Form No.

CHG-1 AA1113085_SRN_FORM
Form language
Application for registration of creation, modification of charge (other than
those related to debentures) including particulars of modification of charge by English Hindi
Asset Reconstruction Company in terms of Securitization and Reconstruction of
Financial Assets and Enforcement of Securities Interest Act, 2002 (SARFAESI)
[Pursuant to sections 77,78 and 79 and pursuant to Section 384 read with 77,78 and
79 of the Companies Act, 2013 and Rule 3(1) and 13 of the Companies (Registration of Charges) Rules 2014]

Refer instruction kit for filing the form

All fields marked in * are mandatory

Entity’s Details

1 *Corporate Identity Number (CIN) or Foreign Company Registration Number (FCRN) U26933GJ2015PTC084040

2(a) *Name of the Company SEZ VITRIFIED PRIVATE

LIMITED

(b) *Address of the registered office or principal place of business in India of the Survey No. 327,
Rangpar, Pipli Road,
Opp. Somnath Petrol
Pump,Bela, Morbi,,
Morbi, Rajkot,
Gujarat, India,363641

(c) *e-mail ID of the company [email protected]

3 (a) *This form is for registration of

Creation of charge Modification of charge

(b) *Charge ID of the charge to be modified or rectified 100027797

4 *Whether the applicant is Company Charge holder

Details of charge instrument

5(a) *Date of the instrument creating or modifying the charge (DD/MM/YYYY) 09/11/2022

(b)*Nature, description and brief particulars of the instrument creating or modifying Hypothecation of Goods
the charge and Book debts to
secure Cash Credit
Facility and Assets to
Secure Term Loan

(c)* Whether charge is created or modified outside India Yes No

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 6 (a) Whether charge is modified in favour of asset reconstruction company (ARC) Yes No
or assignee

(b) Whether charge holder is authorised to assign the charge as per the Yes No
charge agreement

7 Type of charge

(a) *Description of the property charged indicating whether it is a charge on

Immovable property or any interest therein - Residential Immovable property or any interest therein - Commercial

Immovable property or any interest therein - Others ✔ Movable property - Equipment and Machinery

✔ Movable property – Inventory ✔ Movable property - Inventory (incl. Receivables)

Movable property - Motor Vehicle (Hypothecation) Movable property - Ship or any share in a ship

✔ Movable property - Others Intangible – Goodwill

Intangibles - Trademarks Intangible - Patent

Intangible - Licence Intangible - Licence under a Patent

Intangible - Copyright Intangible - Copyright under a Patent

Intangible - Designs Intangible - IPR

Intangible - Others Solely of Property situated outside India

Uncalled share capital Calls made but not paid

✔ Book debts Others

(b) If others, please specify

Details of charge holder

8(a) *Whether consortium finance is involved: Yes No

If Yes, enter Lead Banker's Name

(b) *Whether joint charge involved Yes No

(c) *Number of charge holder(s) 1

(d) Whether Charges rank pari passu Yes No

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 List of the Charge holder (s)

Name of the Particulars of the Details of their extent Maximum amount secured (in
Rank
Charge holder property charged on the charge (in %) INR)

9 Particulars of the charge holder (in case charge is modified in favour of ARC or assignee, enter the particulars of ARC or assignee)

*Category
(Nationalised bank/Scheduled bank/Private Sector Bank/Financial institution/ Nationalised bank
Non-banking financial company/Co-operative bank/Foreign bank/Individual/Others)

If others, please specify

*Name of the charge holder Others

CIN (if applicable)

PUNJAB NATIONAL BANK

*Name

LALPAR BRANCH TAL:

*Address Line 1 MORBI LALPAR

Address Line 2

*Country India

*Pin code/Zip Code 363642

*Area/ Locality Lalpar

Morvi
*City

Rajkot
*District

*State/UT Gujarat

*E-mail ID [email protected]

*Whether charge holder is having a valid Income Tax PAN ● Yes No

Income Tax- Permanent Account Number (PAN) AAACP0165G

BSR Code / Branch Code 778000

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Details of charge

10(a) *Maximum Amount secured by the charge 232600000

(In case the amount is in foreign currency, rupee equivalent to be stated) (in INR.).
(In case of modification of charge, enter the amount secured by the charge after such modification)

(b) *Maximum Amount secured by the charge in words Rupees Twenty Three
Crore Twenty Six Lakhs

