Professional Documents
Culture Documents
tl
PART - B
D
T^+-l ..,r.c.rihF; chtre (in RuDees
Equity Preference
Subscribed shar€ caPital
Number of shares
N^min.l amn'lnr ner share (in Rupees)
'7. a) Correspondenceaddress
,"..noofl"0'n
'Phone (with STD code )l
Fax
1
(b) "Particulars of non-ind ividual first subscriber(s)
CategorY
Corporate identity number(CIN) or foreign company I Pre-Fill
registratron number(FCRN) or any other registration number
Name of the body corporate
'Line I
Line II
City
State
Fax
'email
Particulars of the authorised person
First Name
Middle Name
'Surname
' Father's First
Father's Middle
Father's Surname
'NationalitY
Gender
''--_i"",
o PAN o PassPort number I Verift I
Aadhaar number
'Place of Birth (District & State
Occupation tyPe
' Area of OccuPataon
' Educational qualification
Present Address
Line I
Line Il
'city
'State /Union Territory 'Pin code
"'First Name
Middle
'Surname
Father's flrst name
father's surname
*Nationality
'Ccnder 'j'Date of Birth
^Place of Birth
'Area of OccuPatio,
Aadhaar number
'e ail lD
Pennanent
't-ine I
Line ll
"City
State/ [Jnion TerritorY
Line II
b
'State./ Union |
Territory I
Name
"Cender
{'Date of Birth Nationality l--_l
rCategory
'.Designation
Whether D Cltuirrn- c Executive director tr Non-executive director
*email ID
father's surname
'Cr'nder 'Date of Birth "Nationality
Placc ol'B
'Category
cmail ID
Pernranent Address
Linc I
Line II
City
State/ tJnion Territory
Present address
'Line I
t-ine ll
'City
.l ''Pin code
State/ Union cnitory
Isil Country codd-l Country
I
Driving license number
Aadhaar Number
attachments'
Submit the proof of identity and proof of address under
Others (specifY)
'Designation-.''categorY
Whether n Chairman I Executive director r-l Non-executive
director
q
Others (specifY)
First Name
Middle
"Surname
Pldcc ol'Birth
o Student o Serviceman
Occupation type o Self Ernployed o Professional o Homemaker
A rea ol'OccuDalion
f.lrcaliorrrl()ualltlcallolll I
'
Designariorrfll CategorY
'enail lD
Pernrancnt Address
l.ine I
Line Il
City
State/ Union Territory
"lso country code I Country
Present address
t-ine I
Line ll
'City
le
'iState/ Union Territory
*Pin code
Numberofentitiesinwhichdirectorhaveinterest
Percentage of Shareholding
V. OPC Nomination
9. (a)
(a) "'Nomination
Nominatiotl
Arrx ol ()ccLrprlion
lrductlionitl qurlilicatioll
PcrDrancnl Addrcss
l-i o l
I.i'r! ll
cirY
St tc /tjnion Tcrntory
lS( ) (i)untry coclc
tinrntr)
I,hdrc (with S l l)/lSI) code)
Mobrlc
la\
cmlil id
'l'roolot idcnlrl)
| 0. Particulars of payment of stamp duty
. 3 lt-:': f ' l-,nr'r_ t;fi r!]rr'i r:ip€.:t a'i \t'r!'rt 5 i'1r!
:
l-', ! :3rd ar '31'r Pia
: .i'e:':r glrr'F :,1-,' r !l a: o:1tl n9."o'( 3 t dlrc-9" l'lc'q:1 st5lenl
itl -'r.r i r' :':.r.,,1-.i tc bp a,.riC
A't;cles ct Jl9')crl:rl:.n
Type ef d,1c|l.re t
Plrticul,rrg igtoatiticlx
:.:l st c rin F9 l
hJm: :.',':'or. ct
-€3!ury' 9' i,:13::l
OI;"' Cf'er Ca'll::+_:
3g*-:y !'ll'cns€al:l
l': ei: S:::-'g alul, :'!a
!: tlir+F :JFer: :f:s
erbe!9 the doa'lrEn19 cr
t:. :: !oP_9; :::,'l:
',1:!a.-ers 5_ cahJlf C:4.:
':ifve.- tle':
5e.: '-n',:er,t'
erbcls _S,:r 5LlrF::"
.-:r..p p.ra€. tr' lfE3:u?
