Every Form for registration of any transaction relating to assignment of receivables, satisfaction of receivables on realisation and every request for inspection of any record maintained by the Central Registry shall be accompanied by a fee specified in the Table given below to be paid to the Central Registry in the manner as may be specified by the Central Registrar from lime to time.
TABLE Serial Number ( I )
1.
2.
3.
4.
Nature of transaction j FORM No.
to be Registered | _ (?)_ ~~"J "II (3J " Particulars of j FORM I Assignment of j Receivables 'Satisfaction of; KORMlf' registration on !
realisation of the \ receivables [ __ Any application for \ — information recorded j or maintained in the j Register by anv_person j Any application for j — condonation of delay j up to 30 days !
Amount payable of fee
(4) Rs. 500 assignment receivables Rs. 250 Rs. 50 Rs. 2500 for of [L No. 6/3/2010-BO.H] ALOK.NIGAM,Jt.Secy.
THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—Sue. 3{ CENTRAL REGISTRY FORM I Assignment of Receivables jp favour of Factor (Particulars of assignment of receivables)
(a) Category of the Assignor of receivables (Fill up only one category):
Individual I i Proprietorship Film I I Limited Liability Partnership Firm (LLP/ ] Partnership Firm Company Trust Q HUF 1
(b) Whether the receivables are free from any encumbrance? O Yes O No
(c) If not, name and address of the Name of Bank/Financial Institution Bank or Financial Institution holding any Security interest over the receivables.
Address of Bank/Financial Institution
(el) If security interest over receivables is held by Consortium of Banks, name and address of the Leader Name and address of Leader of Consortium [*nn II—TS^S 3(i)] •q^rl T̂T TJWTX : 3raitTT^T
(e) If security interest over receivables is held by Multiple Banks, name and address of the Bank authorised to act on behalf of other Banks Name and address of the Bank representing Multiple Banks Note: If there is no single Bank representing Multiple Banks names of all the Banks may be furnished.
2. Assignor
(a) Individual
(i) Name Title Surname (Mr./Mrs./Ms.)
Father's/Husband's name Date of Birth
(ii) Permanent Account Number (PAN) of Individual Assignor Name (dd/mm/yyyy)
(b) Proprietorship Firm
(i) Name of Proprietorship Firm
(ii) Permanent Account Number (PAN) of Proprietorship Firm
(iii) Name of the Proprietor
(a) in case of company Corporate Identity Number of Proprietor Company
(b) in ease of individual Title (Mr./ Mrs./Ms.)
OR Surname Name 24 THE GAZETTE OK INDIA : EXTRAORDINARY [PARI II—SF.C. 3(i)] Father's/Husband's name Date of Birth (dd/mm/yyyy) Permanent Account Number (PAN) OR
(c) Limited Liability Partnership Firm (LLP)
(i) Limited Liability Partnership (LLP) Firm Name
(ii) Name ofthe partner or partners who is/are making assignment of receivables belonging to the Limited Liability Partnership (LLP) Firm.
Title (Mr./Mrs./Ms.;
(1) Surname Name Father's/Husband's name Date of Birth (dd/jTim/yyy)
(2) Title (Mr./Mrs./Ms.
Surname Name Fathers/Husband name Date of Birth (dd'mm/yyy) (Above details for multiple partners can be captured multiple times)
(iii) Permanent Account Number (PAN) of Limited Liability Partnership Firm (LLP) OR
(d) Partnership Firm
(i) Partnership Firm Name [*rm ii—13*5 3(i)] •HRcI ^1 TRT̂ f : 3TOimr^ 25
(ii) Name of the partner or partners who is /are making assignment of receivables belonging to the Partnership Firm
(a) Title Surname Father's/Husband's name Date of Birth (Mr./Mrs./Ms.)
Name (dd/mm/yyyy)
(b) Title Surname Father's/Husband's name (Mr/Mrs/Ms) Name Date of Birth (dd/mm/yyyy) (Above details for respective Partners can be captured multiple times)
(iii) Permanent Account Number (PAN)
(e) Company
(i) Company name OR
(ii) Corporate Identity Number (CIN) or foreign company registration number OR
(f) Trust
(i) Name of the Trust
(ii) Whether Private Trust or Public Trust
(iii) If Public Trust, registration number as such Trust, if any 1211 GI/2012—4 26 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)]
(iv) Trust Permanent Account Number
(v) Name of the Trustee/person who is making assignment of receivables belonging to the Trust Title Name (Mr./Mrs./Ms.)
Surname Father's/Husband's name Date of birth
(g) HUF Title of HUF Name of Karta (dd/mm/yyyy) (Mr./Mrs./Ms.)
Surname Father's/Husband's name Date of birth (dd/mm/yyyy) Permanent Account Number (PAN) of HUF
3. Address of the Assignor:
Shop/Flat/House No.
PtetNo.
Building No. Building Name Street Name/No.
Village Taiuka State/UT District PIN Code Basic Statistical- Return Code (fiSR) Code if any [*in i i — ^ P S 3(i)] TO ^T TT^m : aTOTtlTCOT 27 assigned to Assignor Note: In the case of companies the address of Registered Office and in the case of others the address of principal place of business may be furnished.
4. Particulars of the Factor being the Assignee of receivables Name of Assignee Corporate Identity Number Permanent Account Number (PAN) Address Shop/Flat/House No.
Plot Number Building Number Building Name Street Name/No.
