1515GI/2022 (1) रजिस्ट्री स.ं डी.एल.- 33004/99 REGD. No. D. L.-33004/99 xxxGIDHxxx xxxGIDExxx असाधारण EXTRAORDINARY भाग II—खण् ड 3—उप-खण् ड (ii)
PART II—Section 3—Sub-section (ii) प्राजधकार स ेप्रकाजित PUBLISHED BY AUTHORITY जित् त ंं् ाल (जित्ती सिेा जिभाग) अजधसचूना नई दिल् ली, 3 ंाचच, 2022 का.आ. 995(अ).—कें द्री सरकार, िीिन बींा जनगं अजधजन ं, 1956 (1956 का 31) की धारा 50 द्वारा प्रित् त िज त क का प्र ग करते एए, ह अजधसूजचत करती ह ैदक दकए िाने िाली घ षणा के संबंध ंें जिजहत दकए गए प्ररूप, रीजत, अिजध और ब् ौरे तथा कंपनी अजधजन ं के अधीन रखे िान े िाल े रजिस्ट्टर ंें िाजंल की िान े िाली जिजिजि ां जनम्नजलजखत उपांतरणक, अपिािक और ितों के साथ अजधजन ं की धारा 5ग के अधीन जनगं क लागू ह गी, अथाचत ्:--
1. रजिस्ट्रीकृत ि ेर धारक ि ऐस ेि ेरक ंें लाभप्रि जहत नहीं रखत ेहै द्वारा घ षणा--(1) क ई व्यजि, जिसका नां जनगं ंें िे र धारक के रूप ंें जनगं के सिस्ट् क के रजिस्ट्टर ंें प्रजिि ह ैलेदकन ि ऐसे िे रक ंें लाभप्रि जहत नहीं रखता ह,ै उस तारीख से तीस दिनक के भीतर, जिसक ऐसे व्यजि का नां उस रजिस्ट्टर ंें प्रजिि दक ा ग ा ह,ै अजधजन ं की धारा 5ग की उपधारा (1) ंें जनदिि प्ररूप 1 ंें घ षणा करेगा ।
(2) िहां जनगं के िे रक ंें लाभप्रि जहत ंें क ई पररितचन ह ता ह ैिहां उप परैा (1) ंें जनर्िचि व्यजि ऐसे पररितचन की तारीख से तीन दिनक की अिजध के भीतर अजधजन ं की धारा 5ग की उपधारा (3) ंें जनर्िचि प्ररूप 1 ंें घ षणा करेगा ।
(3) जनगं उप पैरा (1) ा उप परैा (2) के अधीन घ षणा की प्राजि की तारीख से तीस दिनक के भीतर उसंें अंतर्िचि ब् ौरक की प्रजिजि सिस्ट् क के रजिस्ट्टर ंें करेगा और प्ररूप 2 ंें एक अजभस्ट्िीकृजत िारी करेगा । स.ं 965] नई दिल्ली, िुक्रिार, ंाचच 4, 2022/ फाल् गनु 13, 1943 No. 965] NEW DELHI, FRIDAY, MARCH 4, 2022/PHALGUNA 13, 1943 सी.जी.-डी.एल.-अ.-04032022-233917 CG-DL-E-04032022-233917 ufsredt &. St.Wer.- 33004/99 REGD. No. D. L.-33004/99 Zita LIsTda Che Gazette of India UGH. -S1. We.-37.-04032022-233917 CG-DL-E-04032022-233917 FAATATCT EXTRAORDINARY aT —ats 3—34-@u¢ (ii)
PART I—Section 3—Sub-section (ii) srferere & warts PUBLISHED BY AUTHORITY a. 965] ae faeett, THart, ATS 4, 2022/ Grey 13, 1943 No. 965] NEW DELHI, FRIDAY, MARCH 4, 2022/PHALGUNA 13, 1943 fact Farersa (fata aar far) we feeeft, 3 ard, 2022 HTB. 995(H).— hata aca, staat star fra afatdaa, 1956 (1956 ar 31) Ft aret 50 arer acd Maat BT TAT Hed SU, Ae ataahra Het & fe feo od are aro & tae H fated few aT ved, Offa, vate ate att aat aod afataae & aefte ce ore are threex F oer Ft Oe art faforteat fraterted sara, Ararat aire erat area ates Ft are Sa sella fra ar ary eet, AAT :--
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(2) wet fara & oat F arava fea F are aad dat Z sat Ta Aer (1) F Aes oa wa oad Ft atte & att feat At safer ae sftae aterttare AT arer St At Saarer (3) F Pfs wea 1 A ATT HAT |
(3) Fra so fet (1) aT Se Aer (2) & aelta Broo FY ora FT aretha a dia feat ahax vad salts sat At fate aaeat cisre|et F HT sie Wed 2 Fu attredrars aet FATT | 1515G1/2022 (1) 2 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
2. लाभप्रि स्ट्िांी, ि ि ेरक ंें लाभप्रि जहत धारण ा अर्िचत करता ह,ै जिसका नां सिस्ट् क के रजिस्ट्टर ंें प्रजिि नहीं ह,ै द्वारा घ षणा—(1) प्रत् ेक व्यजि, ि जनगं के िे रक ंें लाभप्रि जहत धारण ा अर्िचत करता है, उस तारीख से, जिस पर िह जनगं के िे रक ंें ऐसे लाभप्रि जहत अर्िचत करता है, तीस दिनक की अिजध के भीतर अजधजन ं की धारा 5ग की उपधारा (2) ंें जनर्िचि प्ररूप 3 ंें घ षणा करेगा ।
(2) िहां जनगं के िे रक ंें लाभप्रि जहत ंें क ई पररितचन ह ता ह ैिहां उप परैा (1) ंें जनर्िचि व्यजि ऐसे पररितचन की तारीख से तीन दिनक की अिजध के भीतर अजधजन ं की धारा 5ग की उपधारा (3) ंें जनर्िचि प्ररूप 1 ंें घ षणा करेगा ।
(3) जनगं उप पैरा (1) ा उप परैा (2) के अधीन घ षणा की प्राजि की तारीख से तीस दिनक के भीतर उसंें अंतर्िचि ब् ौरक की प्रजिजि सिस्ट् क के रजिस्ट्टर ंें करेगा और प्ररूप 2 ंें एक अजभस्ट्िीकृजत िारी करेगा ।
3. लाभप्रि स्ट्िांी, ि ि ेरक ंें ंहत्िपणूच लाभप्रि स्ट्िाजंत्ि धारण ा अर्िचत करता ह,ै द्वारा घ षणा—(1) प्रत् ेक व्यजि, ि अजधजन ं की धारा 5 की उपधारा (6) ंें था जिजनर्िचि ंहत्िपूणच लाभप्रि स्ट्िांी ह,ै इस अजधसूचना के प्रकािन की तारीख से नब्बे दिन की अिजध के भीतर प्ररूप 4 ंें घ षणा करेगा ।
(2) प्रत् ेक व्यजि, ि अजधजन ं की धारा 5ग की उपधारा (6) ंें जनर्िचि लाभप्रि जहत ा अजधकार अर्िचत करता ह ै ा उसके जहत की प्रकृजत और उप पैरा (1) के अधीन की गई घ षणा ंें जिजनर्िचि अन् जिजिजि ां पररितचन के अधीन ह ैत ऐसे अिचन ा पररितचन की तारीख से तीस दिनक की अिजध के भीतर प्ररूप 4 ंें घ षणा करेगा ।
(3) जनगं उप पैरा (1) ा उप परैा (2) के अधीन घ षणा की प्राजि की तारीख से तीस दिनक के भीतर उसंें अंतर्िचि ब् ौरक की प्रजिजि सिस्ट् क के रजिस्ट्टर ंें करेगा और प्ररूप 2 ंें एक अजभस्ट्िीकृजत िारी करेगा ।
4. रजिस्ट्टर—जनगं प्ररूप 5 ंें अजधजन ं की धारा 5ग की उपधारा (7) ंें जनर्िचि रजिस्ट्टर रखेगा । प्ररूप 1 (धारा 5ग(1) िेखें) ि ेरक के रजिस्ट्रीकृत धारक, ि ऐस ेि ेरक ंें लाभप्रि जहत नहीं करत ेहैं, द्वारा घ षणा सेिा ंें : भारती िीिन बींा जनगं, कें द्री का ाचल ‘ गक्षें’ िीिन बींा ंागच नरींन पाइंट ंुंबई-400021
1. ि ेरक के रजिस्ट्रीकृत स्ट्िांी की जिजिजि ा ं
(i) नां : ........................................................
(ii) ंाता ा जपता ा पजत ा पत्नी का नां : .................................................
(iii) व्यिसा : ........................................................
(iv) ा भारती नागररक हैं हां नहीं
(v) राष्ट्री ता (जििेिी नागररकता के ंांले ंें) : .................................................