a.',rlL]'n,r'13E-
A rca c ode
lnfornr:ltion sptcific to l AN
Sorrrcc o[ lncomc
Llusiness/l'()lcssion code
VII. Attachments
List of attachments
Attachments
t. Memorandum of association: Attach
2. Articles of Association:
Attach
Declaration by first strbscriber(s) and director(s)
(Atlidavit is not required to be attached); nttach
4. Proof of Offlce ad<Jress (Conveyance/ Lease deed/Rent Attach
Agfeement along with rent receipts);
5. Copy ofthe utility bills (not older than two months); Attach
\ 4--
Vlll. Declaration
Declaration
guidelines framed
I have gone through the provisions ofthe companies Act,20l3, the rules thereunder and prescribed
th.i"urid., in resp"ect ofieservation of name, understood the meaning thereof and the proposed name is in conformity
thereot.
(MCA) for checking the
I have used the search tacitities available on the portal of the Ministry of Corporate Affairs
with the companies and Limited Liability partnerships (LLPs) respectively already
resemblance ofthe proposed name
already approved. I have also used the search facility for checking the resemblances ofthe
registered or the names
pr-oposed name with registered trademarks and trade mark subject ofan application under the Trade
Marks Act' 1999
satisfy myself with the compliance of
and other relevant search for checking the resemblance ofthe proposed name to
the provisions ofthe Act for resemblance ofname and Rules thereof'
Use) Act,
The orooosed nanre is not in violation of the provisions of Emblems and Names (Prevention of Improper
1950 as arnended from time to time.
profanity or words
The proposed name is not offensive to any section of people, e.g. proposed name does not contain
or phras;s that are generally considered a slur against an ethnic group, religion, gender or heredity
The proposed name is not such that its use by the company will constitute an offence under any
law for the time being
in force.
I undenake to bc fully responsible for the conscquences in case the name is subsequently found to be in contraventlon
gone
of the provisions of iection 4(2) and section 4(4) of the companies Act, 20 | 3 and rules thereto and I have also
througl and understood the provisions ofsection 4(5) (ii) (a) and (b) ofthe Companies Act,20l3 and rules thereunder
and fullv declare for the thereofl
E
havingMcrnbershipnu.b",E]and/orcertificateofpracticenumber
has bJen cngaged to give declaration undcr section 7( l) (b) and such declaration is attached'
lr
ffictions7(5)and7(6)which'inte|4'lio,proyidesthatfurnishingof
anyfa|seorincorrectparticularsofanyinformationorsuppressionofanymaterialinformationshal|attract
449 which provide
punishment for fraud under section 447. Attention is also drawn to proYisions ofsection 448 and
for punishment for false statement l|nd punishment for falsc evidence r€spectively'
DIN / PAN
nembcr of
of
who is engaged in the formation ofthe company declare that I have been duly engaged for the purpose ofcertification
Act' 2013 and rules thereunder
this fom. ii i-s hereby also certified that I havc gone through the ptovisions ofthe Companies
tbr thc subject nratier.ofthis form and rnatGrs incidenial thereto and I have verified the above particulars (including
attachmentirs)) liom the original/certifled records maintained by the applicant which is
subject matter of this form and
form suppressed l f'urther certil]
tound them to be h.uc, correct and contptete and no information materiat to this has been
that:
(i) the drali memorandum and articles of association have been drawn up in confonnity
with the provisions of
sections 4 and 5 and rules made thereunder: and
(ii) all the requirements of Companies Act,20t3 and the rules made thereunder relating to registration
ofthe
co pany under section ? ofthe Act and matters precedent or incidental thereto have been complied with The
said records have been properly prepared, signed by the required officers of the company and Inaintained as
pcrthcrelevantprovisionsol'theCompaniesAat,20l3andwerefoundtobeinorder;
and
(iii) i have opened a the attactrmcnts to this form and have verified these to be as per requirements, oomplete
Iegiblc:
giv-en in the form
(iv) | i-unhcr declare that I have pcrsonally visited the premises ofthe proposcd registered office
ar the address mentroned hcrcin above and verifiecl that the said proposed registered offrce of the company
will bc functioning for the business purposes of the company (wherever applicable in respect of the proposed
registered office has been givcn).
(v) ltls understood that I sha'il bc liable for action under Seclion 448 ofthe Companies Act, 2013 for wrong
cettification. ifany found at any stage.
Chartered accoJn'ianl iin'.'hole-tinre pracaicei or Cosl accountanl (in ',\ hole-tLme cractlc€) or
Itlen-bersl'ric rrtt'tber
Cedlf cate of )ractLce nul'l'lcer
'l'if. I i.l:: f),'\ l'J
Check;orm
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