(a)* Whether CSR amount for the financial year has been spent Yes No
(b) If yes, CSR amount has been spent against:
O Ongoing projects O Other than ongoing projects O Both (Ongoing and other than ongoing projects) [भाग II—खण् ड 3(i)] भारत का राजपत्र : ऄसाधारण 11
(i) Details of CSR amount spent against ongoing projects for the financial year:
Number of Ongoing Projects for the financial year 1 2 3 4 5 6 7 8 9 10 S.
N o.
Project ID Item from the list of activi ties in sched ule VII Name of the Project Lo cal Ar ea (Ye s/N o) Location of the Project Proje ct dura tion (in mont hs) Amou nt spent in the Financ ial Year (in Rs.)
Mode of Imple mentation - Direct (Yes/N o) Mode of Implementation - Through Implementing Agency St at e Dis tric t CSR Registr ation No.
Name 1 2 3 4 5 Total XX
(ii) Details of CSR amount spent against other than ongoing projects for the financial year:
x Number of Other than Ongoing Projects for the financial year 1 2 3 4 5 6 7 8 S.
No.
Item from the list of activiti es in schedu le VII Name of the Project Local Area (Yes/N o) Location of the Project Amount Spent in the Financial Year (in Rs.)
Mode of Implementa tion - Direct (Yes/No) Mode of Implementation - Through Implementing Agency State District CSR Registration No.
Name 1 2 3 Total XX
(c)* Amount spent in Administrative Overheads
(d)* Amount spent on Impact Assessment, if applicable
(e)* Total Amount Spent for the Financial Year
(f)* Amount unspent/ (excess) spent for the Financial Year [6(d)-7(e)] unspent for Ongoing projects)
(g)* Amount eligible for transfer to Unspent CSR Account for the Financial Year as per Section 135(6) (before adjustments)
(h)* Amount to be transferred to Fund specified in Schedule VII for the Financial Year (if total unspent for the Financial Year is greater than unspent for Ongoing projects) 12 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)]
8. Details of transfer of Unspent CSR amount for the financial year:
(a) Transfer to Unspent CSR account as per Section 135(6) Amount to be transferred to Unspent CSR account Amount actually transferred to Unspent CSR account Date of Transfer Deficiency, if any
(b) Transfer to Fund specified in Schedule VII as per second proviso to Section 135(5) for the Financial Year:
Amount to be transferred to Fund specified in Schedule VII Amount actually transferred to Fund specified in Schedule VII Date of Transfer Deficiency, if any
9. *Specify the reason(s) if the company has failed to spend two per cent of the average net profit as per section 135(5):
10. *Whether any unspent amount of preceding three financial years (financial year ending after 22 nd January 2021) has been spent in the financial year Yes No
(a) Details of CSR amount spent in the financial year pertaining to three preceding financial year(s):
1 2 3 4 5 6 7 8 S .
N o .
Preced ing Financ ial Year(s ) Amount transferre d to Unspent CSR Account under Section 135(6) (in Rs.)
Balance Amount in Unspent CSR Account under section 135 (6) (in Rs) Amount Spent in the Financial Year (in Rs) Amount transferred to a Fund as specified under Schedule VII as per second proviso to Section 135(5), if any Amount remaining to be spent in succeedin g financial years (in Rs) Deficiency , if any Amount (in Rs) Date of Transfer 1 FY-1 2 FY-2 3 FY-3
(b) Details of CSR amount spent in the financial year for ongoing projects of the preceding financial year(s):
Number of Ongoing Projects [भाग II—खण् ड 3(i)] भारत का राजपत्र : ऄसाधारण 13 1 2 3 4 5 6 7 8 S.
N o.
Project ID Name of the Project Financial Year in which the project was commenced Amount spent for the project at the beginning of the Financial Year (In Rs) Amount Spent in the Financial Year (in Rs) Cumulative Amount Spent at the end of Financial Year (in Rs) Status of the project - Completed /Ongoing 1 2 3 4
(c) (i) Whether any new CSR project has been undertaken in the financial year from the Unspent amount pertaining to preceding three financial years : Yes No
(ii) If yes, nature of the new CSR Project(s) is/are :
O Ongoing project(s) O Other than ongoing project(s) O Both (Ongoing and other than ongoing projects)
(iii) Details of amount spent against new ongoing CSR project in the financial year :
Number of Ongoing Projects 1 2 3 4 5 6 7 8 9 10 11 S.