(c) In case amount secured by the charge is in foreign currency, mention details

11 Brief of the principal terms and conditions, extent and operation of charge

(a) Date of Creating Security Interest by actual/ constructive deposit of title deeds
09/11/2022
within bank/ housing finance company (DD/MM/YYYY)

(b) Borrower’s customer/account number

(c)*Rate of interest 8.75%

(d) *Repayment term (in months) 60

(e) *Terms of Repayment 60 Monthly

installments

(f) Nature of facility

(g) Date of Disbursement (DD/MM/YYYY)

(h) Miscellaneous narrative information

(i) *Margin 25

(j) *Extent and operation of the charge First Exclusive Charge

in Favour of Punjab
National Bank Lalpar
Branch

(k) Others

Asset Details

12 In case of acquisition of property, subjected to charge, furnish the details relating to the existing charge on the property
so acquired

(a) Date of instrument creating or evidencing the charge (DD/MM/YYYY) 03/05/2016

(b) Description of the instrument creating or evidencing the charge Hypothecation and
Mortgage Deed

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 (c) Date of acquisition of the property (DD/MM/YYYY) 03/05/2016

(d) Charge ID 100027797

(e) Amount of the charge (in INR) 500000000

(f) Particulars of the property charged 500000000

13 (a) *Short particulars of the property or asset(s) charged (including complete address and location of the property)

In case of CC First Exclusively Charge by way of hypothecation of stocks of Raw

Materials SIP finished goods stores and spares packing materials consumables stock
in transits trade receivables and other current assets of the firm both present and
future primary security for cash credit shall also collaterally cover other credit
facilities sanctioned to the Firm and in case of TL hypothecation of the plant and
machines purchased out of bank Finance

(b) Plot Unit / Dwelling Interest Plot Dwelling Interest

Evaluated Price of Asset Nature of Property PLOT ID Number Survey No. /GAT No. etc.
as on Security interest
Creation date (in INR)

Street Number & Name Sector /Block Number Locality Landmark

Village/Town Name Taluka Pin code District

Area of plot (Sq. feet, Sq. meter, Acre,

State Latitude Longitude Gunta, Cents, Hectares)

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 (ii) Details of Dwelling Interest

Evaluated Price of Asset

Nature of Property PLOT ID Number Survey No. /GAT No.*
as on Security interest
Creation date (in INR)

Dwelling Unit ID Floor No. Building Name & Street Name / No.
Number Society Name

Sector/Block Number Locality Landmark Village/Town Name

Taluka Pin Code District State

Latitude Longitude Area of dwelling (Sq. feet, Sq. Meter)

(iii) Bounded by

By North By South By East By West

*Survey number, GAT number, Khesra number; khweta number, Mouza number, Phase number or any other such similar representation in various states or union territories
can be captured in this field.

(All the fields should be captured as appearing in the revenue record, flat no, house no, Municipal Office/Municipal Corporation / Grampanchayat are to be specified and also
the area of the immovable property as well as boundaries)

14 Description of document by which the company / borrower / third party acquire title

Number of title documents deposited by customer

Document
Type(Sale deed/ Documen Sub Taluka Country Pin Code/ State/UT
tNumber registrar City District
Lease deed/ Zip code
Award/Others)

15(a) *Whether any of the property or interest therein under reference is not registered Yes ● No
in the name of the company

(b) (i) CIN / LLPIN of the company in whose name property or interest therein is
registered (if applicable)

(ii) PAN of the Individual in whose name property or interest therein is

registered (if applicable)

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 (iii) Name of entity / individual person in whose name it is registered

Other Details

16 *Date of creation/last modification prior to the present modification (DD/MM/YYYY) 20/10/2020

17 *Particulars of the present modification (please ensure that the correct particulars are In addition to the
entered as the same shall be displayed in the certificate of modification of charge) existing Credit
Facility Fresh Term
Loan amounting Rs 5
crores and enhancement
of Bank Guarantee
amounting Rs 80 Lakhs
by way of
Hypothecation

Attachments

(a) *Instrument(s) of creation or modification of charge HYPOTHECATION DEED.pdf

(b) Instrument(s) evidencing creation or modification of charge

in case of acquisition of property which is already subject HYPO AGREEMENT FOR
SECURE TERM LOAN NEW
to charge together with the instrument evidencing
creation 2.pdf
such acquisitions;

SANCTION LETTER.pdf
(c) Optional attachment(s)- if any

Declaration

✔ I am authorised by the Board of Directors of the Company vide resolution no 01 dated

07/11/2022 to sign this is form and declare that all the requirements of Companies Act, 2013 and the
rules made thereunder in respect of the subject matter of this form and matters incidental thereto have been complied with. I
also declare that all the information given herein above is true, correct and complete and as per the attached charge
instrument(s) or document(s) and nothing material has been suppressed. A copy of the attached charge instrument(s) or
document(s) is/ are available at the registered office or principal place of business in India of the company.

