Annexure ‘C’
[Refer to paragraph 4(2) of Schedule I]
Return to be filed by an Indian company who has arranged issue of GDR/ADR

1. Name of the Company :
2. Address of Registered Office :
3. Address for correspondence :
4. Existing Business (Please give the NIC Code of the activity in which the company is predominantly engaged)
:
5. Details of the purposes for which GDRs/ADRs have been raised.
If funds are deployed for overseas investment, details thereof.
:
6. Name and address of the Depository abroad
:
7. Name and Address of the Lead/Manager Investment/Merchant Banker
:
8. Name and addresses of the Sub- Managers to the issue
:
9. Name and address of the Indian custodians
:
10. Details of FIPB approval (Please quote the relevant NIC Code if the GDRs are being issued under the Automatic Route)
:
11. Whether any overall sectoral cap
for foreign investment is
applicable. If yes, please give
details.
:
2
12. Details of the Equity Capital
(a) Authorised Capital
(b) Issued and Paid-up Capital
(i) Held by persons Resident in India
(ii) Held by foreign Investors other than
FIIs/NRIs/PIOs/OCBs (A list of foreign investors holding more than 10 per cent of the paid-up capital and number of shares held by each of them should be furnished)
(iii) Held by
NRIs/PIOs/OCBs
(iv) Held by FIIs.
Total Equity held by non –
residents
(c) Percentage of equity held by
non-residents to total paid-up
capital
: Before Issue After Issue
13. Whether issue was on private placement basis. If yes, please give details of the investors and ADRs/GDRs issued to each of them.
:
14. Number of GDRs/ADRs issued :
15. Ratio of GDRs/ADRs to
underlying shares
:
16. Issue Related Expenses :
(a) Fee paid/payable to Merchant
Bankers/Lead Manager
(i) Amount (in US $ etc.)
(ii) Amount as percentage to the
total issue.
(b) Other Expenses
17. Whether funds are kept abroad. If yes, name and address of the bank.
:
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18. Details of the listing arrangement :
Name of Stock Exchange
Date of commencement of trading
Certified that all the conditions laid down by Government of India and Reserve Bank of India have been complied with.
Sd/- Sd/-
Chartered Accountant Authorised Signatory of the Company