Declaration by the registered owner of shares who does not hold the beneficial interest in such shares

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..... 4] To- Name of the company Registered office address: 1. Particulars of the Registered owner of shares: (i) Name : (ii) Father s / Mother s / Spouse name: (iii) Occupation : (iv) Whether citizen of India Yes No (v) Nationality (vi) Date of Birth __________ (vii) Gender Male Female (viii) .....

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..... D 2. Particulars of the shares in respect of which declaration is being made by the registered owner: i) Class of shares: ii) Number of shares: iii) Distinctive numbers: From . To .. iv) Certificate No.: v) Folio No. vi) Nominal value of shares: vii) Paid up value of shares: 3. Declaration: In pur .....

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..... onal) Distinctive No., if applicable. (6) (7) (8) (9) 4. Details of the beneficial interest: i) Nature of the beneficial interest: ii) Date of creation of the beneficial interest: iii) Reasons for not registering sh .....

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