(vi) िन्ं की तारीख ा आ ु: ................................................. ween me enn e eee e meen eee eee eee eee > Elle Lk BL b Lp Heals (IA) eee ence ee ee neon eee eee e eee eeeeeeeseneseeaeeees > (2 BHI Ye LP >| | LsPbl) bt ab (A) “falls de Uh Lie bib Lie bby Le Lbtte (1) bcssteuseveseiteatisetsteveavinsetssevststsetseseee ie (1) Ibapele} ye [lbs Deb Frinf> & Pbls “| LZ000r-3&h 23lh bhp ele Lei bab Ls Jrkelelte, feb lele bel See ‘Helebe} Lit} bb [is fe] Pal ts ‘ft lbh Uobie 218 ‘2 Pre [Bb D2} DbIE f Phils bd [ls “brie Pe Fale} Lbs (Be (|)1eG Leis) | bk | Lise» 22aie)> Ablbl bt (Z) DeLBhe [yp bG Lait (ye bbb| elle ft G bok blb|—aoaiap “py | Une [lls BBipatelie woh be Z beh ale Ulsate fe Deal) oe [pa bh Blbelh lye [Le Abbie BO 2Dife & Jhb) BID B BIPID Ly RIUK [yp lnblls bile & (Z) Lb be Le (|) Deb he teleb (€) | Une linbis bY bok 2DUs se Bible Ye lee] Bip B BILD bb bbb ath Ip bine bo lb 2 bibl & bbbejh Ibailele| hale Able) fe Mobi Ble yp blfele & (|) Deb be die RISK Lp D2) ene le 2 Ibo Disiie 2ibtalie Ie BZ) PKL abil fe (Q) LIhe [yp WG Laie Lp ltbebltalie Ls ‘ake bok (Z) | Uret Unhle p beak eblf & flete Le bel feb fe Bel ele Ie bisibk bb Pls BS “2 |blb? SKID Inhb2h BP bl bl lek & (Q) Pibhe IY G Lie Ye Beb| Bie Ls “Ajke teh (|) )—Ueblb 1218 ‘2 1b>w Diojie Ip lori bli) SKID lohbBk b Phils Ls “[elbs DkRIb "ES | Une [pills BUBipatgtie deh be Z beh aie Unde fe pedi) oe hobh Bll lye PL be ApJble BBE 2bi b [bbl IP B BIRD Lb RIK Lb Unblls bile se (Z) Leb he Le (|) eb he Hise} (€) | Une Unis | bsek abil ft (€) Ieltehe Ye bG DLs kp bebitalie >be ee Klble Lb Use| BL b BlpLb kb bbbelh BD Qfte able) (|) Deb bh 12k 2 1B bbe ath Ble b BZ) Phil» b Lely se belsbl 12is (Z) | Used Uinbile b € bk Aplb} fe (Z) Laltehe |p LG Iris |p Bebjblie 2Plft de Bible [yp lhe) bib “2 [bob Dis|ie P2| Philp bab Leelee Bibb] 2b 2h bls} 'R BLIP be '2 [bob Dist Ip Ini D2) PhD b Lebls se leh} Us “fhe hk (})—lobte DMB "2 1Bb bis ft 2Pe)> th [hobh bb |bbll ‘2 1Pr Piojie Le Inple PBJ DKRID b PIs [is ‘Yale DERI “Z [Ee “OAS—TI Lavd] AUYVNICUOVALXA : VIGNI AO ALLAZVD FHL C [भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 3
(vii) ललगं : पुरुष स्त्री थडच िेंडर
(viii) आ -कर स्ट्था ी खाता संख् ा (पेन) : .................................................
(ix) पहचान का सबूत (क) भारती क के जलए (जनम्न ंें से क ई) आ -कर पेन काडच भारत जनिाचचन आ ग द्वारा िारी जनिाचचन फ ट पहचान काडच पासप टच ड्राइलिंग लाइसेंस जिजिि पहचान संख् ा (आधार) काडच (ख) जििेिी और अजनिासी भारती क के जलए पासप टच अन्
(x) स्ट्था ी आिासी पत ेका ब् ौरा : (क) अंतराचष्ट्री ंानकीकरण संगठन (आईएसओ) द्वारा जन त ििे क ड : .................................... (ख) िेि : .................................... (ग) लैंडलाइन फ न नंबर : .................................... (घ) ं बाइल नंबर : .................................... (ङ) फैस नंबर : .................................... (च) ई-ंेल पता : ....................................
(xi) ा ितचंान आिासी पता िही ह,ै ि स्ट्था ी आिासी पता ह ै हां नहीं
(xii) दि नहीं त ितचंान आिासी पत ेका ब् ौरा : (क) अंतराचष्ट्री ंानकीकरण संगठन (आईएसओ) द्वारा जन त ििे क ड : .................................... (ख) िेि : .................................... (ग) लैंडलाइन फ न नंबर : .................................... (घ) ं बाइल नंबर : .................................... (ङ) फैस नंबर : .................................... (च) ई-ंेल पता : ....................................
2. ि ेरक की जिजिजि ा,ं जिसके सबंधं ंें रजिस्ट्रीकृत ि ेर धारक द्वारा घ षणा की गई ह ै:
(i) िे रक का िगच : .................................... scseeseseeseeeeseeueseesseteseenees be le bbls (1) : 2 Bl Up nhl IIB dolls ably BEUSolal> fe EB cbbla “halted [ye [able °Z becusecrecaueusecueeateeteeseeeres : Dh bis (b) veceeseeeaeseeneseseeeeeeenenteeees "pbb Beh (3) beveeuetateseuscseeesseaseaseaneas "2bb be ili (fa veceteseeseeeneseeeeteeesseeseenees 2bb bith beIbSb (It sesseseeseesssssessesssssetstettee “pe (B ecusecatecaeeesecaseeseeteesteases > Site oD Pb) 1218 (debnSie) bebb In>pblpbl bg ie (Ye Dlbe Ib Dh blpibie bibbb |b 12h pl (IIx) Be oO BO 2 1Pb blplblie [felte> Us “2 [Pb 1h kl plblie bib Leb (1X) bevseuesustesteseuseeeseateateanens : Dh bis (1) veceeeeeeeaeseeaeeesneetaneneneeeees "pbb Beh (3) scseeeseeneseeseseeseaneseenersess 2bb beiblis (2) veceseeseessesseeseesecseesnesneeees 2b bith BElbeb (12) wee eee ee eeeeeeeeeeeeeseeeseeeeee : 16> (B) sesesessseetsssenseseseete : Skb bb Deb] 218 (ebn ele) boleh Ineelpblis PZ able (12) : DLbe Ib Ph kl blblie Lelie (X) bebe PlbBlh ¢ DE} 4 [e[priis [pleb|ic alle [spe} (Er) Sle (21pile) hob ble 2h Bleje| Pibblh pie blbBh [eth bejeb| Quis DIB bible Hbjek] Pale» pitt bh deville (Sie Be Bel) Db} se Uelpaits (12) PER le bib2h (XI) sesueesesueesesseeeeesnessasneeeesseeesssnesess : (bh) bob ID1E plied 2 bile (IIIA) 2218 gh O Le O heh O ‘Ine (IIA) ) ) ) ) Joribible : kebisl> Le Pele [@)¢ Sob—I] Ib] 4 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
(ii) िे रक की संख् ा : ....................................
(iii) सुजभन्न संख् ाएं ........... से .......... तक
(iv) प्रंाण-प्: ........................................
(v) फ जल संख् ा : ....................................
(vi) िे रक का अजभजहत ंूल् : ....................................
(vii) िे रक का संाित्त ंलू् : ....................................
3. घ षणा : िीिन बींा जनगं अजधजन ं, 1956 की धारा 5ग की उपधारा (1) के अनुसरण ंें, ंैं .................. घ षणा करता ह ं दक नीचे नाजंत व्यजि ( क) उपर ि उजल्लजखत िे रक ंें लाभप्रि जहत धाररत करता हैं/करते हैं, ि जनगं के सिस्ट् क के रजिस्ट्टर ंें ंेरे नां से रजिस्ट्रीकृत ह ै: क्रं सं. लाभप्रि स्ट्िांी का नां पता और ईंेल पता िन्ं की तारीख ा आ ु जपता ा ंाता ा पजत ा पत्नी का नां व्यिसा राष्ट्री ता
(1) (2) (3) (4) (5) (6) (7) कंपनी के ंांल े ंें, जनगं पहचान संख् ा (सीआईएन) ा सीजंत िाज त्ि भागीिारी के ंांले ंें, सीजंत िाज त्ि भागीिारी पहचान संख् ा (एलएलपीआईएन) ा आ -कर स्ट्था ी खाता संख् ा ा आधार संख् ा पासप टच संख् ा (जििेिी नागररक के ंांले ंें) सुजभन्न संख् ा ( दि लाग ूह )
(8) (9) (10)
4. लाभप्रि जहत के ब् ौरे :
(i) लाभप्रि जहत की प्रकृजत : ....................................
(ii) लाभप्रि जहत के सृिन की तारीख : ....................................
(iii) लाभप्रि स्ट्िांी के नां से िे र रजिस्ट्रीकृत न करने के कारण : ....................................
(iv) जलखत ा िस्ट्तािेि की जिजिजि ां, दि क ई ह , ऐसे लाभप्रि जहत के सृिन क दिखान ेके जलए : .......
5. लाभप्रि जहत ंें पररितचन की जिजिजि ा ं:
(i) पररितचन की तारीख : ....................................
(ii) लाभप्रि जहत ंें पररितचन की प्रकृजत : ....................................
(iii) ऐसे पररितचन की संजक्षि जिजिजि ां : ....................................
(iv) ऐसे पररितचन के जलए कारण : ....................................
