Supporting control; applicable filings separately
Legal reference: Sections 124–125 where applicable; Section 378E
When applicable: Where a distribution may attract unpaid-dividend or IEPF provisions.
Completion instructions: Classify the payment first. Do not automatically treat every withheld price or patronage amount as ordinary dividend. Obtain a transaction-specific assessment and maintain any required statutory statement separately.
Editable preparation format. It is not a verbatim reproduction of a prescribed MCA form or a filing service. Where a statutory form is prescribed, reconcile all fields and use its current prescribed layout for the formal register. Maintain required authentication, access controls and retention.
| Company name | |
|---|---|
| CIN | |
| Registered office | |
| Period / register volume | |
| Custodian and authority |
| Member and folio | |
|---|---|
| Distribution type | |
| Declaration / entitlement date | |
| Amount payable (INR) | |
| Payment attempted and reason unpaid | |
| Applicable-law assessment | |
| Transfer deadline, if applicable | |
| Unpaid account / IEPF transfer details | |
| Member claim and evidence | |
| Settlement details | |
| Filing / statement reference | |
| Reviewer |
Prepared 24 September 2026. Review against the latest Rules and company Articles before statutory adoption. Source: Companies Act, 2013 and the Rules identified above. MCA · India Code