- |
| I also certify that all the information given hereinabove is ture, correct and complete including the attachments to this form and nothing material has been suppressed.|- |
| It is further declared that no other appeal, suit civil revision or any other legal proceedings is pending before any authority on the similar matter.|- |
*To be digitally signed by| |- |
*Designation| |- |
*PAN of the Authorized representative; or DIN/PAN or passport number of the appellant; or DIN of the director; or DIN or PAN of the manager or CEO or CFO; or Membership number of the Company Secretary| |- |
Note :Attention is also drawn to provisions of section 448 and 449 which provides for punishment for false statements and punishment for false evidence respectively.|- |
| | | | |- |
|- |
For office use only :| |- |
eForm Service request number (SRN)| | eForm filing date| (DD/MM/YYYY)|- |
Digital Signature of the authorising officer|- |
This e-Form is hereby approved| | |- |
This e-Form is hereby rejected| |- |
Date of signing| | (DD/MM/YYYY) |