(v) जलखत ा िस्ट्तािेि की जिजिजि ां, दि क ई ह , ऐसे लाभप्रि जहत के सृिन क दिखान ेके जलए : ....... स्ट्थान : ............. तारीख : .............. रजिस्ट्रीकृत िे र धारक के हस्ट्ताक्षर 4 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)] tas stat fare afettaa, 1956 ft aren Sat At Soarer (1) FH AGATA, Fe. ATI LAT & fe ars afta cafe (at) saree steahad sat F arava fea atta Heat e/aed SZ, ST Pe aaeat F tfsreezt FAY ara & cisredta Se: wa F. aTaqye Tat att wer ft far at Ara carat FT sat Fat aretha aT ar ofa ar a ay Tat HT ATA aaa ustzat
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(1) रजिस्ट्रीकृत िे र धारक और लाभप्रि स्ट्िांी की पहचान का सबूत ।
(2) उस लाभप्रि जहत के अधीन जलखत ा िस्ट्तािेि, ि सृजित ा अंतररत ा पररिर्तचत दक ा ग ा ह ै। प्ररूप 2 घ षणा की प्राजि की अजभस्ट्िीकृजत तारीख : .............. .................................................................................................. (घ षणा करन ेिाले सिस्ट् /व्यजि का पता) .................................................................................................. (सिस्ट् /व्यजि का पता) भारती िीिन बींा जनगं, िीिन बींा जनगं अजधजन ं, 1956 की जनम्नजलजखत धारा 5ग की उपधारा (ओ) के अधीन तुम्हारे द्वारा की गई घ षणा की प्राजि की अजभस्ट्िीकृजत : उपधारा (1) उपधारा (2) उपधारा (3) उपधारा (6) ................ (तारीख अतंर्िचि करें) पर हंन ेउि घ षणा प्राि की और जिसके ब् ौरे जनम्नजलजखत रजिस्ट्टर (रजिस्ट्टरक) ंें ररकाडच दकए गए हैं : सिस्ट् क का रजिस्ट्टर ंहत्िपूणच लाभप्रि स्ट्िांी द्वारा घ जषत जहत का रजिस्ट्टर प्राजधकृत व्यजि के हस्ट्ताक्षर नां : ........................ भारती िीिन बींा जनगं कें द्री ‘ गक्षें’ िीिन बींा ंागच नरींन पाइंट, ंुंबई – 400021 प्ररूप 3 (धारा 5ग(2) िेखें) लाभप्रि स्ट्िांी, ि ि ेरक ंें लाभप्रि जहत धारण ा अर्िचत करता ह ैलदेकन उसका नां सिस्ट् क के रजिस्ट्टर ंें प्रजिि नहीं ह,ै द्वारा घ षणा सेिा ंें : भारती िीिन बींा जनगं, कें द्री का ाचल eb belt else ‘hele Litlip bbls LDL Mobile L218 ‘2 ‘Leb Bb abjk ft Dobe) & |bdDb bb MH Jade| > B Loe Dinjle Lb In>lte DEY DIL fe Pobl [is ‘|pelb> DhieLb (Be (Z)bG LL) S bb LZ000p — $b ‘25 lh bab 2eelo|> de P2) Pile Ie1S [ibd Skin) Joh b> 2h 221) Ite [rod be Cc] Cc] 2 Dl ne} Sib bb (beblnj>) 228i)» PEJLIBb) abo bls} aie [yp BLK Unhl BE bee ah (Vb AblPie Blip)
(9) eitphs (¢) Dibhe (Z) bibhs (|) biphs Cc] D ppbipeietic [eb BIIK |b Unni Sie Wye 18 2124 bl ple te (Ue) Pibbe [tp bG Dib PeJb/eb) ib OG6) ‘beb| pile bleb) Jel bbls ‘bieb| itl bbls kL alts (1Ph Ie 2] ro/ eo) by) Rybipela}ie |e BYIK [ye Lnkla Z bs | 2 Lele It} DP |b ath Le PajPle Le Din|B [is ‘Jsb1ba lp Deb) blige be] pki BE (Z) | DBR Ie bib2h |b [elb? DK ID pie b> 1B ahls bails (1) bbb S Inpipi bie} Ehisl> Ide Pale, [Qe SoB—T] tus] 6 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)] ‘ गक्षें’ िीिन बींा ंागच नरींन पाइंट ंुंबई-400021
1. ि ेरक की जिजिजि ा ंजिनंें लाभप्रित जहत घ षणा करन ेिाल ेव्यजि द्वारा धाररत ह :
(i) िे रक का िगच : ........................................................
(ii) िे रक की संख् ा : ....................................
(iii) सुजभन्न संख् ाएं ........... से .......... तक
(iv) प्रंाणप् संख् ा : ....................................
(v) फ जल संख् ा : ....................................
(vi) िे रक का अजभजहत ंूल् : ....................................
(vii) िे रक का संाित्त ंलू् : ....................................
2. लाभप्रि स्ट्िांी की जिजिजि ा ं: क्रं सं. लाभप्रि स्ट्िांी का नां पता और ईंेल पता िन्ं की तारीख ा आ ु जपता ा ंाता ा पजत ा पत्नी का नां व्यिसा राष्ट्री ता 1 2 3 4 5 6 7 कंपनी के ंांल े ंें, जनगं पहचान संख् ा (सीआईएन) ा सीजंत िाज त्ि भागीिारी के ंांले ंें, सीजंत िाज त्ि भागीिारी पहचान संख् ा (एलएलपीआईएन) ा आ -कर स्ट्था ी खाता संख् ा ा आधार संख् ा पासप टच संख् ा (जििेिी नागररक के ंांल ेंें) 8 9
3. घ षणा : िीिन बींा जनगं अजधजन ं, 1956 की धारा 5ग की उपधारा (1) के अनुसरण ंें, ंैं .................. घ षणा करता ह ं दक नीचे नाजंत व्यजि ( क) उपर ि उजल्लजखत िे रक ंें लाभप्रि जहत धाररत करता हैं/करते हैं, ि जनगं के सिस्ट् क के रजिस्ट्टर ंें ंेरे नां से रजिस्ट्रीकृत ह ै।
4. रजिस्ट्रीकृत ि ेर धारक (ि ेर धारकक) की जिजिजि ा ं क्रं सं. लाभप्रि स्ट्िांी का नां पता और ईंेल पता िन्ं की तारीख ा आ ु जपता ा ंाता ा पजत ा पत्नी का नां व्यिसा राष्ट्री ता 1 2 3 4 5 6 7 Z 9 G v € C L Hib Ib [Ph fells Hib le Phh Le lk Bip ip IPh BRS Lue [ft lb» IPrlél> bibbko | Pit lk IPh} | tp Hels zie 1Ph PKL "bh he LG lel} Ay (Jde>U0s able) writs ably WEFiap> “py | 2 bblpalef B lb pb ft 2etln|> de [robb oe bleb| [ls "2 Pab/2 [Do balis P2| PhP b [bls Peolbals Blobs (Lie) Dfke Pills bl de} 3 pew | E eneeescesnecescess bh | ) I i te (1) Bibbs Le bG bib Le 9G6L t |e I Heb} Ltt bb | is : Mobla “€ Lites be ible Le lr&ab IPI [pike Be-bile lk (bo Siielpbabn) Leap bib2h ipibl ba PlD PRI “bh bale te [plbible bo eUD (2 phlt e eefile Ysee}) Lhob glbblh | Pay lke (bOEUe| >) lho blb2h Hleb) ‘fh Bielit ce fabs Z 9 G v € Cc L Hib Leb [Ph elle Hib le Phh le lk BUpip IPh BRS Lue pte Ibrlél> blbbro | Wit lr IPh} |] tp Hels zie 1h PKL 'b he * We@Ulebe yp Lelie» Piste °Z be ceeeaeauaeaueeeueeeueueauavavauees bale BDI Ib 115 (IIA) eeeeeeaeeeeeneeeeeneetnteeeteaees belt p2jis|ie Lu betel (1A) wee eee eee eee eee eens : Leah | 4 See eee eee eee > hob | lbK (A eeeeeeteteeeereeteatereeeeetenenes Lbab Ie Dts (Il) eee eeeseaeeaaeeaaeeaeeuaeauaeeuaeeeueeeauaeueueueueneas Dbeb lee Diels (I) 2 Doyle DIS @fte Ble koe Units BBj DBKKLE Wie Label} Lp DBL “| LZ0007-2eR 2BLb bial elit Le bjs Je¥aleLte, [Ee “OAS—TI Lavd] AUYVNICUOVALXA : VIGNI AO ALLAZVD FHL 9 [भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 7 कंपनी के ंांल े ंें, जनगं पहचान संख् ा (सीआईएन) ा सीजंत िाज त्ि भागीिारी के ंांले ंें, सीजंत िाज त्ि भागीिारी पहचान संख् ा (एलएलपीआईएन) ा आ -कर स्ट्था ी खाता संख् ा ा आधार संख् ा पासप टच संख् ा (जििेिी नागररक के ंांल ेंें) 8 9
5. लाभप्रि जहत के ब् ौरे :
(i) लाभप्रि जहत के सृिन की तारीख : ....................................
(ii) लाभप्रि जहत के अिचन की रीजत : .................................... आबंटन अंतरण अन् दि अन् , जिजनर्िचि : ......................................................
(iii) लाभप्रि जहत की प्रकृजत : ....................................
(iv) ंेरे नां से िे र रजिस्ट्रीकृत न दकए िाने के कारण : ....................................
(v) जलजखत ा िस्ट्तािेि की जिजिजि ां, दि क ई ह , ऐसे लाभप्रि जहत के सृिन क दिखाने के जलए:...........................................................................
