Beneficial Ownership Declaration

Date:

To Whom It May Concern

Dear Sir,

The details of ultimate beneficial owners (UBO) with actual holding over the client account are
given below.

Sr
Name Designation Id Details % of ownership
No
1
2
3
4
5
Total %

We hereby agree to the contents of this declaration and confirm all details provided therein valid,
effective and binding and the same may be deemed to be true and correct.

Signature:

Designation: (Should be signed by any two directors)

Date: