# FORM V

##### <span style="color: rgb(34, 87, 122);">**FORM - V**</span>  


<span style="color: rgb(0, 0, 0);">**(See Section 9(1) and Rule 10)**</span>

Place:  
Date:

To

The Registrar of Chits,

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Dear Sir,

 By your letter dated the \_\_\_\_\_\_\_\_\_\_\_\_\_, you were pleased to grant me / us a certificate of registration to commence a new chit of a chit amount of Rs \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_and of a duration \_\_\_\_\_\_\_\_\_\_\_\_\_\_ months.

 2. I / We have subsequently enlisted the required number of members and we hereby declare in terms of sub-section(1) of Section 9 of the Chit Funds Act, 1982 (Central Act No. 40 of 1982) that all the tickets specified in the chit agreement have been fully subscribed.

 3. I / We remit herewith a sum of Rs \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (Rupees in words only) being the fees prescribed for the purpose of filing this declaration.

Yours faithfully,  
Chairman  
Secretary  
for and on behalf of (Foreman)

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Strike out or delete whatever is not applicable insert such designation(s) as may be  
appropriate to the applicant.