Form - III

(See rule 17)

Declaration of financial or other interest

I, ................., having been appointed as the Chairperson or Member (cross out portion not applicable) of the National Company Law Appellate Tribunal, do solemnly affirm and declare that I do not have, nor shall have in future any financial or other interest which is likely to affect prejudicially my functioning as the Chairperson or Member (cross out portion not applicable), of the National Company Law Appellate Tribunal.

Signature: .................

(Name of the Chairperson/ Judicial/Technical Member)

Designation: .................

National Company Law Appellate Tribunal

Dated:

Place: