FORM NO. 56C
[See clause (c) of sub-rule (4) of rule 2D]
Statement of assets and liabilities

YEARS
First Year	Second Year	Third Year
(Mention years also)

A.

ASSETS

1.	Fixed Assets
	(a) Gross block	Rs.

(b) Depreciation

Rs.

(c) Net value (a – b)

Rs.

2.	Current assets

(a) Investments

Rs.

(b) Cash and bank balances

Rs.

(c) Others (please specify)

Rs.

(d) Total [(a) + (b) + (c)]

Rs.

3.

Current liabilities and provisions

Rs.

4.

Net worth (1+2-3)

Rs.

B.	LIABILITIES

1.

Monies raised/issued and paid-up capital

Rs.

2.

Free reserves (excluding revaluation reserves)

Rs.

3.

Total (1+2)

Rs.

Place
Date	Signature and designation of the applicant

Note : Please give full particulars of investments and also state whether you satisfy the conditions mentioned in sub-rule (5) of rule 2D, if not, indicate reasons with details.