Particulars of person(s) charged for the purpose of sub-clause (iii) or (iv) of clause 60 of Section 2

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....to the Companies Act, 2013 and sub rule (3) of rule 12 of the Companies Registration Offices and Fees) Rules, 2014] Refer instruction kit for filing the form All fields marked in * are mandatory Entity details 1 *Corporate Identity Number (CIN) 2 (a)* Name of the company (b)* Address of the registered office of the company (c)* Email ID of the company Officer Details 3 *Number of person(s) charged Particulars of person(s) charged *Whether consent is accepted or withdrawn or revoked â—‹ Acceptance â—‹ Withdrawal *Date of consent or revocation given under sub-clause (iii) of clause (60) of section 2 (DD/MM/YYYY) *Officer in default *Name *Provision(s) of the Companies Act to which the consent relates *Director Id....

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....ication number of the director or Managing Director; or DIN or PAN of the 20 THE GAZETTE OF INDIA: EXTRAORDINARY [PART II SEC. 3(i)] manager or CEO or CFO; or Membership number of the company secretary Certificate by practicing professional I declare that I have been duly engaged for the purpose of certification of this form. It is hereby certified that I have gone through the provisions of the Companies Act, 2013 and rules thereunder for the subject matter of this form and matters incidental thereto and I have verified the above particulars (including attachment(s)) from the original/certified records maintained by the Company/applicant which is subject matter of this form and found them to be true, correct and complete and no inf....

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....¤¯à¤®à¥‡à¤µ जयते Form language o English o Hindi Note All fields marked in * are to be mandatorily filled Refer instruction kit for filing the form. (a) *Corporate identification number (CIN) of the company (b) Global location number (GLN) of the company 1. (a) Name of the company (b) Address of registered office of the company 39 Particulars of person(s) or key managerial personnel charged or specified for the purpose of sub-clause (iii) or (iv) of clause 60 of section 2 Pre-fill (c) *email ID of the company 3. *Number of person(s) or key managerial personnel(s) charged 4. Particulars of person(s) or key managerial personnel charged (i) * Whether consent is accepted or withdrawn â—....

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....¤ªà¤¤à¥à¤° : असाधारण 41 *Pin code Fax Whether present residential address is same as permanent residential address o Yes o No Present residential address Line I Line II City State ISO country code Country Pin code Phone Fax Date of consent or revocation given under sub-clause (iii) of clause (60) of section 2 (DD/MM/YYYY) Provision(s) of the Companies Act to which the consent relates (iii) *Whether consent accepted or withdrawn OAcceptance Withdrawal or revocation * Director Identification Number (DIN) or Income-tax Permanent Account Number (income-tax PAN) (Please provide DIN in case of Director) Name Designation If other please specify Date of birth Father's name ....