LIST OF ALLOTTEES
FOR FORM PAS-3 (RETURN OF ALLOTMENT)
OX Agry Private Limited
CIN: U01100TN2022PTC149276
ALLOTMENT DETAILS
Date of Allotment: [Insert Date] Type of Securities: Compulsorily Convertible Preference Shares (CCPS) Face Value: ₹1 (Rupee One) per CCPS Issue Price: ₹1 (Rupee One) per CCPS (at par) Total CCPS Allotted: [Insert Total Number] Total Amount Received: ₹[Insert Total Amount]
LIST OF ALLOTTEES
FORMAT FOR FORM PAS-3 FILING
Note: This list must be attached to Form PAS-3 when filing with ROC within 15 days of allotment (for private placement).
ALLOTTEE 1
| Field | Details |
|---|---|
| Serial No. | 1 |
| Name of Allottee | [Full Name as per PAN] |
| PAN | [PAN Number] |
| Category | [Individual/Company/LLP/HUF/Trust/Others] |
| Nationality | [Indian/Foreign] |
| Address (Line 1) | [Address] |
| Address (Line 2) | [Address] |
| City | [City] |
| State | [State] |
| PIN Code | [PIN] |
| Country | India / [Other Country] |
| [Email Address] | |
| Mobile Number | [Mobile with country code] |
| Folio Number | [Folio Number] |
| No. of CCPS Allotted | [Number] |
| Face Value per CCPS | ₹1 |
| Issue Price per CCPS | ₹1 |
| Total Amount (₹) | [Number × ₹1] |
| Mode of Payment | [RTGS/NEFT/Cheque/Others] |
| Date of Payment | [DD/MM/YYYY] |
| Payment Reference No. | [UTR/Transaction Reference] |
| Tranche Allocation | [Tranche 1 / Tranche 2 / Tranche 3] |
| Conversion Multiplier | [1.5x / 1.33x / 1.25x] |
| NRI/FPI Status | [Yes/No] |
| FEMA Compliance | [Compliant/Not Applicable] |
ALLOTTEE 2
| Field | Details |
|---|---|
| Serial No. | 2 |
| Name of Allottee | [Full Name as per PAN] |
| PAN | [PAN Number] |
| Category | [Individual/Company/LLP/HUF/Trust/Others] |
| Nationality | [Indian/Foreign] |
| Address (Line 1) | [Address] |
| Address (Line 2) | [Address] |
| City | [City] |
| State | [State] |
| PIN Code | [PIN] |
| Country | India / [Other Country] |
| [Email Address] | |
| Mobile Number | [Mobile with country code] |
| Folio Number | [Folio Number] |
| No. of CCPS Allotted | [Number] |
| Face Value per CCPS | ₹1 |
| Issue Price per CCPS | ₹1 |
| Total Amount (₹) | [Number × ₹1] |
| Mode of Payment | [RTGS/NEFT/Cheque/Others] |
| Date of Payment | [DD/MM/YYYY] |
| Payment Reference No. | [UTR/Transaction Reference] |
| Tranche Allocation | [Tranche 1 / Tranche 2 / Tranche 3] |
| Conversion Multiplier | [1.5x / 1.33x / 1.25x] |
| NRI/FPI Status | [Yes/No] |
| FEMA Compliance | [Compliant/Not Applicable] |
[Continue for all allottees...]
SUMMARY OF ALLOTMENT
| Particulars | Details |
|---|---|
| Total Number of Allottees | [Number] |
| Total CCPS Allotted | [Total CCPS] |
| Total Amount Received (₹) | [Total Amount] |
| Date of Board Meeting | [Date of Board Meeting approving allotment] |
| Date of Payment Receipt | [Earliest to Latest dates] |
| Date of Allotment | [Date of Allotment] |
CATEGORY-WISE BREAKUP
| Category | No. of Allottees | No. of CCPS | Amount (₹) | % of Issue |
|---|---|---|---|---|
| Individual - Resident | ||||
| Individual - NRI | ||||
| Companies - Resident | ||||
| Companies - Foreign | ||||
| LLP | ||||
| HUF | ||||
| Trust | ||||
| FPI | ||||
| Others | ||||
| TOTAL | 100% |
TRANCHE-WISE ALLOCATION
| Tranche | Investment Range | No. of Allottees | CCPS Allotted | Amount (₹) | Multiplier |
|---|---|---|---|---|---|
| Tranche 1 | First ₹50,00,000 | 1.5x | |||
| Tranche 2 | Next ₹50,00,000 | 1.33x | |||
| Tranche 3 | Final ₹1,00,00,000 | 1.25x | |||
| TOTAL | ₹2,00,00,000 |
PAYMENT DETAILS SUMMARY
| S. No. | Allottee Name | Bank Name | Account No. (last 4 digits) | UTR/Ref No. | Amount (₹) | Date |
|---|---|---|---|---|---|---|
| 1 | ||||||
| 2 | ||||||
| 3 | ||||||
| ... |
PRE-ALLOTMENT SHAREHOLDING PATTERN
| Shareholder | Equity Shares | % of Equity | CCPS Held | % of Total Capital |
|---|---|---|---|---|
| Vijay Maniraj | 99,500 | 99.50% | - | - |
| Maniraj Karuppusamy | 500 | 0.50% | - | - |
| TOTAL | 1,00,000 | 100% | - | - |
POST-ALLOTMENT SHAREHOLDING PATTERN
| Shareholder | Equity Shares | % of Equity | CCPS Held | % of CCPS | Total Capital | % of Total |
|---|---|---|---|---|---|---|
| Vijay Maniraj | 99,500 | 99.50% | - | - | 99,500 | - |
| Maniraj Karuppusamy | 500 | 0.50% | - | - | 500 | - |
| Equity Subtotal | 1,00,000 | 100% | - | - | 1,00,000 | - |
| CCPS Allottee 1 | - | - | [Number] | [%] | [Number] | - |
| CCPS Allottee 2 | - | - | [Number] | [%] | [Number] | - |
| ... | - | - | ... | ... | ... | - |
| CCPS Subtotal | - | - | [Total CCPS] | 100% | [Total CCPS] | - |
| GRAND TOTAL | 1,00,000 | - | [Total CCPS] | - | [1,00,000 + Total CCPS] | 100% |
SHARE CAPITAL STRUCTURE (POST-ALLOTMENT)
| Type of Capital | Authorized Capital | Issued, Subscribed & Paid-up Capital |
|---|---|---|
| Equity Shares (₹1 FV) | ₹10,00,000 (10,00,000 shares) | ₹1,00,000 (1,00,000 shares) |
| CCPS (₹1 FV) | ₹2,00,00,000 (2,00,00,000 shares) | ₹[Amount] ([Number] shares) |
| TOTAL | ₹2,10,00,000 | ₹[1,00,000 + Amount] |
DECLARATIONS
I/We hereby declare that:
-
The allotment has been made in accordance with the provisions of the Companies Act, 2013 and rules made thereunder.
