FORM PAS-3 — RETURN OF ALLOTMENT
Filed under Section 39(4) & 42 read with Rule 12 & 14 of the Companies (Prospectus and Allotment of Securities) Rules, 2014, within 15 days (30 days for private placement) of allotment.
| CIN of the company | [U74999XX2021PTC000000] |
| Name of the company | [ABC Private Limited] |
| Date of allotment | [DD/MM/YYYY] |
| Kind / class of securities | [Equity / Preference / Debentures] |
| Whether allotment against cash / other than cash / bonus / private placement | [__________] |
Details of securities allotted
| No. of securities allotted | Nominal value per security (Rs.) | Premium per security (Rs.) | Total amount (Rs.) |
|---|---|---|---|
| [1,00,000] | [10] | [40] | [50,00,000] |
| [__________] | [____] | [____] | [__________] |
List of allottees
| Name of allottee | PAN | No. of securities | Amount paid (Rs.) |
|---|---|---|---|
| [Mr. A] | [ABCPA1234K] | [60,000] | [30,00,000] |
| [Ms. B] | [XYZPB5678L] | [40,000] | [20,00,000] |
| [________________] | [__________] | [__________] | [__________] |
Attachments: List of allottees; Board/Shareholders’ resolution; valuation report (if applicable); complete record of private placement offer (PAS-4/PAS-5).
Compliance note: For private placement, PAS-3 must be filed within 15 days of allotment and the company cannot utilise the money raised until PAS-3 is filed. The complete list of allottees with PAN and addresses must be attached.