These rules are not made applicable to the holding of shares of companies/body corporates, in case of pooled investment vehicles/investment funds such as Mutual Funds, Alterative Investment Funds (AIFs), Real Estate Investment Trusts(REITs) and Infrastructure Investment Trusts (InvITs) regulated under SEBI Act.
¹Hkkx IIµ[k.M 3(i)º Hkkjr dk jkti=k % vlk/kj.k 13 Annexure Form No. BEN-1 Declaration by the beneficial owner who holds or acquires significant beneficial ownership in shares [Pursuant to section 90(1) of the Companies Act, 2013 and rule 3(1)/3(2)] To- Name of the company:
Registered office address:
1. Particulars of the shares in which significant beneficial interest is held by the person making declaration:
i) Class of shares:
ii) Number and percentage of shares:
iii) Shares/ securities in physical form � Distinctive numbers: From.......... To...........
� Certificate No.:
� Folio No.
iv) Shares/ securities in Demat form � DP ID/ Client ID :
� No. of shares:
�Any other:
v) Nominal value of shares:
vi) Paid up value of shares:
2. Particulars of the holder of the significant beneficial interest PAN * Sl. No. Name of the Beneficial Owner Address and E- mail id Date of Birth/ Age Father’s/ Mother’s/ Spouse’s name
(1) (2) (3) (4) (5) Occupation Nationality CIN (in case of company) Passport No. (in case of foreign national)
(6) (7) (8) (9)
3. Declaration In pursuance of sub-section (1) of section 90 of the Companies Act 2013, I ..........................................hereby declare that I hold / have acquired a significant beneficial interest in the above mentioned shares of the company which are registered in the name of the person whose particulars are furnished below:
4. Particulars of the registered owner PAN * Sl. No. Name of the registered owner Address and E-mail id Date of Birth/ Age Father’s/ Spouse’s name
(1) (2) (3) (4) (5) Occupation Nationality PAN/UIN/CIN (in case of company) Passport No. (in case of foreign national)
(6) (7) (8) (9) 14 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)]
5. Details of the significant beneficial interest:
i) Date of creation / acquisition of significant beneficial interest:
ii) Mode of acquisition of significant beneficial interest: Allotment /Transfer / others, specify iii) Nature of the significant beneficial interest:
iv) Reasons for not registering shares in my name:
v) Particulars of the instrument/document, if any, showing the creation of such significant beneficial interest:
vi) Direct/ Indirect percentage of voting rights:
6. Particulars of the person from whom the significant beneficial interest is acquired, if applicable:
i) Name of the transferor of significant beneficial interest:
ii) Whether shares were registered in his name:
(If not, whether any declaration under sub-section (2) of section 89 was filed by him to the company. If so, date of such declaration) iii) Particulars of the instrument/ document, if any, showing the transfer of such significant beneficial interest:
Date:
Place:
Signature of the holder of the significant beneficial interest CERTIFICATE I hereby certify that the significant beneficial interest in the shares mentioned above has been transferred by me on ................
Signature of the person who has transferred the significant beneficial interest in the shares Date:
Place:
Enclosures: (a) Proof of identity of the registered owner and holder of the significant beneficial interest
(b) Instrument/document under which the significant beneficial interest is created/ transferred/changed.
Form No. BEN-2 Return to the Registrar in respect of declaration under section 90 received by the company [Pursuant to section 90(4) of the Companies Act, 2013 and rule 4] O For Significant beneficial ownership O For Change in Significant beneficial ownership Total percentage O Date of Change .
