District No.

.................. Applicant

.................. Registrar of Companies ............... Respondent

I, ........... of ............. , a *director *secretary of the applicant company, aged eighteen years and upwards MAKE OATH and say as follows:

1. I beg to refer to the contents of the notice of application herein. The state- ments of fact contained in the said notice of application which are within my own knowledge are true. I honestly believe that the information contained in the said notice of application which is not within my own knowledge is true.

2. *[I beg to refer to a print of the company’s annual return in the form for the time being prescribed by the Registrar of Companies covering the period ........ to ........... *and to a copy of the company’s financial state- ments up to ........... upon which marked “A” I have signed my name prior to the swearing hereof.] or *[It has not been possible to date to prepare the company’s annual return covering the period ............ to ....... because (set out reasons)]

3. The reasons why the annual return was not delivered to the Registrar of Companies within the time permitted by section 343(2) or section 343(3) of the Companies Act 2014 are (set out reasons and verify any facts relied on). *It would additionally be just to make an order extending time for delivery of the company’s annual return because (set out reasons and verify any facts relied on).

*4. (Where the applicant will apply to the Court to allow a period longer than 28 days after the date on which an order is made for delivery of a certified copy of the order to the Registrar) The reasons why a longer period than 28 days should be allowed for delivery of a certified copy of the order to the Registrar are (set out reasons and verify any facts relied on);

*5. I beg to refer to the entire sequence of correspondence between the appli- cant and the Registrar concerning this application, upon which pinned together and marked “B” I have signed my name prior to the swearing hereof.

6. I accordingly request an order in the terms set out in the notice of application.

SWORN before me [name in capitals] at ........ in the County of .......... on the .... day of ......... 20 ......., by the said ........... .

*[who is personally known to me],

*[who is identified to me by ......... who is personally known to me]

*[whose identity has been established to me before the taking of this affidavit by the production to me of

†passport no. ........... issued on the ........ day of ......... by the authorities of ........ , which is an authority recognised by the Irish Government,

†national identity card no. ....... issued on the ...... day of ....... by the authorities of .......... which is an EU Member State, the Swiss Confederation or a Contracting Party to the EEA Agreement

†Aliens Passport no. ..... issued on the ...... day of ........... by the authorities of ........ which is an authority recognised by the Irish Government

†refugee travel document no. ........ issued on the ....... day of ........... by the Minister for Justice and Equality

† travel document (other than refugee travel document) ......... issued on the ....... day of ......... by the Minister for Justice and Equality]

.....................

Deponent

......................

*Commissioner for Oaths/ *Practising Solicitor

*Delete if inapplicable

†Where relevant, select appropriate option and delete others.

This affidavit is filed with the District Court Clerk at ...........on the ......day of ...... 20... by ................ on behalf of the applicant in the above proceedings.