6. व्यजि जिसस ेफा िाप्रि जहत अर्िचत दक ा िाता है, की जिजिजि ा ं( दि लाग ूह ) :
(i) फा िाप्रि जहत के अंतरक का नां :--------------------------
(ii) ा उसके नां पर िे र रजिस्ट्रीकृत दकए गए थ े: O हां O नहीं दि नहीं, त िीिन बींा जनगं अजधजन ं, 1956 की धारा 5ग की उपधारा (2) के अधीन क ई घ षणा ह ैि जनगं क उनके द्वारा फाइल की गई थी ? O हां O नहीं दि हां, त ऐसी घ षणा की तारीख --------------------
(iii) ऐसे फा िाप्रि जहत ंें पररितचन ििाचन ेिाल ेजलखत ा िस्ट्तािेि, दि क ई ह , की जिजिजि ां:------
7. फा िाप्रि जहत ंें पररितचन की जिजिजि ां :
(i) पररितचन की तारीख:--------------------------
(ii) फा िाप्रि जहत ंें पररितचन की प्रकृजत:--------------------------
(iii) ऐसे पररितचन की संजक्षि जिजिजि ां:--------------------------
(iv) ऐसे पररितचन के जलए कारण:-------------------------- ‘ Ue@hiohel Le BPE fh be BB) Dklbbelth °Z Ie bib) Hs 2 Mobis Sie bile te (Z) Lelteh® Lp IG Laie ly 9G6) ‘bb b|iglie Hib) Unie bel is |p ‘[2b Bite 2b O 120 ‘fe Die dee) Peb|Fein|> ately 2h bl ebe Leb (I!) sonnnnmnnnnc ssc ccccnnnnnn : Hb [ue o> Pie D2) DkID Eth (I) : (Bab dj) lapel} [yp “B WDE Le} Binjte DB) PKIbbIth Bhs} Bite °g % blbe| le bib b2) bhisle BQ “2 Bide bj ‘Lrallel ly Isklba> lk Peles (A) See : hte Ye blis Ate) b bbls Phils B Bb th (Al) See eee : bye dye P2) Pits (11!) tek O InP O bebe © vseeeeeeaeeeeeeeeeateseaneneeeees : BID bp bile 4 D2) DK» (I!) veceeeeeeteesaeeneeeeeteeeeeeeeey ‘BOLD ly bish & b2y vkRID (! : 2Uhs PA) SKI “G 6 8 Ltt be ible Ue lr IPI [elk 2te-bile le (bASelbbabh) lpab bib2h Pipiel bey PRI “bh baie te P1pibls bib (2 pblt belie [see|) Lh elbblh | Pa} lke (boEle| >) lhoh ble 2h ble) “fe Bielit de phe L Inpipi bie} Ehisl> Ide Pale, [Qe SoB—T] tus] 8 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
(v) ऐसे फा िाप्रि जहत ंें पररितचन ििाचने िाले जलखत ा िस्ट्तािेि, दि की ह , की जिजिजि ां:- ___________________________________________ स्ट्थान:---------------- तारीख:--------------- जहताजधकारी स्ट्िांी के हस्ट्ताक्षर प्रंाणप् ंैं एतिद्वारा प्रंाजणत करता ह ंदक ऊपर उजल्लजखत िे रक ंें फा िाप्रि जहत ंेरे द्वारा -------- क अंतररत कर दि ा ग ा ह ै। स्ट्थान:---------------- तारीख:--------------- व्यजि जिसने िे रक ंें फा िाप्रि जहत अंतररत दक ा ह ैके हस्ट्ताक्षर संलग्नक:
(1) िे र के रजिस्ट्रीकृत धारक और जहताजधकारी स्ट्िांी के पहचान के सबूत
(2) जलखत ा िस्ट्तािेि जिसके अधीन फा िाप्रि जहत सृजित ा अतंररत ा पररिर्तचत दक ा िाता है प्ररुप IV [धारा 5ग(6) िेंखे] जहताजधकारी स्ट्िांी द्वारा घ षणा ि ि ेरक ंें ंहत्िपणूच फा िाप्रि स्ट्िाजंत्ि धारण करता ा अिचन करता ह ै सेिा ंें, भारती िीिन बींा जनगं केन्द्री का ाचल ‘ गक्षें’ िीिन बींा ंागच नरींन पॉइंट ंुम्बई – 400021
1. प्ररुप फाइल करन ेका प्र िन (क ई एक चनुें) : O धारा 5ग की उपधारा (6) के अधीन ंहत्िपूणच जहताजधकारी स्ट्िाजंत्ि की घ षणा के जलए O धारा 5ग की उपधारा (6) के अधीन ंहत्िपूणच जहताजधकारी स्ट्िाजंत्ि ंें पररितचन के जलए Db) bPbeth b Melb? lb eID?) Iphbo2h bps te (Q) PIBhE te bG DIB O Db} lobe by bbb lb) be) Iphbo 2h bile ee (Q) Pitgh® Jy IG Leite O : (PE wh By) biol Ie po BEI hOK “| LZ000r — Seth 23th bib drift Lt |e bbe lis keel, bblble bisa Bey lols bbls fl p elt, ‘ht leR 2 b> bile Ik IP> Jos bb}ib? Dkipbih ph Bk b Phils Us Uoble DIB [rlb> PER D} [Bb (9) Lei] A| b2k 2 IDUs Lee} Pip oth le Pejbie Le Din|h b2) biibblth bile tbls} Isp b2> lt PE! (Z) PER & bib2h |blb> [ple PE] pile brie Dbl Falo|> ob abls (L) phe1ba2 4 2 Lhe) Bel bie BQ) Dklbbelth b Diels bible te 12 “UbEiajel Lb BZ kp 2fk ‘eklbed db bpb) bib bllsb bebalh b b2) bkibelh Ba (A) [Ee “OAS—TI Lavd] AUYVNICUOVALXA : VIGNI AO ALLAZVD FHL 8 [भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 9 दि ंहत्िपूणच जहताजधकारी स्ट्िांी ने कंपनी अजधजन ं, 2013 की धारा 90 के अधीन घ षणा के संबंध ंें कंपनी के रजिस्ट्रार क क ई जििरणी ऑनलाइन प्रस्ट्ततु की ह,ै त ऐसे प्रस्ट्तुत करने पर उत्पन्न ंहत्िपूणच जहताजधकारी स्ट्िांी पहचान संख् ा (“एसबीओआईडी”):---------------------
2. ंहत्िपणूच फा िाप्रि जहत के धारक की जिजिजि ा:ं ंहत्िपूणच जहताजधकारी स्ट्िांी का नां (नां और उपनां िें) पता और ईंेल पता िन्ं की तारीख और आ ु जपता ा ंाता ा पजत/पत्नी का नां व्यिसा राष्ट्री ता पासप टच संख् ा (जििेिी राजष्ट्रक की ििा ंें)
3. जनगं के सिस्ट् के ंाध् ं स ेजनगं ंें अप्रत् क्ष धरण की प्रकृजत ा अजधकार का प्र ग (िहा ंएक स ेअजधक हक, प्ररुप के इस परैा क ि हराए)ं : (क) सिस्ट् के प्रकार {कंपनी ा सीजंत िाज त्ि भागीिारी (एलएलपी) ा जहन्ि ूअजिभि कुटंुब (एच ूएफ) ा भागीिारी फंच ा िैिेदकक न् ास ा पूतच न् ास ा जिजनर्िचि न् ास ा प्रजतसंहरणी न् ास ा पलू्ड इन्िेस्ट्टंेंट जहहकल (पीआईिी) ा पीआईिी द्वारा जन ंज्त इकाई ा क ई अन् जनगं जनका } :--------------------- (ख) सुसंगत जिजध के अधीन आबंरटत, जनगं पहचान संख् ा (सीआईएन) ा सीजंत िाज त्ि भागीिारी पहचान संख् ा (एलएलपीआईएन) ा क ई अन् रजिस्ट्रीकरण संख् ा:--------------------- (ग) सिस्ट् का नां:--------------------- (घ) पता: --------------------- ---------------------- िहर:--------------------- राज् :--------------------- िेि:--------------------- डाक सूचकांक संख् ा(जपन) :--------------------- (ङ) जनगं ंें अप्रत् क्ष धरण की प्रकृजत ा अजधकार का प्र ग: िे रक के आधार पर:---------------------% िे रक ंें ंतिान के अजधकार के अधार पर:---------------------% जितरणी लाभांि ा दकसी अन् जितरण पर अजधकारक के अधार पर:---------------------% जन ं्ण के प्र ग के आधार पर (करार की प्रजत संलग्न करें) ंहत्िपूणच प्रभाि के प्र ग के आधार पर (करार की प्रजत संलग्न करें) (च) जनगं के सिस्ट् ंें ंहत्िपणूच जहताजधकारी स्ट्िांी की प्राजस्ट्थजत (क ई एक चुने) : 0 भागीिार, भागीिारी फंच ा एलएलपी की ििा ंें br Ub> lye [pb nbd Lk path [plbielis “2ibielis 0 ‘(be seh Sib) Biralls [yp [pele [ple l1P2) InhboZi ft bab b cb inlee| (le) (je BB bik [yp alee) 2h alti se Inlteh oe blink lpheoP tC) (42 Bb Pik |p 2lede) 2h aliglie oe lel te Joke) CT] Ofjnnnnnnmnnnnnnnnnnnnn ‘2h pipe we Polu bile th InePb| hele |p| Ir elise kilo>Pbl C] a ‘bh 2iBie 4 Bibel de bIpbR BF kIs O Ofprnnnn nnn nn nnn nnn nnnnn “2h 216i + erie 2 ‘Inte lu pide lh Piebk [tp Job bbl & Hib! (2) wonnnnnnccnnnnannnnnn ‘Ura Ip > |Poln}> pole Sib Ie (ba Sile|phabn 1rOb blb2h Pipi b> PHU Ih (LAS) lrab blb2h Hirbl ‘P2|blle bible 4 Bibl Pebh (b) socnennennnnnnen nnn ‘{ieleb| Hib) bole Ble Ie Sie] Pel eb) P18 [pSilelh Lp (pS ie[h) be2o| Phebes Soh Ip Blee bilo>2hPIK Ip Bike 2>l bl bl Ie Bike Dh Ip Ble tbtel bb Ie Bth PplPieles Ip (hokb hn) bob wh blic B21 Ih (pbnbn) Pipiis bel> Pri Ih ph} idk db bab (4) : (MD2l> kb ab BS h2k ‘2 wei ie P wh 1is) leek I DibBie Ip Pbk |p Io>K Bb Ke b Hib! P BhZlh te beDpP tb Hlebl “*¢ (le Woe Wye ello Yoebl) Lobe PLL IPrlél> kikbko BLb Ib |Pb/Plb Le LPilt Le IP hI kelle aie BLpLP [ye Hels (p HibhS > Le bb) Hnlb Le |plbe ple Ib2) Iohbo2 he UP@us}b} ly b>1B de D2) Pk IDRIth Inhb 2h *Z bibSh |tlb? [ple IP?) jphbo2h Bb >h prob pba ba IP “2 Lb PB ak bElbblle [Jn>bbl Slee [tb 21 BaIop> 4 [phe f BER & Mobis bile + 06 Lele Lb €L0Z ‘bkb|ble [ph b [blk [plekib2) |nhkokr bite 6 Inpipi bie} Ehisl> Ide Pale, [Qe SoB—T] tus] 10 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)] 0 कताच, एच ूएफ न् ासी ा िैिेदकक न् ास ा पूतच न् ास की ििा ंें 0 जहताजधकारी, जिजनर्िचि न् ास की ििा ंें 0 लेखक ा व्यिस्ट्थापक, प्रजतसंहरणी न् ास की ििा ंें 0 साधारण भागीिार, जनिेि प्रबंधक ा ंखु् का चपालक अजधकारी, पीआईिी ा पीआईिी द्वारा जन ंज्त इकाई की ििा ंें 0 व्यजि, कंपनी ा क ई अन् जनगं जनका की ििा ंें (छ) दि सिस्ट् भागीिारी फंच ा एलएलपी ह,ै त जिजनर्िचि करें दक ा ंहत्िपूणच जहताजधकारी स्ट्िांी------- भागीिार हैं; जनगं जनका भागीिार ंें बएसंख् ा पण* धारण करता ह;ै जनगं जनका भागीिार की क्रंांजतं जन ं्ी कंपनी ंें बएसंख् ा पण* धारण करता ह ै। (ि) दि सिस्ट् कंपनी ा क ई अन् जनगं जनका ह ैत जिजनर्िचि करें दक ा ंहत्िपूणच जहताजधकारी स्ट्िांी (क ई एक चुनें)----- 0 ऐसी कंपनी ा जनगं जनका ंें बएसंख् ा पण*; 0 ऐसी कंपनी ा जनगं जनका की क्रंांजतं जन ं्ी कंपनी ंें बएसंख् ा पण* धारण करता ह ै।
