CONTROLLER’S FORM
Section 21 (2) (c))
Name of Company Company
Number
Important Note: If there is more than one controller, each of the controllers should fill
in a separate form.
CONTROLLER’S DETAILS
Controller’s Name:
Residential Address:
Nature of Association with company
i.e., Nature of control
For shareholding, state percentage
of Contribution held in the company:
Signature ...........................................................
Date
IMPORTANT INFORMATION
• Beneficial Owner must be a natural person.
• Provide full names and residential address of every beneficial owner including
amount to be paid or other consideration.
• Where the Beneficial Owner holds a managerial position in the company, the
managerial position must be disclosed. Where some shares are to be held by a
foreign company, the identification of natural persons who own, and/or hold
shares and control the foreign company must be disclosed.
Completed by:
Postal Address: