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FORM WIN 91

[See rule 170]

BEFORE THE NATIONALCOMPANYLAWTRIBUNAL


BENCH AT .

IN THE MATTER OF-----LTD (give the name of the company)


(Company incorporated under Companies Act, )

Petition No of 20 .
.. .. Petitioner

Authority to Company Liquidator to pay dividend to another person

Address:

Date:
Sir,
I hereby authorise and request you to pay the dividend referred to in the
enclosed notice
to of.. (a specimen of whose signature is given below)
whose receipt shall be a sufficient discharge.

Signature
Witnesses to the signature of. .
1. . ( signature)
................. ............ (occupation)
.............................. (address

2. . ( signature)
.............................. (occupation)
.............................. (address)

Specimen signature of person appointed as above

(specimen)
Witness to specimen signature :
.............................. ( signature)
.............................. (occupation)
.............................. (address)

Dated the day of , 20 .

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