Declaration by the beneficial owner who holds or acquires beneficial interest in shares but whose name is not entered in the register of members

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..... anies Act, 2013 and rule 9(2) of the Companies (Management and Administration) Rules, 2014] To- Name of the company Registered office address: 1. Particulars of the shares in which beneficial interest is held by the person making declaration: i) Class of shares: ii) Number of shares: iii) Distinctive numbers: From………. To……….. iv) Certificate No.: .....

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..... ered owner Address and E- mail id Date of birth/ Age Father'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 beneficial interest: i) Date of creation / acquisition of beneficial interest: ii) Mode of acquisition of beneficial interest: Allotment / .....

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..... ulars of such change: iv) Reason for such change: v) Particulars of the instrument/ document, if any, showing the change in such beneficial interest: Date: Place: Signature of beneficial owner CERTIFICATE I hereby certify that the beneficial interest in the shares mentioned above has been transferred by me on ……………. Signature of the person who has transfe .....

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