O SRN of BEN-2 latest(last) filed for significant beneficial Ownership Total percentage
1. (a) CIN:
¹Hkkx IIµ[k.M 3(i)º Hkkjr dk jkti=k % vlk/kj.k 15
(b) GLN:
2. (a) Name of the company:
(b) Registered office address:
(c) E-mail id:
3. Particulars of significant beneficial interest:
PAN * S. No. Date of declarations under subsection (1) of section 90 Date of receipt of the said declarations by the company Particulars of shares in respect of which beneficial interest is created Class of shares No. of shares Distinctive Nos. of shares/ DP and Client ID of shares
(1) (2) (3) (4) (5) (6) Particulars of shares in respect of which beneficial interest is created Particulars of registered owner Face value of shares Paid up value of shares Name of the registered owner Address and email id Date of Birth/ Age Father’s/ Spouse’s name Occupation
(7) (8) (9) (10) (11) (12) (13) Particulars of registered owner Particulars of beneficial owner Name & Nationality Address and e-mail id Nationality PAN/UIN/CIN (in case of company) Passport No.
(in case of foreign national)
(14) (15) (16) (17) (18) Date and Nature of beneficial interest Remarks Father’s/ Spouse’s Name
(19) (20) (21) Date:
Place:
Attachments:1. Declaration under section 90 (1); 2. Optional attachments, if any.
Prefill 16 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)] Form no. BEN-3 Register of beneficial owners holding significant beneficial interest [Pursuant to section 90(2) of the Companies Act, 2013 and rule 5(1)] Name of the company:
Registered office address:
1. Particulars of the beneficial owner holding significant beneficial interest PAN * Sl. No. Name of the Beneficial Owner Address and E-mail id Date of Birth/ Age Father’s/ Mother’s/ Spouse’s name
(1) (2) (3) (4) (5) Occupation Nationality PAN/UIN/CIN (in case of company) Passport No. (in case of foreign national) Status
(6) (7) (8) (9) (10) Date of declaration under section 90 Date of cessation Date of entry in Register Date of filing of BEN-2(SRN wise) Amount of guarantee, if any
(11) (12) Any other interest, if any Instructions, if any, given by the member wt
2. Particulars of the shares in which significant beneficial interest is held by the beneficial owner:
i) Class of shares:
ii) Number of shares:
iii) Shares/ securities in physical form � Distinctive numbers: From.......... To...........
� Certificate No.:
� Folio No.
iv) Shares/ securities in Demat form � DP ID/ Client ID :
� No. of shares:
�Any other:
v) Nominal value of shares:
vi) Paid up value of shares:
Prefill ¹Hkkx IIµ[k.M 3(i)º Hkkjr dk jkti=k % vlk/kj.k 17 Form no. BEN-4 [Pursuant to section 90(5) of the Companies Act, 2013 and rule 6] [<<Insert Company Name>>] (the “Company”) <<Insert Date>> [By post/email] To:
Name and address of SBO/any other person Date:
Subject: Notice under sub-section (5) of Section 90 of the Companies Act, 2013 and rules made there under The Company has reasonable cause to believe that* :
� you are a significant beneficial owner of the company;
� have knowledge of the identity of significant beneficial owner of ………………..likely to have such knowledge;
� have been a significant beneficial owner of the company during the three years immediately preceding the date of this notice, and in respect of the above significant beneficial ownership the return prescribed under Section 90 of the Act has not been filed in compliance with the Act.
You are accordingly advised to give the following information within 30 days of the date of this notice in accordance with the section 90 of the Companies Act, 2013 :
1. Name and Address of the Beneficial Owner (B.O) (i.e. yourself or the significant BO if you are not the significant BO)
2. PAN of the B.O
3. Name of the person/entity/trust/body etc in whose name the shares/rights are registered/held
4. Folio number/DP and Client ID of the shares/securities
5. Nominal value of the shares/securities
6. Date of acquiring beneficial interest
7. Documents, terms and conditions or any other particulars regarding the BO ownership
8. Reason for not filing declaration in Form No. BEN-4.
9. Any other information incidental to or relevant or in your possession or knowledge to enable the company to evaluate this matter 18 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)] The abovementioned particulars should be submitted in writing to the registered address of the company not later than 30 days of the date of this notice failing which the company shall proceed in the matter without further notice as per the provisions of the Act.
Name & signature (Person authorized to issue notice) *Delete whichever is not applicable [ F.No. 1/1/2018 CL-V] K.V.R.MURTY, Jt. Secy.
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.
2018-06-16T09:57:53+0530 ALOK KUMAR