N o.
Proje ct ID Fina ncial year to whic h the new proje ct perta ins Item from the list of activi ties in sched ule VII Name of the project Lo cal Ar ea (Ye s/N o) Location of the Project Proje ct dura tion (in mont hs) Amou nt spent in the Financ ial Year (in Rs.)
Mode of Imple mentat ion - Direct (Yes/N o) Mode of Implementation - Through Implementing Agency St at e Dis tric t CSR Registr ation No.
Name 1 2 3 4 5 Total XX
(iv) Details of amount spent against new other than ongoing projects in the financial year:
Number of Other than Ongoing Projects 1 2 3 4 5 6 7 8 9 S.
No.
Finan cial year to Item from the list of Name of the project Local Area (Yes/ No) Location of the Project Amount Spent in the Financial Mode of Implement ation - Direct Mode of Implementa tion - Through 14 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)] which the new projec t pertai n activit ies in sched ule VII Year (in Rs.)
(Yes/No) Implementing Agency State District CSR Registrat ion No.
Name 1 2 3 Total XX
11. Whether any unspent amount pertaining to FY 2014-15 to FY 2019-20 has been spent in the financial year Yes No Details of amount spent against CSR projects in the financial year:
Number of CSR Projects 1 2 3 4 5 6 7 8 9 S.
No.
Financ ial year to which the new projec t pertai n Item from the list of activit ies in sched ule VII Name of the project Local Area (Yes/ No) Location of the Project Amount Spent in the Financial Year (in Rs.)
Mode of Implement ation - Direct (Yes/No) Mode of Implementation - Through Implementing Agency State District CSR Registrati on No.
Name 1 2 3 Total XX
12. *Whether any capital assets have been created or acquired through CSR spent in the financial year Yes No If Yes, enter the number of Capital assets created/ acquired Furnish the details relating to such asset(s) so created or acquired through CSR spent in the financial year:
Sr.
No.
Short particulars of the property or asset(s) [including complete address and location of the property] Pin code of the property or asset(s) Date of creation Amount of CSR spent Details of entity/ Authority/ beneficiary of the registered owner CSR Registration Number, if applicable Name Registered address Total XXXX [भाग II—खण् ड 3(i)] भारत का राजपत्र : ऄसाधारण 15 (All the fields should be captured as appearing in the revenue record, flat no, house no, Municipal Office/Municipal Corporation/ Gram panchayat are to be specified and also the area of the immovable property as well as boundaries) Attachments List of Attachment
1.Optional attachment(s), if any Declaration I am authorized by the Board of Directors of the Company vide resolution number * *Dated to sign this form and declare that all the requirements of Companies Act, 2013 and the rules made thereunder in respect of the subject matter of this form and matters incidental thereto have been complied with. I further declare that:
13. Whatever is stated in this form and in the attachments thereto is true, correct and complete and no information material to the subject matter of this form has been suppressed or concealed and is as per the original records maintained by the company.
14. All the required attachments have been completely and legibly attached to this form.
To be digitally signed by one director.
*To be digitally signed by *Designation *DIN of the director;
Note: Attention is drawn to provisions of Section 448 and 449 which provide for punishment for false statement / certificate and punishment for false evidence respectively.
This eform has been taken on file maintained by the Registrar of Companies through electronic mode on the basis of statement of correctness given by the authorized person.
[F. No. 1/19/2013-CL-V-Part III] K. V. R. MURTY, Jt. Secy.
Note : The principal rules were published in the Gazette of India vide number G.S.R. 239(E), dated the 31st March, 2014 and was subsequently amended vide notifications number G.S.R. 723(E), dated the 14th October, 2014, G.S.R.
37(E), dated the 16th January, 2015, G.S.R. 680(E), dated the 4th September, 2015, G.S.R. 742(E), dated the 27th July, 2016, G.S.R. 1371(E), dated the 7th November, 2017, G.S.R. 191(E), dated the 27th February, 2018, G.S.R.
725(E), dated the 31st July, 2018, G.S.R. 803 (E), dated the 22nd October, 2019, G.S.R. 60 (E), dated the 30 th January, 2020 and G.S.R. 205(E), dated the 24 th March, 2021.
Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064 and Published by the Controller of Publications, Delhi-110054.
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