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FiLLiP M28062886_SRN_FORM
English Hindi
Form for Incorporation of Limited Liability Partnership
[Pursuant to Rule 8, Rule 11 and Rule 18 of Limited Liability Partnership Rules, 2009]
(d) CIN
Attachments
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(d) Copy of approval from the competent authority in case of
collaboration and connection with the foreign country or place Max 2 MB Choose file
*Country India
*area Govindpura
*City Huzur
District Bhopal
*Longitude 77.45867
*Latitude 23.27439
(b) Contact
Details
Phone (with STD/ISD code)
*Mobile No 7000882050
Fax
*Email ID rbmishra06@gmail.com
c) Attachments
(d) * Name of the office of Registrar in whose jurisdiction the proposed LLP is to Registrar of Companies, Madhya
be registered Pradesh
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4.Details of business activity carried out by LLP on incorporation /conversion
Primary Industry sub class (as
Description of NIC code
(checkbox) per NIC codes 2008)
21001 Manufacture of medicinal substances used in the
manufacture of pharmaceuticals: antibiotics,
endocrine products, basic vitamins; opium derivatives;
Delete
sulpha drugs; serums and plasmas; salicylic acid, its
salts and esters; glycosides and vegetable alkaloids;
chemically pure suger etc.
Delete
Delete
*Description of industrial activities to be carried out by the
(a) *Main industrial activity
*- NIC code
6.Particulars of individual designated partners /designated partners who are nominee of body corporate
*Name
Yes
No
In case of company seeking
conversion
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(ii) *Description of contribution
*Form of contribution
(Conversion/Cash /Other than cash)
Middle Name
Surname MISHRA
*Gender
Female
( Male/Female/ Transgender)
*Date of Birth (dd/mm/yyyy) 31/03/1979
*Nationality India
*Whether resident of India
Yes
No
*Income-tax PAN/Passport number
PAN
Passport number
*Occupation type
(Business/Professional/Government
Employment/Private Employment /Housewife/Student/Others)
Business
Description of others
Page 4 of 23
*Area of Occupation Business
*Educational Qualification
(Primary education/Secondary education
Vocational qualification/Bachelor's degree/Master degree/Doctorate or higher/Professional/
Professional
Diploma /Others)
If ‘Others’ selected, please specify
*Mobile No +917000882050
*Email ID rbmishra06@gmail.com
(ii) *Permanent address
*Country India
*City Huzur
District Bhopal
*State / UT Madhya Pradesh
Jurisdiction of Police Station AYODHYA NAGAR
Phone (with STD/ISD code) 07552600646
(iii) * Whether present residential address same as permanent residential address
Yes
No
*Present address
*Country India
*City Huzur
District Bhopal
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Duration of stay at present address (Years/Month)
*If Duration of stay at present address is less than one year then address of previous
residence
*Residential Proof
(Bank Statement/Electricity Bill/Telephone bill/Mobile bill/Utility Bill/Registered/Notarized
Rent Agreement) Bank Statement
*Form of contribution
(Conversion/Cash /Other than cash) Cash
Middle Name
Surname MISHRA
*Gender
Male
( Male/Female/ Transgender)
Page 6 of 23
*Date of Birth (dd/mm/yyyy) 08/08/1980
*Nationality India
*Whether resident of India
Yes
No
*Income-tax PAN/Passport number
PAN
Passport number
*Occupation type
(Business/Professional/Government
Employment/Private Employment /Housewife/Student/Others)
Business
Description of others
*Educational Qualification
(Primary education/Secondary education
Vocational qualification/Bachelor's degree/Master degree/Doctorate or higher/Professional/
Professional
Diploma /Others)
If ‘Others’ selected, please specify
*Mobile No +919425380608
*Email ID bjmishra08@gmail.com
(ii) *Permanent address
*Country India
*City Huzur
District Bhopal
*State / UT Madhya Pradesh
Jurisdiction of Police Station AYODHYA NAGAR
Phone (with STD/ISD code)
Page 7 of 23
(iii) * Whether present residential address same as permanent residential address
Yes
No
*Present address
*Country India
*City Huzur
District Bhopal
*If Duration of stay at present address is less than one year then address of previous
residence
*Residential Proof
(Bank Statement/Electricity Bill/Telephone bill/Mobile bill/Utility Bill/Registered/Notarized
Rent Agreement) Bank Statement
Page 8 of 23
*Form of contribution
(Conversion/Cash /Other than cash) Cash
