FORM NO.10
Registration No. of the company
Nominal Capital Rs

THE COMPANIES ACT, 1956

Particulars of a series of debentures, containing or
giving by reference to any other instruments, any
charge, to the benefit of which the debenture-holders
of the said series, are entitled pari passu, created by
a company registered in India and also of any issue

of debenture in a series
[pursuant to section 128 and 129]

THIS FORM IS TO BE USED FOR REGISTRATION OF
PARTICULARS OF THE ENTIRE SERIES AND ALSO

FOR ANY ISSUE IN A SERIES.

Name of the company Limited/Private
Limited.

Presented by

Total amount secured by whole series

Amount of the percent issue of series

Date of the resolution authorizing the issue of the series

Date of the covering deed (if any ) by which the security is created or defined or if there is no such deed, the first execution of any debenture of the series 1 1 1 1

General description of the property charged

Gist of the terms and conditions and extent and operations of the charge

Names and addresses of the trustees (if any) for the

debenture-holders

Date of registration of the series(c) 5 5 5 5

Date of present issue

Amount of present issue

Gist of the terms and conditions and extent and operation of the charge

Particular as to the amount or rate per cent of the commission, allowance or discount (if any), paid or made either, directly or indirectly by
the company to any person in consideration of subscribing or agreeing to subscribe, whether absolutely or conditionally or procuring or agreeing to procure subscription whether absolute or conditional for any of the debentures included in this return.9 9 9 9

Dated the day of 19 .

Signature

Designation

Note :
(a) A description of the instrument e.g. “Trust Deed”
,

‘Mortgage’
,
‘Debenture’ etc. as the case may be should

be given.
(b) ‘Charge’ includes ‘mortgage’ see section 124.
(c) The date of registration may be confirmed from the
certificate of registration.
(d) The rate of interest under the terms of the debenture
should not be entered.
(e) State position in relation to the company.