| APPLICATION FORM FOR THE RELEASE OF SECURITY AS PRESCRIBED UNDER RULES 22(1) OF THE DELHI | |
| 1. Name of the Foreman and address | : |
| 2. Registration No. of chit | : |
| 3. Amount of Chit | : |
| 4. Date of Commencement | : |
| 5. Date of Termination | : |
| 6. Amount of Security | : |
| 7. Nature of Security | : |
| 8. Purpose of Security | : |
| 9. Have the claims of all the prized subscriber been fully cleared off | : |
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10. If not, give details of the prized subscriber whose account have not been settled finally. |
: |
| 11. Whether the prized amount in the | : |
| a) Case of any defaulting prized subscriber has been deposited and intimated to him/her/them. | : |
| b) Ticket number of the paid/prized defaulters with amount due and and action taken in each case by Foreman. | : |
| 12. Number of defaulting/removed subscriber | : |
| 13. Amount received from each defaulting subscribers and its desposal | : |
| 14. Whether the dues payable under the Act/Rules to Registrar have been made | : |
| 15. If not, give the nature and extent of defualts. | : |
| 16. Whether Balance Sheet filed | : |
| 17. Whether request made for final release or for re-apropriation | : |
I hereby declare that the above contents are true to the best of my knowledge and belief and affidavit to this effect has furnished.
Signature and Seal of Foreman/Manager
/GeneralAttorney of the Company.
Chit Fund Department