Untitled Page

Annexure

Form No. BEN-I

Declaration by the beneficial owner who holds or acquires significant beneficial

ownership in shares

[Pursuant to section 90(1) of the Companies Act, 2013 and rule 3(1)/3(2)]

To-

Name of the company:

Registered office address:

1. Particulars of the shares in which significant beneficial interest is held by the person making

declaration:

i) Class of shares:

ii) Number and percentage of shares:

iii) Shares/ securities in physical form

-Distinctive numbers: From.......... To.,.........

-Certificate No.:

-Folio No.

iv) Share/securities in Demat form

-DP ID/ Client ID :

-No. of shares:

-Any other:

v) Nominal value of shares:

vi) Paid up value of shares:

2. Particulars of the holder of the significant beneficial interest

PAN*

SI. No.	Name of the Beneficial Owner	Address and E- mail id	Date of Birth/ Age	Father's/ Mother's/ Spouse's name
(1)	(2)	(3)	(4)	(5)
Occupation	Nationality	CIN (in case of company)	Passport No. (in case of foreign national)
(6)	(7)	(8)	(9)

3. Declaration

In pursuance of sub-section (l) of section 90 of the Companies Act 2013, I

................hereby declare that I hold / have acquired a significant beneficial

interest in the above mentioned shares ofthe company which are registered in the name of the

person whose particulars are fumished below:

4. Particulars ofthe registered owner

PAN*

SI. No.	Name of the Beneficial Owner	Address and E-mail id	Date of Birth/ Age	Father's/ Mother's/ Spouse's name
(1)	(2)	(3)	(4)	(5)
Occupation	Nationality	PAN/UIN/CIN (in case of company)	Passport No. (in case of foreign national)
(6)	(7)	(8)	(9)

5. Details of the significant beneficial interest:

i) Date of creation / acquisition of signific4nt beneficial interest:

ii) Mode of acquisition of significant beneficial interest: Allotment lTransfer / others,

specify

iii) Nature ofi the significant beneficial interest:

iv) Reasons lor not registering shares in my name:

v) Particulars ofthe instrument/document, ifany, showing the creation of such significant

beneficial interest:

vi) Direct/ Indirect percentage of voting rights:

6. Particulars of the person from whom the significant beneficial interest is acquired, if

applicable:

i) Name ofthe transferor of significant beneficial interest:

ii) Whether shares were registered in bis name:

(lf not, whefher any dcclaration under sub-section (2) ofsection 89 was filed by him to the

company, If so, date of such declaration)

iii) Pnrticulars of the instrument/ document, if any, showing the transfer of such significant beneficial interest:

Date:

Place:

Signature of the holder of the significant beneficial interest

CERTIFICATE

I hereby certify that the significant beneficial interest in the shares mentioned above has been

transferred by me on...........................

Signature of the person who has transfened the significant beneficial interest in the shares

Date:

Place:

Enclosures:(a) Proof o fidentity oft he registered owner and holder ofthe significant beneficial

interest

(b) Instrument/ document under which the significant beneficial interest is created/ transfened/

changed

Form No. BEN-2

Return to the Registrar in respect ofdeclaration under section 90 received by company

lPursuant to section 90(4) of the Companies Act, 2013 and rule 4]

O For Significant beneficial ownership O For Change in Significant beneficial ownership

Total percentage

O Date of Change .

O SRN of BEN-2 latest(last) filed for significant beneficial

Ownership

Total percentage ... . . . .. ..

l. (a) CIN:

(b) GLN:

2. (a) Name of the company:

(b) Registered office address:

3. Particulars of significant beneficial interest:

PAN *

Prefill

S. No	Date of declarations .			Date of receipt of		Particulars of shares in respect of which beneficial interest is created
	under subsection (l) of section 90			the said declarations by the company		Class of shares		No. of shares			Distinctive Nos. of shares/ DP and Client ID of shares
(1)	(2)			(3)		(4)		(5)			(6)
Particulars of shares in respect of which beneficial interest is created						Particulars of registered owner
Face value of shares			Paid up value of shares			Name of the registered owner	Addres s and email id		Date of Birth/ Age			Father' s/ Spouse 's name	Occu patio n
(7)			(8)			(9)	(10)		(11)			(12)	(13)
Particulars of registered owner						Particulars of beneficial owner
Nationality		PAN/UIN/ CIN (in case of company)			Passport No. (in case of foreign national)	Name & Nationality				Address and e-mail id
(14)		(15)			(16)	(17)				(18)
						Date and Nature of beneficial interest				Remarks
Father's/ Spouse's Name
(19)						(20)				(21)

Date:

Place:

Attachments: I . Declaration under section 90 (1); 2. Optional attachments, if any

Form no. BEN-3

[Pursuant to section 90(2) of the Companies Act, 201 3 and rule 5(l)]

Name of the company:

Registered office address:

l. Particulars of fte beneficial owner holding significant beneficial interest

PAN *

Prefill

Sl. No.	Name of the Beneficial owner	Address and Email id	Date of Birth/ Age	Father's/ Mother's/ Spouse's name
(1)	(2)	(3)	(4)	(5)
Occupation	Nationality	PAN/UIN/CIN (in case of company)	Passport No. (in case of foreign national)	Status
(6)	(7)	(8)	(9)	( 10)
Date of declaration under section 90	Date of cessation	Date of entry in Register	Date of filing of BEN-2(SRN wise)	Amount of guarantee, if any
(11)	(12)
Any other interest, if any	Instructions, if any, given by the member wt

2. Particulars of the shares in which significant beneficial interest is held by the beneficial owner:

i) Class of shares:

ii) Number of shares:

iii) Shares/ seeurities in physical form

-Distinctive numbers: From.......... To........

-Certificate No.:

-Folio No.

iv) Shares/ securities in Demat form

-DP ID/ Client ID :

-No. of shares

-Any other:

v) Nominal value of shares:

vi) Paid up value of shares:

Form no. BEN-4

[Pursuant to section 90(5) ofthe Companies Act, 2013 and rule 6]

[<<Insert Company Name>>] (the "Company'')

<<Insert Date>>

[By post/email]

To:

Name and address of SBO/any other person

Date:

subject: Notice under sub-section (5) of Section 90 of the companies Act,20l3 and rules

made there under

The Company has reasonable cause to believe that*

- you are a significant beneficial owner of the company;

-have knowledge ofthe identity ofsignificant beneficial owner of.......... .. ... . ....likely

to have such knowledge;

-have been a significant beneficial owner of the company during tbe three years

immediatelv preceding the date of this notice, and

in respect of the above significant beneficial ownership the retum prescribed under Section 90

of the Act has not been filed in compliance with the Act.

You are accordingly advised to give the following information within 30 days of the date of

this notice in accordance with the section 90 of the Companies Act,2013 :

l. Name and Address of the Beneficial owner (B.o) (i.e. yourself or the significant BO if you are not the significant BO)

2. PAN of the B.O

3. Name of the person/entity/trust/body etc in whose name the shares/rights are registered/held

4. Folio number/DP and Client ID of the shares/securities

5. Nominal value of the shares/securities

6. Date of acquiring beneficial interest

7. Documents, terms and conditions or any other particulars regarding the BO ownership

8. Reason for not filing declaration in Form No. BEN-4.

9. Any other information incidental to or relevant or in your possession or knowledge to

enable the company to evaluate this matter

The abovementioned particulars should be submitted in writing to the registered address of the

company not later than 30 days of the date of this notice failing which the company shall

proceed in the matter without further notice as per the provisions ofthe Act.

Name & signature

(Person authorized to issue notice)

*Delete whichever is not applicable