(i) ा ंहत्िपणूच जहताजधकारी स्ट्िांी का जनगं ंें क ई प्रत् क्ष धरण ा अजधकार ह ै(क ई एक चुनें) : O हां O नहीं दि हां, नीचे ब् ौरे प्रजिि करें: िे रक के आधार पर:---------------------% िे रक ंें ंतिान के अजधकार के अधार पर:---------------------% जितरणी लाभांि ा दकसी अन् जितरण पर अजधकारक के अधार पर:---------------------% जन ं्ण के प्र ग के आधार पर (करार की प्रजत संलग्न करें) ंहत्िपूणच प्रभाि के प्र ग के आधार पर# (करार की प्रजत संलग्न करें) स्ट्थान:---------------- तारीख:--------------- ंहत्िपूणच जहताजधकारी स्ट्िांी के धारक के हस्ट्ताक्षर * “बएसंख् ा पण” से अजभप्रेत ह ै– (क) जनगं जनका ंें साधारण अंि पूंिी के आध ेसे अजधक धारण करना; ा (ख) जनगं जनका ंें आध ेसे अजधक ंतिान अजधकार रखना; ा (ग) जनगं जनका द्वारा जितरणी लाभांि ा क ई अन् जितरण के आध ेसे अजधक प्राि करने ा उसंें भाग लेन े का अजधकार ह ना । 10 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)] O Beat, WAU ares aT sath ATT AT Ot RATT At eT 0 fearfereré, fatafee =a ft aor F 0 tan aT aera, Widttecotts mare at sat H 0 ararey wefan, frasr wae aT yer arorers ater, traredt ar tterect arr fratera sare at eat QO eats, aot ar are area fare Pare Ht cert FH (&) afe aaeg anttart mH ar caveat @, at fatttes ae fh sar wecayt earteenret earett-—----- O anftaré: O fra freara anftare F aeetear To* ATT HAT F; O fra freara atten at martes frat aot H ageteat Tor* aT HAT F |
(a) ate qaey Hot at ars aeg fra fears @ at fatates ae fe ear wecayer earth carat (ate wap oO tet aot ar fre fare AF agate TT"; 0 Wat are ar fare frare ht parte faatt aott H ager qT* GIT FLAT & |
(i) Fat Faecayer earterenret carat ar PTs A Hrs eset acy aT ateranre S (HTS UH FA) : Oat O at ate at, area sare ofeae ae: O oat arare qe-------------- ee o% react H aaa Bh at faeTe BH ATT YT: ---------------- % faacofte arater ar Peet area facor ae aferenret AaIe Wi --------------------4 % Paar TAT Hh ATATT I (HATE AT Tht ArT He) O O O Ol AScagot THATS TANT Hh ATATe IH (Hee At Wit ArH He) Hecayt fearteraret cart oh TL Bh SEATAT * “Teqear To” & alas s—
(a) Feore fears F Aaya er Tht a ae A ares ATO TAT; AT
(a) frre fara Harel & ates Aart ateae LAAT; AT
(7) fava fears arer face araiet ar are area Fae areal ales oa Hed AT Sa ATT at aT ATHTT STAT | [भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 11 # “ंहत्िपूणच प्रभाि” से अजभप्रते ह ैभारती िीिन बींा जनगं के जित्ती और प्रचालन नीजत जिजनश्च क ंें प्रत् क्ष ा अप्रत् क्ष रूप से भाग लेन ेकी िजि, दकन्त ुउन नीजत क का जन ं् ण ा सं ुि जन ं्ण नहीं ह ै। संलग्नक:
(1) ---------------------
(2) --------------------- प्ररुप V [धारा 5ग(7) िेंखे] भारती िीिन बींा जनगं के ि ेरक ंें ंहत्िपणूच जहताजधकारी स्ट्िाजं क द्वारा घ जषत जहत का रजिस्ट्रर क्र.सं. जहताजधकारी स्ट्िाजं क के नां पता और ईंेल पता िन्ं की तारीख ा आ ु जपता ा ंाता ा पजत/पत्नी का नां व्यिसा राष्ट्री ता
(1) (2) (3) (4) (5) (6) (7) जनगं पहचान संख् ा (सीआईएन), कंपनी ा सीजंत िाज त्ि भागीिारी पहचान संख् ा (एलएलपीआईएन) की ििा ंें, सीजंत िाज त्ि भागीिारी ा आ कर स्ट्था ी खाता संख् ा ा आधार संख् ा की ििा ंें पासप टच संख् ा (जििेिी राजष्ट्रक की ििा ंें)
(8) (9) भारती िीिन बींा जनगं अजधजन ं, 1956 की धारा 5ग(6) के अधीन घ षणा की तारीख ंहत्िपूणच फा िाप्रि जहत की संाजि की तारीख इस रजिस्ट्टर ंें प्रजिजि की तारीख क ई अन् जहत ( दि क ई हक) प्राजस्ट्थजत अजधप्रंाणन ा हस्ट्ताक्षर
(10) (11) (12) (13) (14) (15) [फा.सं. I-13011/03/2021-बींा. II] सौरभ जंश्रा, सं ुि सजचि MINISTRY OF FINANCE (Department of Financial Services) NOTIFICATION New Delhi, the 3rd March, 2022 S.O. 995(E).—In exercise of the powers conferred by section 50 of the Life Insurance Corporation Act, 1956 (31 of 1956), the Central Government hereby notifies that the form, manner, period and details prescribed in respect of declaration to be made and particulars to be included in the register to be maintained under the Companies Act shall [art W—ave 3(ii)] ART BT UST : AATATCT 11 # ‘Tecay vara” a atawad S areca stag stat fra & facts sie ware aie fattest A wearer ar ATTA BTS ATT cet AT ore, Peg Sat Atiaat ar eer at aaeH Paar eT S |
(1) seneenecceceeneeseeee
(2) wencenceeceennennenns yer V [aver 511(7) 2a] sever a ater Fore Srret H mrgergeh Farha ma. | fearterert carat | wee AY atta | frat arama ar | eager | asa rare eT | EAT TAT | AT aT afa/ret ar art
(1) (2) (3) (4) (5) 6) 7 fara Gears Heart (Arareva), Hot ar sta araca afar veara | arate aear (fast als Ft der (wavattareua) At aor FH, ata arcs aeftaret ar arazae | ast F) CATHY QTAT SEAT AT AAT AeA AT st F
(8) (9) anda <taq dt) secapiaaese oj cater dla oaer| safest = | afer fra aferfara, 1956 | fea Fi aarie Ft ware = st | fea (ate AT BEATAT AT amet 5a(6) & aefta | atte arr are et) aro Ft are
(10) (11) (12) (13) (14) (15) [HT.4. 1-13011/03/2021-aTaT. II] ares ar, aa ahs MINISTRY OF FINANCE (Department of Financial Services) NOTIFICATION New Delhi, the 3rd March, 2022 S.O. 995(E).—In exercise of the powers conferred by section 50 of the Life Insurance Corporation Act, 1956 (31 of 1956), the Central Government hereby notifies that the form, manner, period and details prescribed in respect of declaration to be made and particulars to be included in the register to be maintained under the Companies Act shall 12 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)] apply to the Corporation under section 5C of the Act with the following modifications, exceptions and conditions, namely:—
1. Declaration by registered holder of shares who does not hold beneficial interest in such shares.—(1) A person whose name is entered in the register of members of the Corporation as the holder of shares in the Corporation but who does not hold beneficial interest in such shares shall, within a period of thirty days from the date on which the name of such person is entered in that register, make a declaration in Form I, referred to in sub-section (1) of section 5C of the Act.
