(a) *Whether the application is being digitally signed by the holder of DIN himself o Yes o No
(b) *Particulars of the applicant
(i) Name
(ii) Relation with the DIN holder
(iii) DIN of the applicant (if any)
(iv) PAN Attachments List of attachments
(1) *Proof of identity of the applicant;
(2) *Proof of residence of the applicant;
(3) Affidavit including declaration that retained DIN will be updated with all associated CIN/LLPIN;
(4) Copy of court order declaring DIN holder as insolvent/unsound mind
(5) Copy of death certificate
(6) Optional Attachment-if any.
Declaration *I hereby declare that Information and other particulars given in this form are true and correct.
I further declare that I have never been appointed as director/designated partner in any company/LLP and the DIN has never been used for filing of any document with any authority.
*To be digitally signed by *Name *DIN/PAN Certificate by practicing professional *I declare that I have been duly engaged for the purpose of certification of this form.
*I have satisfied myself about the identity of the applicant based on perusal of the original of the attached document.
DSC Box Attach Remove attachment Attach Attach Attach Pre-fill Attach Attach 8 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)] Note: In case where the applicant is residing outside India the particulars have to be verified from the documents duly attested by the attesting authority as prescribed.
*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 records maintained by the applicant which is subject matter of this form and found them to be true, correct and complete and no information material to this form has been suppressed.
*I further certify that all the required attachments have been completely and legibly attached to this form and it is understood that I shall be liable for action under Section 449 of the Companies Act, 2013 for wrong certification, if any found at any stage.
*To be digitally signed by □ Chartered accountant (in whole-time practice) or □ Cost accountant (in whole-time practice) or □ Company secretary (in whole-time practice) *Whether associate or fellow o Associate o Fellow *Membership number Certificate of Practice number Note: Attention is also drawn to provisions of section 448 and 449 which provide for punishment for false statement and false evidence.
[F. No. 1/22/2013-CL-V] AMARDEEP SINGH BHATIA, Jt. Secy.
Note: The principal rules were published in the Gazette of India, Extraordinary, Part II, section 3, sub-section (i) vide number G.S.R. 259(E) dated the 31 st March, 2014 and were subsequently amended vide number G.S.R. 671(E) dated the 18 th September, 2014 and G.S.R. 42(E) dated the 19 th January, 2015.
Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064 and Published by the Controller of Publications, Delhi-110054.
DSC Box 2017-07-10T14:54:34+0530 ALOK KUMAR