C * Particulars of bodies corporate and their nominees as designated partners having DIN/DPIN
(i) *Particulars of body corporate
*Type of body corporate
(LLP/Company/Foreign LLP/ Foreign company/LLP incorporated outside India (LIOI)/
Company incorporated outside India (CIOI)
*Corporate identity number (CIN) or foreign Company registration number (FCRN) or Limited
liability partnership identification number (LLPIN) or Foreign limited liability partnership
identification number (FLLPIN) or any other registration number
PAN
*Name of body corporate
*Registered office address or Principal place of business in India or Principal place of business outside India
*Address Line I
*Address Line II
*Country
*Area/ Locality
*City
District
*State / UT
Jurisdiction of Police Station
Contact details
Phone (with STD/ISD code)
*Mobile No
Fax
*Email ID
In case of company seeking conversion
*Form of contribution
(Conversion/Cash /Other than cash)
Page 9 of 23
If 'Other than cash' selected, please specify
Max 2 MB
D *Particulars of bodies corporate and their nominees as designated partners not having DIN/DPIN
(i)* Particulars of body corporate
*Type of body corporate
(LLP/Company/Foreign LLP/ Foreign company/LLP incorporated outside India (LIOI)/
Company incorporated outside India (CIOI)
*Corporate identity number (CIN) or foreign Company registration number (FCRN) or Limited
liability partnership identification number (LLPIN) or Foreign limited liability partnership
identification number (FLLPIN) or any other registration number
PAN
*Name of body corporate
*Registered office address or Principal place of business in India or Principal place of business outside India
*Address Line I
*Address Line II
*Country
*Area/ Locality
*City
District
*State / UT
Jurisdiction of Police Station
Contact details
Phone (with STD/ISD code)
*Mobile No
Page 10 of 23
Fax
*Email ID
In case of company seeking conversion
*Gender
( Male/Female/ Transgender)
*Nationality
*Whether resident of India
Yes
No
*Income-tax PAN/Passport number
PAN
Passport number
*Income-tax PAN/Passport number details
*Occupation type
(Business/Professional/Government
Page 11 of 23
Employment/Private Employment /Housewife/Student/Others)
Description of others
*Area of Occupation
*Educational Qualification
(Primary education/Secondary education
Vocational qualification/Bachelor's degree/Master degree/Doctorate or higher/
Professional/Diploma /Others)
If ‘Others’ selected, please specify
*Mobile No
*Email ID
*Permanent address
*Address Line I
*Address Line II
*Country
*Area/ Locality
*City
District
*State / UT
Jurisdiction of Police Station
Phone (with STD/ISD code)
Yes
No
*Present address
*Address Line I
*Address Line II
*Country
*Area/ Locality
*City
District
*State / UT
Jurisdiction of Police Station
Phone (with STD/ISD code)
Page 12 of 23
*If Duration of stay at present address is less than one year then address of previous
residence
*Residential Proof
(Bank Statement/Electricity Bill/Telephone bill/Mobile bill/Utility Bill/Registered/Notarized
Rent Agreement)
Max 2 MB
*Name
Yes
No
In case of company seeking
conversion
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*Number of company(s) in which he/ she is a director
*Gender
( Male/Female/ Transgender)
*Nationality
*Whether resident of India
Yes
No
*Income-tax PAN/Passport number
PAN
Passport number
*Income-tax PAN/Passport number details
*Occupation type
(Business/Professional/Government
Employment/Private Employment /Housewife/Student/Others)
Description of others
*Area of Occupation
*Educational Qualification
(Primary education/Secondary education
Vocational qualification/Bachelor's degree/Master degree/Doctorate or higher/Professional/
Diploma /Others)
If ‘Others’ selected, please specify
*Mobile No
*Email ID
(ii)*Permanent address
*Address Line I
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*Address Line II
*Country
*Area/ Locality
*City
District
*State / UT
Yes
No
*Present address
*Address Line I
*Address Line II
*Country
*Area/ Locality
*City
District
*State / UT
*If Duration of stay at present address is less than one year then address of previous
residence
*Residential Proof
(Bank Statement/Electricity Bill/Telephone bill/Mobile bill/Utility Bill/Registered/Notarized
rent Agreement)
Page 15 of 23
*Proof of identity
Max 2 MB
*Residential proof
Max 2 MB
(v) In case of company seeking conversion