(2) Where any change occurs in the beneficial interest in shares of the Corporation, the person referred to in subparagraph (1) shall, within a period of thirty days from the date of such change, make a declaration in Form I, referred to in sub-section (3) of section 5C of the Act.
(3) The Corporation shall, within thirty days of receipt of a declaration under sub-paragraph (1) or sub-paragraph (2), enter the details contained therein in the register of members, and issue an acknowledgment in Form II.
2. Declaration by beneficial owner who holds or acquires beneficial interest in shares but whose name is not entered in register of members.—(1) Every person who holds or acquires beneficial interest in shares of the Corporation shall, within a period of thirty days from the date on which he acquires such beneficial interest in shares of the Corporation, make a declaration in Form III, referred to in sub-section (2) of section 5C of the Act.
(2) Where any change occurs in the beneficial interest in shares of the Corporation, the person referred to in subparagraph (1) shall, within a period of thirty days from the date of such change, make a declaration in Form III, referred to in sub-section (3) of section 5C of the Act.
(3) The Corporation shall, within thirty days of receipt of a declaration under sub-paragraph (1) or sub-paragraph
(2), enter the details contained therein in the register of members, and issue an acknowledgment in Form II.
3. Declaration by beneficial owner who holds or acquires significant beneficial ownership in shares.—(1) Every individual who is a significant beneficial owner as referred to in sub-section (6) of section 5C of the Act shall, within a period of ninety days from the date of publication of this notification, make a declaration in Form IV .
(2) Every individual who acquires the beneficial interest or rights referred to in sub-section (6) of section 5C of the Act, or the nature of whose interest and other particulars specified in a declaration made under sub-paragraph (1) undergo a change shall, within a period of thirty days from the date of such acquisition or change, make a declaration in Form IV.
(3) The Corporation shall, within thirty days of receipt of a declaration under sub-paragraph (1) or sub-paragraph (2), enter the details contained therein in the register to be maintained under sub-section (7) of section 5C of the Act, and issue an acknowledgment in Form II.
4. Register.—The Corporation shall maintain the register referred to in sub-section (7) of section 5C of the Act in Form V. FORM I [See section 5C(1)] Declaration by the registered holder of shares who does not hold beneficial interest in such shares To: Life Insurance Corporation of India Central Office ‘Yogakshema’ Jeevan Bima Marg Nariman Point Mumbai – 400 021 12 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)] apply to the Corporation under section 5C of the Act with the following modifications, exceptions and conditions, namely:—
1. Declaration by registered holder of shares who does not hold beneficial interest in such shares.—(1) A person whose name is entered in the register of members of the Corporation as the holder of shares in the Corporation but who does not hold beneficial interest in such shares shall, within a period of thirty days from the date on which the name of such person is entered in that register, make a declaration in Form I, referred to in sub-section (1) of section 5C of the Act.
(2) Where any change occurs in the beneficial interest in shares of the Corporation, the person referred to in subparagraph (1) shall, within a period of thirty days from the date of such change, make a declaration in Form I, referred to in sub-section (3) of section 5C of the Act.
(3) The Corporation shall, within thirty days of receipt of a declaration under sub-paragraph (1) or sub-paragraph (2), enter the details contained therein in the register of members, and issue an acknowledgment in Form II.
2. Declaration by beneficial owner who holds or acquires beneficial interest in shares but whose name is not entered in register of members.—(1) Every person who holds or acquires beneficial interest in shares of the Corporation shall, within a period of thirty days from the date on which he acquires such beneficial interest in shares of the Corporation, make a declaration in Form III, referred to in sub-section (2) of section 5C of the Act.
(2) Where any change occurs in the beneficial interest in shares of the Corporation, the person referred to in subparagraph (1) shall, within a period of thirty days from the date of such change, make a declaration in Form III, referred to in sub-section (3) of section 5C of the Act.
(3) | The Corporation shall, within thirty days of receipt of a declaration under sub-paragraph (1) or sub-paragraph
(2), enter the details contained therein in the register of members, and issue an acknowledgment in Form II.
3. Declaration by beneficial owner who holds or acquires significant beneficial ownership in shares.—(1) Every individual who is a significant beneficial owner as referred to in sub-section (6) of section SC of the Act shall, within a period of ninety days from the date of publication of this notification, make a declaration in Form IV .
(2) Every individual who acquires the beneficial interest or rights referred to in sub-section (6) of section 5C of the Act, or the nature of whose interest and other particulars specified in a declaration made under sub-paragraph (1) undergo a change shall, within a period of thirty days from the date of such acquisition or change, make a declaration in Form IV.
(3) The Corporation shall, within thirty days of receipt of a declaration under sub-paragraph (1) or sub-paragraph (2), enter the details contained therein in the register to be maintained under sub-section (7) of section SC of the Act, and issue an acknowledgment in Form II.
4. Register.—The Corporation shall maintain the register referred to in sub-section (7) of section SC of the Act in Form V. FORM I [See section 5C(1)] Declaration by the registered holder of shares who does not hold beneficial interest in such shares To: Life Insurance Corporation of India Central Office “Yogakshema’ Jeevan Bima Marg Nariman Point Mumbai — 400 021 [भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 13
1. Particulars of the registered owner of the shares
(i) Name: ____________________________
(ii) Name of the father or mother or spouse: ______________________
(iii) Occupation: ______________________
(iv) Whether citizen of India Yes No
(v) Nationality (in case of foreign national): ______________________
(vi) Date of birth or Age: ______________________
(vii) Gender: Male Female Third gender
(viii) Income-tax Permanent Account Number (PAN): ______________________
(ix) Proof of identity:
(a) For Indian nationals (any of the following): Income-tax PAN card Electoral photo identity card issued by the Election Commission of India Passport Driving licence Unique identification number (Aadhaar) card
(b) For foreign nationals and non-resident Indians Passport Other
(x) Permanent residential address details:
(a) Country code assigned by the International Organisation for Standardization (ISO): ______________
(b) Country: ______________
(c) Landline phone number: ______________
(d) Mobile number: ______________
(e) Fax number: ______________
(f) Email address: ______________
(xi) Whether the present residential address is same as the permanent residential address Yes No
(xii) If no, details of the present residential address: [art W—ave 3(ii)] ART BT UST : AATATCT 13
1. Particulars of the registered owner of the shares
(1) Name:
(11) Name of the father or mother or spouse:
(iii) Occupation:
(iv) Whether citizen of India O Yes O No
(v) Nationality (in case of foreign national):
(vi) Date of birth or Age:
(vii) Gender: O Male O Female O Third gender
(viii) Income-tax Permanent Account Number (PAN):
(ix) Proof of identity:
(a) For Indian nationals (any of the following): e Income-tax PAN card e Electoral photo identity card issued by the Election Commission of India e Passport e Driving licence e Unique identification number (Aadhaar) card
(b)For foreign nationals and non-resident Indians e Passport e §=©Other
(x) Permanent residential address details:
(a)Country code assigned by the International Organisation for Standardization (ISO):
(b)Country:
(c) Landline phone number:
(d)Mobile number:
(e) Fax number:
(f) Email address:
(xi) Whether the present residential address is same as the permanent residential address O Yes O No
(xii) Ifno, details of the present residential address: 14 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
(a) Country code assigned by the International Organisation for Standardisation (ISO): ______________
(b) Country: ______________
(c) Landline phone number: ______________
(d) Mobile number: ______________
(e) Fax number: ______________
(f) Email address: ______________
2. Particulars of the shares in respect of which declaration is being made by the registered holder of shares:
(i) Class of shares: _______________
(ii) Number of shares: _______________
(iii) Distinctive numbers: From _______________ to _______________
(iv) Certifícate number: _______________
(v) Folio number: _______________
(vi) Nominal value of shares: _______________
(vii) Paid-up value of shares: _______________
3. Declaration: In pursuance of sub-section (1) of section 5C of the Life Insurance Corporation Act, 1956, I, _______________, hereby declare that the person(s) named below hold(s) beneficial interest in the shares mentioned above which are registered in my name in the register of members of the Corporation: S. No. Name of beneficial owner Address and email address Date of birth or Age Name of the father or mother or spouse Occupation Nationality
(1) (2) (3) (4) (5) (6) (7) Corporate Identity Number (CIN), in case of company or Limited Liability Partnership Identification Number (LLPIN), in case of limited liability partnership or Income-tax Permanent Account Number or Aadhaar number Passport number (in case of foreign national) Distinctive number (if applicable)
(8) (9) (10)
4. Details of beneficial interest:
(i) Nature of the beneficial interest: _______________
(ii) Date of creation of the beneficial interest: _______________
(iii) Reasons for not registering shares in the name of the beneficial owner: _______________
(iv) Particulars of the instrument or document, if any, showing the creation of such beneficial interest: __________________________________________________ 14 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
(a)Country code assigned by the International
(b)Country:
(c) Landline phone number:
(d)Mobile number:
(e) Fax number:
(f) Email address: Organisation for Standardisation (ISO):
2. Particulars of the shares in respect of which declaration is being made by the registered holder of shares:
(i) Class of shares:
(ii) Number of shares:
(11) Distinctive numbers: From to
(iv) Certificate number:
(v) Folio number:
(vi) Nominal value of shares:
(vii)Paid-up value of shares:
3. Declaration: In pursuance of sub-section (1) of section 5C of the Life Insurance Corporation Act, 1956, I, hereby declare that the person(s) named below hold(s) beneficial interest in the shares mentioned above which are registered in my name in the register of members of the Corporation: 2 Name of the Name of Address and Date of father or . No. . . O ti Nationalit S.No beneficial owner | email address | birth or Age mother or ceupation anronany spouse