Village Town Taluka City District State /UT Pin Code e-mail ID Telephone 23 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)] 5):
(a)
(b) i) DEBTOR (Buyer) DEBTOR (Buverl Limit Particulars of Debtor Individual Debtor Title Surname (Mr./Mrs /Ms.1 Father' s/Husband' s name Date of Birth Name (dd/mm/yyyy) (rh Individual debtor Permanent Account Number (PAN) OR
(ii) Proprietorship Firm Debtor
(i) Name of Proprietorship Firm
(ii) Proprietorship Firm Permanent Account Number (PAN)
(iii) Name of the Proprietor
(a) in case of company Title
(b) in case of individual (Mr./Mrs./Ms.)
Surname Name Father's name Age [vW\ II—7TO 3(i)] MRcf ^1 TF5PT3 : araim*"!
Date of Birth (dd/mm/yyyy) OR
(iii) Partnership Firm Debtor Partnership Firm Name 29 Partnership Firm Permanent Account Number (PAN) Name of the partner or partners of debtors Title Surname (Mr./Mrs./Ms.)
Name Father's/Husband's name Age Date of Birth (dd/mm/yyyy) OR
(iv) Limited Liability Partnership Firm (LLP) Debtor Limited Liability Partnership (LLP) Firm Name LLP firm Permanent Account Number (PAN) Name of the partner or partners Title I (Mr./Mrs./Ms.)
(1) Surname Name 1211 GI/2012—5 30 THE GAZETTE OF INDIA : EXTRAORDINARY [PANI II Sir. 3(i) Father's/Husband's name Age Date of Birth (dd/mm/yyyy) OR
(v) Company Debtor Company name Corporate Identity Number (CIN) or foreign company registration number Company PAN
(vi) Trust Name of the Trust OR Type of Trust (Private/Public) If Public Trust, registration number as such Trust, if any Trust Permanent Account Number Name of the Trustee/person who is making assignment of receivables belonging to the Trust Title (Mr./Mrs./Ms.)
Surname Name Father's/Husband's name [*TFT II—TsFZ 3 ( i ) ] *TTCrT ^ T < M 1 ^ : S^TT^T^ 31 Age Date of birth
(vii) HUF Title of HUF Name of Karta Title Surname (dd/mm/yyyy) (Mr./Mrs./Ms.)
Name Father's/Husband's name Age Date of birth (dd/mm/yyyy) Permanent Account Number (PAN) of HUF c) Address of the Debtor:
' Shop/Flat/House No.
Plot No.
Building No.
Building Name Street Name/No.
Village/Town Taluka State District PIN Code 32 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)] Email ID I Telephone i (In case of multiple debtors in respect of a single assignor, the details of multiple debtors may be provided) 6) Assignment Details 6 (a). Financial Details of the Assignment
(i) Total Limit/Facility sanctioned under the agreement 0 (in case the amount is in foreign currency, rupee equivalent to be stated) • (Rupees only)
(ii) Ejected realisation or repayment I period (in days) ' '
(iii) Amount receivables assigned or given as | ™ Security for loan / credit limit I 6(b). Whether assignment is absolute without recourse to assignor O Yes O No If not, amount of loan or credit limit secured by receivables:
(Rupees only) Payment schedule of the loan from or period during which assignment subsists DD MM YYYY t o I 1 I 1 I DD MM YYYY If credit limit renewable from time to time and secured by specific receivables, or present and future receivables, please mention:
Particulars of specific receivables | Description of future receivables 7) Description of document by which the receivables are assigned:
» [*nn II—T3*s 3 ( i ) ] MTTcT "^T TTmi : 3T?TT*TR̂ T 33 Assignment Deed or assignment as security for a loan Name of the Parties (1)
(2) Date of Document Place of execution Taluka District Pin code State Description of receivables which are assigned or given as security in favour of the Factor i) Whether the assignment is on (a) whole turnover basis
(b) Invoice basis (non whole turnover basis) a) In case of Whole Turnover Basis:
i) Brief description of goods or services ii) Sub-Limit sanctioned for the goods and services iii) Sale proceeds of goods manufactured and sold or services provided / rendered or to be provided / rendered for the period frorri tp.
OR i) Brief description of goods or services 34 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)] ii) Sub-Limit sanctioned for the goods and services iii) Sale proceeds of goods sold or to be sold or services rendered or to be provided /rendered as trader /selling Agent / retailer for the period from to (Above details for different goods type can be captured multiple times depending upon the number of types of goods) b) In case of Invoice Basis (non-whole turnover basis):
i) Invoice No.
ii) Date iii) Amount of invoice iv) Serial numbers or any other identification marks (e.g. Chassis No. for vehicles) v) Brief Description of goods vi) Payable by date (DD/MM/YYYY)
8. Brief particulars of the principal terms and conditions of the assignment agreement A. Discount B. Margin amount details .
C. Extent and operation of the charge [w\ ii—~®vz 3(i)] «rrm F̂T TTSHT̂ : aroreRq 35 D. Others
10. Digital signature of the authorised representative of Assignee/ Factor CENTRAL REGISTRY FORM II Satisfaction on realization of receivables (Particulars for Satisfaction on realization of receivables)
1. Assignor Permanent Account Number (PAN)
2. (a) Name of the Assignor I
(b) Address of the Assignor Building No.
Building Name City I State/UT I
3. Assignment registration ID Number I
(a) Particulars of the Assignee Factor Permanent Account Number Name I Address Building No.
Building Name City I State/UT I 36 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)]
(b) Particulars of registration of assignment of receivables:
(i) Registration date (ddVmm/yyyy)
(ii) Final amount assigned (in Rupees)
4. Date of realization of receivables or repayment of loan in full (ddVmm/yyyy) For office use only It is certified that the above document for charge satisfaction is hereby registered Digital signature of the authorised officer at the Central Registry Digital signature of the authorised officer at the Central Registry Printed by the Manager, Government of fndia Press, Ring Road. Mayapuri. New Delhi-I [0064 and Published by the Controller or Publicauons. Delhi- ] 10054