[Pursuant to section 232(7) and rule 21]

                                                                                                               In the Matter of compromise and / or arrangement of …………………

Statement to be filed with Registrar of Companies


1. (a) Corporate identity number (CIN) of company:

    (b) Global location number (GLN) of company:


2. (a) Name of the company:

    (b) Address of the registered office of the company:

    (c) E-mail ID of the company:


3. Date of Board of Directors’ resolution approving the scheme

4. Date of Order of Tribunal approving the Scheme under Section 232(3)

5. Details regarding:-

a) Completed actions under the Order

b) Pending actions under the Order with status


Declaration of compliance of scheme as per the Order of the Tribunal

I, the Director / Company Secretary of …………………. do solemnly affirm and declare that we are in compliance with the Order of the Tribunal dated ________.


A copy of the scheme of the compromise or arrangement is enclosed. 




Director / Company Secretary


Chartered Accountant in practice / Cost Accountant in practice / Company Secretary in practice  






1) Scheme of Compromise or Arrangement

2) Details of Compliance of the Scheme

3) Other Attachments, if any