(1) (2) (3) (4) (5) (6) (7) Corporate Identity Number (CIN), in case of company or Limited Liability Passport number Distinctive Partnership Identification Number (LLPIN), in case of limited liability (in case of foreign number (if partnership or Income-tax Permanent Account Number or Aadhaar number national) applicable)
(8) (9) (10)
4. Details of beneficial interest:
(i) Nature of the beneficial interest:
(ii) Date of creation of the beneficial interest:
(iii) Reasons for not registering shares in the name of the beneficial owner:
(iv) Particulars of the instrument or document, if any, showing the creation of such beneficial interest: [भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 15
5. Particulars of change in beneficial interest:
(i) Date of change: _______________
(ii) Nature of the change in the beneficial interest: _______________
(iii) Brief particulars of such change: _______________
(iv) Reason for such change: _______________
(v) Particulars of the instrument or document, if any, showing the change in such beneficial interest: ___________________________________________________ Place: _______________ Date: _______________ Signature of the registered holder of shares Attachments:
(1) Proof of identity of the registered holder of shares and the beneficial owner
(2) Instrument or document under which the beneficial interest is created or transferred or changed FORM II Acknowledgment of receipt of declaration Date: ________________ ______________________________________________________ [Name of the member/ person making the declaration] ___________________________________________________________________________ ___________________________________________________________________________ [Address of the member/person] The Life Insurance Corporation of India hereby acknowledges receipt of the declaration made by you under the following sub-section(s) of section 5C of the Life Insurance Corporation Act, 1956: Sub-section (1) Sub-section (2) Sub-section (3) Sub-section (6) We have received the said declaration on __________ [insert date] and the details have been recorded in the following register(s): Register of members Register of interest declared by significant beneficial owner Signature of authorised person Name: _______________________ Life Insurance Corporation of India Central Office, ‘Yogakshema’, Jeevan Bima Marg Nariman Point, Mumbai – 400 021 [art W—ave 3(ii)] ART BT UST : AATATCT 15
5. Particulars of change in beneficial interest:
(i) Date of change:
(ii) Nature of the change in the beneficial interest:
(iii) Brief particulars of such change:
(iv) Reason for such change:
(v) Particulars of the instrument or document, if any, showing the change in such beneficial interest: Place: Date: Signature of the registered holder of shares Attachments:
(1) Proof of identity of the registered holder of shares and the beneficial owner
(2) Instrument or document under which the beneficial interest is created or transferred or changed FORM I Acknowledgment of receipt of declaration Date: [Name of the member/ person making the declaration] [Address of the member/person] The Life Insurance Corporation of India hereby acknowledges receipt of the declaration made by you under the following sub-section(s) of section 5C of the Life Insurance Corporation Act, 1956: CL] Sub-section (1) CL] Sub-section (2) C) Sub-section (3) C) Sub-section (6) We have received the said declaration on [insert date] and the details have been recorded in the following register(s): O Register of members O Register of interest declared by significant beneficial owner Signature of authorised person Name: Life Insurance Corporation of India Central Office, “Yogakshema’, Jeevan Bima Marg Nariman Point, Mumbai — 400 021 16 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)] FORM III [See section 5C(2)] Declaration by the beneficial owner who holds or acquires beneficial interest in shares but whose name is not entered in the register of members To: Life Insurance Corporation of India Central Office ‘Yogakshema’ Jeevan Bima Marg Nariman Point Mumbai – 400 021
1. Particulars of the shares in which beneficial interest is held by the person making declaration:
(i) Class of shares: _______________
(ii) Number of shares: _______________
(iii) Distinctive numbers: From _______________ to _______________
(iv) Certifícate number: _______________
(v) Folio number: _______________
(vi) Nominal value of shares: _______________
(vii) Paid-up value of shares: _______________
2. Particulars of the beneficial owner: S. No. Name of beneficial owner(s) Address and email address Date of birth or Age Name of the father or mother or spouse Occupation Nationality
(1) (2) (3) (4) (5) (6) (7) Corporate Identity Number (CIN), in case of company or Limited Liability Partnership Identification Number (LLPIN), in case of limited liability partnership or Income-tax Permanent Account Number or Aadhaar number Passport number (in case of foreign national)
(8) (9)
3. Declaration: In pursuance of sub-section (2) of section 5C of the Life Insurance Corporation Act, 1956, I, _______________, hereby declare that I hold or have acquired beneficial interest in the share mentioned above, which are registered in the name of the person whose particulars are furnished in item 4 below.
4. Particulars of the registered holder of share(s): S. no. Name of registered holder of share Address and email address Date of birth or Age Name of the father or mother or spouse Occupation Nationality
(1) (2) (3) (4) (5) (6) (7) 16 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)] FORM III [See section 5C(2)] Declaration by the beneficial owner who holds or acquires beneficial interest in shares but whose name is not entered in the register of members To: Life Insurance Corporation of India Central Office “Yogakshema’ Jeevan Bima Marg Nariman Point Mumbai — 400 021
1. Particulars of the shares in which beneficial interest is held by the person making declaration:
(1) Class of shares:
(ii) Number of shares:
(iii) Distinctive numbers: From to
(iv) Certificate number:
(v) Folio number:
(vi) Nominal value of shares:
(vii) Paid-up value of shares:
2. Particulars of the beneficial owner: Name of Name of the . Address and Date of father or . . . S. No. beneficial . . Occupation | Nationality email address | birth or Age mother or owner(s) spouse
(1) Q) G) (4) (5) (6) (7) Corporate Identity Number (CIN), in case of company or Limited Liability Passport number (in Partnership Identification Number (LLPIN), in case of limited liability partnership or case of foreign Income-tax Permanent Account Number or Aadhaar number national)
(8) (9)
3. Declaration: In pursuance of sub-section (2) of section 5C of the Life Insurance Corporation Act, 1956, I, ; hereby declare that I hold or have acquired beneficial interest in the share mentioned above, which are registered in the name of the person whose particulars are furnished in item 4 below.
4. Particulars of the registered holder of share(s): N f Name of the ame oO . Address and Date of father or . . . S. no. registered holder . . Occupation | Nationality email address | birth or Age mother or of share spouse
(1) (2) (3) (4) (5) (6) (7) [भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 17 Corporate Identity Number (CIN), in case of company or Limited Liability Partnership Identification Number (LLPIN), in case of limited liability partnership or Income-tax Permanent Account Number or Aadhaar number Passport number (in case of foreign national)
(8) (9)
5. Details of the beneficial interest:
(i) Date of creation of the beneficial interest: _______________
(ii) Mode of acquisition of beneficial interest: Allotment Transfer Other If other, specify: _______________________________________________
(iii) Nature of the beneficial interest: _______________
(iv) Reasons for not registering shares in my name: _______________
(v) Particulars of the instrument or document, if any, showing the creation of such beneficial interest: __________________________________________________
6. Particulars of the person from whom the beneficial interest is acquired (if applicable):
(i) Name of the transferor of beneficial interest: ______________________________
(ii) Whether shares were registered in his name: Yes No If no, whether any declaration under sub-section (2) of section 5C of the Life Insurance Corporation Act, 1956 was filed by him to the Corporation? Yes No If yes, the date of such declaration: ___________________
(iii) Particulars of the instrument or document, if any, showing the change in such beneficial interest: ___________________________________________________
7. Particulars of change in beneficial interest:
(i) Date of change: _______________
(ii) Nature of the change in the beneficial interest: _______________
(iii) Brief particulars of such change: _______________
(iv) Reason for such change: _______________
(v) Particulars of the instrument or document, if any, showing the change in such beneficial interest: ___________________________________________________ Place: _______________ Date: _______________ Signature of the beneficial owner [art W—ave 3(ii)] ART BT UST : AATATCT 17 Corporate Identity Number (CIN), in case of company or Limited Liability Passport number (in Partnership Identification Number (LLPIN), in case of limited liability partnership or case of foreign Income-tax Permanent Account Number or Aadhaar number national)
(8) (9)
5. Details of the beneficial interest:
(i) Date of creation of the beneficial interest:
(ii) Mode of acquisition of beneficial interest: O Allotment O Transfer O Other If other, specify:
(iii) Nature of the beneficial interest:
(iv) Reasons for not registering shares in my name:
(v) Particulars of the instrument or document, if any, showing the creation of such beneficial interest:
6. Particulars of the person from whom the beneficial interest is acquired (if applicable):
(i) Name of the transferor of beneficial interest:
(ii) Whether shares were registered in his name: O Yes O No If no, whether any declaration under sub-section (2) of section 5C of the Life Insurance Corporation Act, 1956 was filed by him to the Corporation? O Yes O No If yes, the date of such declaration:
(iii) Particulars of the instrument or document, if any, showing the change in such beneficial interest:
7. Particulars of change in beneficial interest:
(i) Date of change:
(ii) Nature of the change in the beneficial interest:
(iii) Brief particulars of such change:
(iv) Reason for such change:
(v) Particulars of the instrument or document, if any, showing the change in such beneficial interest: Place: Date: Signature of the beneficial owner 18 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)] CERTIFICATE I hereby certify that the beneficial interest in the shares mentioned above has been transferred by me on ___________. Place: _______________ Date: _______________ Signature of the person who has transferred the beneficial interest in the shares Attachments:
(1) Proof of identity of the registered holder of share and the beneficial owner
(2) Instrument or document under which the beneficial interest is created or transferred or changed FORM IV [See section 5C(6)] Declaration by the beneficial owner who holds or acquires significant beneficial ownership in shares To: Life Insurance Corporation of India Central Office ‘Yogakshema’ Jeevan Bima Marg Nariman Point Mumbai – 400 021
