REPORT TO THE CENTRAL GOVERNMENT

       (See rule 13(4) of the Companies (Audit and Auditors) Rules, 2014)

Subject: Report under sub- section (12) of section 143 of the Companies Act, 2013 on suspected offence involving fraud being committed or having been committed

 1) (A) Name of the Company ;(b) CIN;(c) Address of the Registered Office:

2) (A) Name of the auditor or auditor’s Firm;(b) Membership Number;(c) Address

3) Date of the annual general meeting when the Auditor was appointed or reappointed

4) SRN and date of filing

5) Address of the office or location where the suspected offence is believed to have been or is being committed

6) Full details of the suspected offence involving fraud (attach documents in support)

7) Particulars of the officers or employees who are suspected to be involved in the commission of the offence, if any:

a) Name(s):

b) Designation

c) If Director, his DIN

d) PAN

8) Basis on which fraud is suspected:

9) Period during which the suspected fraud has occurred

10) Date of sending report to the Board or Audit committee as per rule 13(1)

11) Date of reply received from Board or Audit committee, if any and if so received, attach copy thereof and give gist of the reply

12) Whether the auditor is satisfied with the reply of the Board or Audit committee. Yes _____ No _____.

13) Estimated amount involved in the suspected fraud;

14) Details of steps, if any, taken by the company in this regard;

(Furnish full details with references)

15) Any other relevant information.

                                                   VERIFICATION

I………………, Proprietor/Partner of ……………………………, Chartered

Accountants do hereby declare that the information furnished above is true, correct and complete in all respects including the attachments to this form.