FORM V

FORM - V

(See Section 9(1) and Rule 10)

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)

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