1. Purpose of filing the form (choose any one): For declaration of significant beneficial ownership under sub-section (6) of section 5C For change in significant beneficial ownership under sub-section (6) of section 5C In case the significant beneficial owner has earlier submitted online any return to the Registrar of Companies in respect of a declaration under section 90 of the Companies Act, 2013, the significant beneficial owner identity number (“SBO ID”) generated upon such submission: ____________
2. Particulars of the holder of the significant beneficial interest: Name of the significant beneficial owner (given name and last name) Address and email address Date of birth or Age Name of the father or mother or spouse Occupation Nationality Passport number (in case of foreign national) 18 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)] CERTIFICATE I hereby certify that the beneficial interest in the shares mentioned above has been transferred by me on Place: Date: Signature of the person who has transferred the beneficial interest in the shares Attachments:
(1) Proof of identity of the registered holder of share and the beneficial owner
(2) Instrument or document under which the beneficial interest is created or transferred or changed FORM IV [See section 5C(6)] Declaration by the beneficial owner who holds or acquires significant beneficial ownership in shares To: Life Insurance Corporation of India Central Office “Yogakshema’ Jeevan Bima Marg Nariman Point Mumbai — 400 021
1. Purpose of filing the form (choose any one): O For declaration of significant beneficial ownership under sub-section (6) of section 5C O For change in significant beneficial ownership under sub-section (6) of section 5C In case the significant beneficial owner has earlier submitted online any return to the Registrar of Companies in respect of a declaration under section 90 of the Companies Act, 2013, the significant beneficial owner identity number (“SBO ID”) generated upon such submission:
2. Particulars of the holder of the significant beneficial interest: Name of the significant beneficial owner (given name and last name) Address and email address Date of birth or Age Name of the father or mother or spouse Occupation Nationality Passport number (in case of foreign national) [भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 19
3. Nature of indirect holding or exercise of right in the Corporation through member of the Corporation (where more than one, repeat this paragraph of the form):
(a) Type of member {company or limited liability partnership (LLP) or Hindu undivided family (HUF) or partnership firm or discretionary trust or charitable trust or specific trust or revocable trust or pooled investment vehicle (PIV) or entity controlled by PIV or any other body corporate}: ___________
(b) Corporate Identity Number (CIN) or Limited Liability Partnership Identification Number (LLPIN) or any other registration number, allotted under the relevant law: ________
(c) Name of the member: _________
(d) Address: ___________________________________________ ___________________________________________ City: _________ State: _________ Country: _________ Postal Index Number (PIN): _________
(e) Nature of indirect holding or exercise of right in the Corporation: By virtue of shares: ________% By virtue of voting rights in shares: _______% By virtue of rights on distributable dividend or any other distribution: __________% By virtue of exercise of control (attach copy of agreement) By virtue of exercise of significant influence # (attach copy of agreement)
(f) Status of significant beneficial owner in the member of the Corporation (choose any one): Partner, in case of a partnership firm or an LLP Karta, in case of an HUF trustee or a discretionary trust or a charitable trust Beneficiary, in case of a specific trust Author or settlor, in case of a revocable trust General Partner, Investment Manager or Chief Executive Officer, in case of PIV or entity controlled by PIV Individual, in case of a company or any other body corporate
(g) In case the member is a partnership firm or LLP, specify whether the significant beneficial owner— is a partner; holds majority stake * in the body corporate partner; holds majority stake * in the ultimate holding company of the body corporate partner.
(h) In case the member is a company or any other body corporate, specify whether the significant beneficial owner holds (choose any one)— majority stake * in such company or body corporate; [art W—ave 3(ii)] ART BT UST : AATATCT 19
3. Nature of indirect holding or exercise of right in the Corporation through member of the Corporation (where more than one, repeat this paragraph of the form):
(a) Type of member {company or limited liability partnership (LLP) or Hindu undivided family (HUF) or partnership firm or discretionary trust or charitable trust or specific trust or revocable trust or pooled investment vehicle (PIV) or entity controlled by PIV or any other body corporate}:
(b) Corporate Identity Number (CIN) or Limited Liability Partnership Identification Number (LLPIN) or any other registration number, allotted under the relevant law:
(c) Name of the member:
(d) Address: City: State: Country: Postal Index Number (PIN):
(e) Nature of indirect holding or exercise of right in the Corporation: LO By virtue of shares: % LO By virtue of voting rights in shares: % O By virtue of rights on distributable dividend or any other distribution: % O By virtue of exercise of control (attach copy of agreement) O By virtue of exercise of significant influence” (attach copy of agreement)
(f) Status of significant beneficial owner in the member of the Corporation (choose any one): O Partner, in case of a partnership firm or an LLP O Karta, in case of an HUF trustee or a discretionary trust or a charitable trust O Beneficiary, in case of a specific trust O Author or settlor, in case of a revocable trust O General Partner, Investment Manager or Chief Executive Officer, in case of PIV or entity controlled by PIV O Individual, in case of a company or any other body corporate
(g) In case the member is a partnership firm or LLP, specify whether the significant beneficial owner— O is a partner; LO holds majority stake’ in the body corporate partner; LO holds majority stake" in the ultimate holding company of the body corporate partner.
(h) In case the member is a company or any other body corporate, specify whether the significant beneficial owner holds (choose any one)— O majority stake’ in such company or body corporate; 20 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)] majority stake * in the ultimate holding company of such company or body corporate.
(i) Whether significant beneficial owner has any direct holding or right in the Corporation (choose any one): Yes No If yes, enter details below: By virtue of shares: _______% By virtue of voting rights in shares: ______% By virtue of rights on distributable dividend or any other distribution: ________% By virtue of exercise of control (attach copy of agreement) By virtue of exercise of significant influence # (attach copy of agreement) Date: _______________ Place: _______________ Signature of the holder of the significant beneficial interest * “Majority stake” means—
(a) holding more than one-half of the equity share capital in the body corporate; or
(b) holding more than one-half of the voting rights in the body corporate; or
(c) having the right to receive or participate in more than one-half of the distributable dividend or any other distribution by the body corporate. # “Significant influence” means the power to participate, directly or indirectly, in the financial and operating policy decisions of the Life Insurance Corporation of India but is not control or joint control of those policies. Attachments:
(1) _______________
(2) _______________ … FORM V [See section 5C(7)] Register of interest declared by significant beneficial owners in shares of the Life Insurance Corporation of India S. no. Name of beneficial owner(s) Address and email address Date of birth or Age Name of the father or mother or spouse Occupation Nationality
(1) (2) (3) (4) (5) (6) (7) 20 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)] O majority stake’ in the ultimate holding company of such company or body corporate.
(1) Whether significant beneficial owner has any direct holding or right in the Corporation (choose any one): O Yes O No If yes, enter details below: O By virtue of shares: % O By virtue of voting rights in shares: % O By virtue of rights on distributable dividend or any other distribution: % O By virtue of exercise of control (attach copy of agreement) O By virtue of exercise of significant influence” (attach copy of agreement) Date: Place: Signature of the holder of the significant beneficial interest * “Majority stake” means—
(a) holding more than one-half of the equity share capital in the body corporate; or
(b) holding more than one-half of the voting rights in the body corporate; or
(c) having the right to receive or participate in more than one-half of the distributable dividend or any other distribution by the body corporate. * “Significant influence” means the power to participate, directly or indirectly, in the financial and operating policy decisions of the Life Insurance Corporation of India but is not control or joint control of those policies. Attachments:
(1)
(2) FORM V [See section 5C(7)] Register of interest declared by significant beneficial owners in shares of the Life Insurance Corporation of India Name of Name of the . Address and Date of father or . . . S. no. beneficial . . Occupation | Nationality email address | birth or Age mother or owner(s) spouse
(1) (2) (3) (4) (5) (6) (7) [भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 21 Corporate Identity Number (CIN), in case of company or Limited Liability Partnership Identification Number (LLPIN), in case of limited liability partnership or Income-tax Permanent Account Number or Aadhaar number Passport number (in case of foreign national)
(8) (9) Date of declaration under section 5C(6) of the Life Insurance Corporation Act, 1956 Date of cessation of significant beneficial interest Date of entry in this register Any other interest (if any) Status Authentication or signature
(10) (11) (12) (13) (14) (15) [F. No. I-13011/03/2021-Ins.II] SAURABH MISHRA, 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. [ArT ave 3(ii)] WT BT USAT: TATA 21 Corporate Identity Number (CIN), in case of company or Limited Liability Partnership Identification Number (LLPIN), in case of limited liability partnership or Income-tax Passport number (in case of foreign Permanent Account Number or Aadhaar number national)
(8) (9) . . . Date of Date of declaration under section | Date of cessation of entry in Any other Authentication or 5C(6) of the Life Insurance significant beneficial this interest (if | Status ; Corporation Act, 1956 interest any) signature register
(10) (11) (12) (13) (14) (15) [F. No. I-13011/03/2021-Ins.1T] SAURABH MISHRA, 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. SURENDER Digitally signed by SURENDER MAHADASAM. MAHADASAM Date: 2022.03.04 16:12:59 +05'30' 2022-03-04T16:12:59+0530 SURENDER MAHADASAM