-
The Private Placement was conducted in compliance with Section 42 of the Companies Act, 2013 and Rule 14 of the Companies (Prospectus and Allotment of Securities) Rules, 2014.
-
The Company has received the full subscription amount from all allottees before allotment.
-
Form PAS-4 (Private Placement Offer Letter) was issued to all allottees and acceptances were received in Form PAS-5.
-
The issue does not violate any provisions of the Memorandum and Articles of Association of the Company.
-
Necessary Board and Shareholder approvals have been obtained for the allotment.
-
For NRI/FPI allottees, FEMA compliance has been ensured and Form FC-GPR will be/has been filed with RBI within 30 days.
-
The allotment has been made within 12 months from the date of passing the Special Resolution by shareholders.
-
All allottees are identified persons and proper KYC has been completed.
-
The details provided in this list are true and correct to the best of my knowledge and belief.
For OX Agry Private Limited
____________________________ Vijay Maniraj Managing Director DIN: [Insert DIN]
Place: Palani Date: [Insert Date]
____________________________ [Company Secretary Name] Company Secretary Membership No: [Insert Membership No.]
Place: Palani Date: [Insert Date]
Company Seal:
CHARTERED ACCOUNTANT'S CERTIFICATE
(Required for PAS-3 Filing)
To, The Board of Directors OX Agry Private Limited Palani, Tamil Nadu
Subject: Certificate for Form PAS-3 - Return of Allotment of CCPS
We have examined the books of accounts, records, documents, and papers of OX Agry Private Limited (CIN: U01100TN2022PTC149276) in connection with the allotment of [Number] Compulsorily Convertible Preference Shares (CCPS) of face value ₹1 each at par, aggregating ₹[Amount].
Based on our examination and the information and explanations provided to us, we certify that:
-
The allotment has been made in accordance with the provisions of the Companies Act, 2013 and rules made thereunder.
-
The Company has complied with the requirements of Section 42 of the Companies Act, 2013 relating to Private Placement.
-
The Company has received the full subscription amount of ₹[Amount] from the allottees before making the allotment.
-
The particulars of the allottees as mentioned in the List of Allottees are correct as per the records of the Company.
-
Necessary approvals from the Board of Directors and Shareholders have been obtained for the allotment.
-
The allotment has been made within the prescribed timelines.
This certificate is issued for the purpose of filing Form PAS-3 with the Registrar of Companies.
____________________________ [Chartered Accountant Name] [Firm Name] Membership No.: [Membership No.] Firm Registration No.: [FRN] UDIN: [UDIN]
Place: [Place] Date: [Date]
Firm Seal:
IMPORTANT NOTES FOR MCA FILING
1. Documents to be Attached with PAS-3:
- ☐ List of Allottees (this document)
- ☐ Copy of Board Resolution approving allotment
- ☐ Copy of Shareholder Resolution approving CCPS issuance
- ☐ Valuation Report (if obtained)
- ☐ Copy of Private Placement Offer Letter (Form PAS-4) - Sample
- ☐ Record of private placement (Form PAS-5)
- ☐ Chartered Accountant / Company Secretary / Cost Accountant Certificate
- ☐ Proof of payment received from allottees (consolidated bank statement)
2. Filing Timeline:
- Private Placement: File PAS-3 within 15 days of allotment
- Other Allotments: File PAS-3 within 30 days of allotment
3. Late Filing Penalty:
- Company: ₹1,000 per day (max ₹25 Lakh for private placement)
- Officers in default: Penalty as applicable
4. Digital Signature:
- Form PAS-3 must be digitally signed by:
- Director (minimum 1)
- Company Secretary / Chartered Accountant / Cost Accountant (certifying professional)
5. FEMA Compliance (if applicable):
- File Form FC-GPR with RBI within 30 days of receipt of funds (for NRI/FPI investors)
6. ROC Processing:
- Form PAS-3 is auto-approved (STP) if all details are correct
EXCEL FORMAT FOR ALLOTTEE LIST
For ease of data entry in MCA portal, prepare the allottee list in Excel with the following columns:
| S.No | Name | PAN | Category | Nationality | Address | City | State | PIN | Country | Mobile | Folio | CCPS Allotted | Face Value | Issue Price | Amount Paid | Payment Mode | Payment Date | UTR Ref |
|---|
Note: This is a template. Fill in all bracketed information with actual allottee details. Ensure all data is accurate as this will be filed with MCA and becomes part of the public record.