I further declare that:

1 the delay in filing the particulars of creation/modification, was accidental or due to inadvertence or some other sufficient
cause and are or is not of a nature to prejudice the position of the charge holder, shareholders or creditors of the company;
2 no prejudice would be caused to the charge holder(s) or any other creditor(s) of the company, if the delay is condoned;

3 the company has not created or modified any other charge(s) whatsoever on the assets of the company, since the
creation / modification of the present charge;
4 the company is carrying on the business as on the date of filing this application and no proceedings to wind-up the company
have commenced or are pending against the company;

5 there is no litigation proceedings pending before any court of law for which condonation of delay is being filed;
6 the company has not applied for striking off the name of the company from the register of Registrar of Companies

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 Digitally signed by
RONAK

To be digitally signed by
RONAK DINESHBHAI
DINESHBHAI JETHALOJA

07887483
Date: 2022.11.23

DIN1
JETHALOJA 15:33:25 +05’30’

Director or manager or secretary or CEO or CFO or IRP/RP/Liquidator (In case of an Indian company)
or an authorised representative (In case of a foreign company)

Designation Director
(Director/Manager/Company Secretory/CFO/ CEO/Authorised Representative/Authorised Representative
IRP/RP/Liquidator)

DIN of the director; PAN of the manager or CEO or CFO or authorised representative or 07887483
IRP/RP/Liquidator; or membership number of company secretary

Declaration

✔ I/we confirm that the attached charge instrument(s) or document(s) is/are true copies of the original which is/are available with
the charge holder and/or assignee and all the information and particulars mentioned above are derived there from are concisely
and correctly stated. I/we am/are duly authorised to sign this form.

I/we am/are a multilateral/International financial institution who has/have been exempted from payment of income tax in India
under the UN Privileges and Immunities Act.

To be digitally signed by VIPIN Digitally signed by

VIPIN YADAV
Date: 2022.11.23
YADAV
DIN2 18:30:42 +05’30’ AAACP0165G
Charge holder

PAN of the charge holder AAACP0165G

To be digitally signed by

ARC or assignee

PAN of the ARC or assignee

Certificate by Practicing Professional

I declare that I have been duly engaged for the purpose of certification of this form. It is hereby certified that I have gone through
the provisions of the Companies Act, 2013 and rules thereunder for the subject matter of this form and matters incidental thereto
and I have verified the above particulars (including attachment(s)) from the original/certified records maintained by the
Company/applicant which is subject matter of this form and found them to be true, correct and complete and no information
material to this form has been suppressed. I further certify that:
i. The said records have been properly prepared, signed by the required officers of the Company and maintained as per
the relevant provisions of the Companies Act, 2013 and were found to be in order;
ii .All the required attachments have been completely and legibly attached to this form.

To be digitally signed by BRIJESHKUM

AR
Digitally signed by
BRIJESHKUMAR
BHUPATLAL
BHUPATLAL KALARIA

DIN3 Date: 2022.11.23

122875
Chartered accountant (in whole-time practice) or
KALARIA 15:35:37 +05’30’

Cost accountant (in whole-time practice) or

Company secretary (in whole-time practice)

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Whether associate or fellow:

Associate Fellow

Membership number 122875

Certificate of practice number

Note: Attention is drawn to provisions of Section 447, section 448 and 449 of the Companies Act, 2013 which provide
for punishment for fraud, punishment for false statement/ certificate and punishment for false evidence respectively

For office use only:

eForm Service request number (SRN) AA1113085

eForm filing date (DD/MM/YYYY)

Digital signature of the authorising officer

This eForm is hereby registered

Date of signing (DD/MM/YYYY)

Or

This eForm has been taken on file maintained by the registrar of companies through electronic mode and on the basis of
statement of correctness given by the filing company.

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This eForm has been taken on file maintained by the registrar of companies through electronic mode
and on the basis of statement of correctness given by the filing company.

For Office Use Only:

eForm Service request number(SRN) AA1113085

eForm filing date(DD/MM/YYYY) 23/11/2022

Signature
Not Verified
Digitally signed by
DS MINISTRY
OF CORPORATE
AFFAIRES 1
Date: 2023.04.09
16:20:14 IST