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Return to the Registrar in respect of declaration under section 89 received by the company

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....and pursuant to rule 9(3) of The Companies (Management and Administration) Rules, 2014] सत्यमेव जयते Refer instruction kit for filing the form All fields marked in * are mandatory Company Information 1*Corporate Identity Number (CIN) 1(a) *Name of the Company (b) *Registered office address (c) *email id 2 *Number of Registered Owners for whom the form is being filed Form language English Hindi 3 Particulars of shares in respect of which the person whose name is entered in the register of members of the company as a holder of shares does not hold the beneficial interest in such shares (a) *Number of Shares (b) Distinctive Number of Shares (From) *Distinctive Number of....

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.... (i) First Name (ii) Middle Name (iii) Last Name (e) *Date of Birth (DD/MM/YYYY) (f) *Nationality (g) *Mobile number (h) *Email Id (i) Address *Address Line 1 Address Line 2 (j) *Country (k) *Pin Code/Zip code (I) *Area/Locality (m) *City (n) District (o) *State/UT (p) *Father's Name/Husband's Name Father's Name Husband's Name Page 11 of 13 First Name Middle Name Last Name (q) *Date of declaration (DD/MM/YYYY) (r) *Date of receipt of declaration by the company (DD/MM/YYYY) Attachments (a) *Declaration by person referred to in section 89(1) Choose File Remove Download (b) *Declaration by person referred to in section 89(2) or 89(3) Choose File Remove Download (c) Optional attachment(s)- if any Choose File ....

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.... the Registrar in respect of declaration under section 89 received by the company Pre-Fill 1. Particulars of shares in respect of which the person whose name is entered in the register of members of the company as a holder of shares does not hold the beneficial interest in such shares 1.(a) Number of shares (b) Distinctive number of shares From (c) *Kind of shares (d) *Face value of shares (Rs.) 0 Το (e) *Paid-up value of shares (Rs.)| 2.(a) *Name of the person in whose name the above shares have been registered as holder in the register of members (b) Address Line I Line II (c) *City (d) *State Arunachal Pradesh-AR (e) *Country (f) *Pin code (g) *Nationality (h) Father's name or Husband's name Father's name H....

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....y (h) Date of declaration (DD/MM/YYYY) (i) Date of receipt of declaration by the company (DD/MM/YYYY) III. Particulars of shares in respect of which the person whose name is entered in the register of members of the company as a holder of shares does not hold the beneficial interest in such shares 1.(a) Number of shares (b) Distinctive number of shares From (c) Kind of shares (d) Face value of shares (Rs.) (e) Paid-up value of shares (Rs.) To 2.(a) Name of the person in whose name the above shares have been registered as holder in the register of members (b) Address Line I Line II (c) City (d) State (e) Country Page 3 of 8 (f) Pin code (g) Nationality (h) Father's name or Husband's name Father's name Husband's name....

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....) (i) Date of receipt of declaration by the company (DD/MM/YYYY) V. Particulars of shares in respect of which the person whose name is entered in the register of members of the company as a holder of shares does not hold the beneficial interest in such shares 1(a) Number of shares (b) Distinctive number of shares From (c) Kind of shares (d) Face value of shares (Rs.) (e) Paid-up value of shares (Rs.) Το Page 5 of 8 2.(a) Name of the person in whose name the above shares have been registered as holder in the register of members (b). Address Line I Line II (c) City (d) State (e) Country (f) Pin code (g) Nationality (h) Father's name or Husband's name Father's name Husband's name (i) Name of the Authorized perso....