FORM PAS-5

FORM PAS-5

(Section 42(7) and Rule 14(3) of Companies (Prospectus and Allotment of Securities) rules, 2014)

Record of a private placement offer to be kept by the company

Name of the Company:

Registered office:

CIN:

DETAILS OF PRIVATE PLACEMENT OFFER:

Date when approval of the relevant authority (board or the shareholders, as the case may be) obtained for the current Private Placement Offer Letter:

Amount of the offer:

Date of circulation of Private Placement Offer Letter:

Details of the persons to whom Private Placement Offer Letter has been circulated:

i	Name
ii	Father’s Name
iii	Address	.
iv	Phone no
v	Email ID
vi	Initial of the Officer of the company designated to keep the Record