C *Particulars of bodies corporate and their nominees as designated partners not having DIN/DPIN
(i)* Particulars of body corporate
*Type of body corporate
(LLP/Company/Foreign LLP/ Foreign company/LLP incorporated outside India (LIOI)/
Company incorporated outside India (CIOI)
*Corporate identity number (CIN) or foreign Company registration number (FCRN) or Limited
liability partnership identification number (LLPIN) or Foreign limited liability partnership
identification number (FLLPIN) or any other registration number
PAN
*Country
*Area/ Locality
*City
District
*State / UT
Jurisdiction of Police Station
Contact details
Phone (with STD/ISD code)
*Mobile No
Page 16 of 23
Fax
*Email ID
In case of company seeking conversion
(iii) *Particulars of the person /designated partner signing on behalf of the body corporate as nominee
Max 2 MB
D *Particulars of bodies corporate and their nominees as designated partners not having DIN/DPIN
(i)* Particulars of body corporate
*Type of body corporate
(LLP/Company/Foreign LLP/ Foreign company/LLP incorporated outside India (LIOI)/
Company incorporated outside India (CIOI)
*Corporate identity number (CIN) or foreign Company registration number (FCRN) or Limited
liability partnership identification number (LLPIN) or Foreign limited liability partnership
identification number (FLLPIN) or any other registration number
PAN
*Name of body corporate
*Registered office address or Principal place of business in India or Principal place of business outside India
*Address Line I
*Address Line II
*Country
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*Pin code / Zip Code
*Area/ Locality
*City
District
*State / UT
Jurisdiction of Police Station
Contact details
Phone (with STD/ISD code)
*Mobile No
Fax
*Email ID
In case of company seeking conversion
*Gender
( Male/Female/ Transgender)
*Nationality
*Whether resident of India
Yes
No
*Income-tax PAN/Passport number
PAN
Page 18 of 23
Passport number
*Income-tax PAN/Passport number details
*Occupation type
(Business/Professional/Government
Employment/Private Employment /Housewife/Student/Others)
Description of others
*Area of Occupation
*Educational Qualification
(Primary education/Secondary education
Vocational qualification/Bachelor's degree/Master degree/Doctorate or higher/Professional/
Diploma /Others)
If ‘Others’ selected, please specify
*Mobile No
*Email ID
*Permanent address
*Address Line I
*Address Line II
*Country
*Area/ Locality
*City
District
*State / UT
Jurisdiction of Police Station
Phone (with STD/ISD code)
(iv) * Whether present residential address same as permanent residential address
Yes
No
*Present address
*Address Line I
*Address Line II
*Country
*Area/ Locality
*City
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District
*State / UT
Jurisdiction of Police Station
Phone (with STD/ISD code)
*If Duration of stay at present address is less than one year then address of previous
residence
*Residential Proof
(Bank Statement/Electricity Bill/Telephone bill/Mobile bill/Utility Bill/Registered/Notarized
Rent Agreement)
Max 2 MB
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*Source of Income
(Income from Business/profession/ Capital Gains /Income from house property
Income from other source /No Income) Income from Business/profession
*Business/Profession code 20
Attachments
(a)Valuation Certificate
Max 2 MB
(b)Optional attachment(s) - if any
Max 2 MB
liability partnership or body corporate or a registered trade mark or a trade mark which is subject of an application for registration of
any other person under the Trade Marks Act, 1999.
*Subscribers' sheet including consent.
Max 2 MB
Part B: Statement
Declaration by designated partner
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* To be digitally signed by a designated partner
DIN0 AEFPN6684L
*Signature Field 1
I HEMANT KUMAR JAIN Son / Daughter of MAHESH CHANDRA JAIN do state that I am*
Chartered Accountant in whole time practice Cost Accountant in whole time practice
engaged in the formation of the limited liability partnership and my membership number or certificate of practice number
(ii) all the requirements of the Limited Liability Partnership Act, 2008 and the rules made thereunder have been complied with, in
respect of incorporation and matters precedent and incidental thereto;
* Whether:
Associate Fellow
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For office use only:
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