(On Company Letter Head)
Company Beneficial Ownership Information
1. Name of Company / Entity:
2. Entity Type: Listed Company / Private Company/ Unlisted company / Partnership
Firm / TASC
3. Registered Number/CIN:
4. Registered Address:
The company as stated above hereby confirms and declares that on the below date:
(Please tick the correct check box)
Applicable for company accounts:
The beneficial owner is the natural person(s) who whether acting alone or together or
through one or more juridical person, has/have a controlling ownership interest or who
exercise control through other means. “Controlling ownership interest” mean ownership
of / entitlement to more than 10% of the shares or capital or profits of the company.
“Control” shall include the right to appoint majority of the directors or to control the
management or policy decisions including by virtue of their shareholding or management
rights or shareholders agreements or voting agreements.)
Applicable for Partnership / TASC accounts:
The following natural Person(s) (listed in Table below) exercise control or ultimately
have a controlling ownership interest in the entity i.e. having ownership/entitlement of more
than 10% of capital / profits of the entity.
There are no natural person (individual) ultimately owns or controls, directly or
indirectly, 10% or more of the shares or capital or profits or voting rights of the company or
otherwise exercises control over the management of the company. Therefore, the details of
natural person(s) holding the position of directors/senior management in the company are
given in the below Table.
(*If you have ticked any of the above, please complete Table below before signing
the declaration)
Sr. Name Date Address Nationali Designatio Controlli Politica
No of ty n ng l
. Birth ownershi expose
p d
interest Person
(%) (Yes/No
)
For …………………………………
Name:
Designation:
Date: