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FORM 40

Companies Act, 1965

Section 111 (2)

Company No.

CERTIFICATE OF REGISTRATION OF CHARGE

This is to certify that a charge dated the ........... day of ......................, 20.........., created by
.......................................... in favour of ........................................ to secure the amount stated in the
Statement of Prescribed Particulars in respect of the charge dated the ........... day of .....................,
20.........., has been registered and numbered ........................., in the Register of Charges.

Given under my hand and seal, at ........................., this ............... day of ........................., 20..........

.................................................
Registrar of Companies

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