ANNEXURE – SHAICL_AML_KYC_UBO_TMP
DECLARATION OF BENEFICIAL OWNERSHIP
(Applicable to Company (except the company listed on a stock exchange or in case of a subsidiary of such a company),
partnership firm, unincorporated association or body of individuals and trusts)
1. Name of the Entity: _______________________________________________________________
2. Registration Number :
3. Registered Office Address :
4. Principal Place of Business : _______________________________________________________
5. DARPAN Registration Details [ for Non-Profit / Voluntary Organization ] : Reg. No. ___________________
6. Entity is Politically Exposed : Yes / No
A. Applicable for Listed Company / Subsidiary of a Listed Company [ Strike out the one that is not applicable ]
I We Hereby declare that-
Our Company is a Listed Company listed on recognized stock Our Company is a Subsidiary of a Listed
exchange in India Company
Our Company is controlled by a Listed Company
Details of the Listed Company ^
Stock Exchange on which it is listed Security ISIN
^ The Details of holding/parent company to be provided in case the applicant / investor is a subsidiary company
B. Type of Customer’s Legal Constitution (Please tick the correct box)
Company [ Public / Private ] Partnership Firm / LLP
Association of Persons (AOP) / Welfare Association Body of Individuals / Un-Incorporated Association
NGO / Trust / Society / Section 8 Company Self Help Group [ SHG ]
Others (Govt. Agency, Local Authority, Artificial Juridical Person, Co-operative Society / HUF etc.)
C. The Legal Entity as stated above hereby confirms and declares that on the below date: (Please tick correct box)
The following natural person(s) (listed in Table below) exercise “Control” or ultimately have a
“Controlling Ownership interest” i.e., having ownership/entitlement of more than 10% in case of a Company,
NGO, Trust, Society , Partnership firm, LLP etc., and more than 15% in case of unincorporated association or body
of individual.
“Control” shall include the right to appoint majority of the directors or to control the management or policy
decisions through Share Holding, Management rights, Shareholders agreement, Voting Agreements etc., and
controlling through entitlement of capital/profits/property etc.
Or
There are no natural person(s) who exercise control or ultimately have a controlling ownership interest
as stated above, therefore details of senior managing official(s) who are natural person(s).
(* If you have ticked any of the above, please complete the Table below accordingly before signing the declaration)
S. Full Name of Date Nationality Address PAN KYC Documents Controlling Politically
No. Beneficial owner / of Number Provided ownership Exposed
controlling natural Birth PoI PoA Interest (%) [Y/N]
person(s)
Also, in addition to the above, provide the details of the persons as mentioned below in the above table.
1) Company : Names of the relevant persons holding senior management position
2) Partnership : Names of all the partners
3) Trust/Society : Names of the beneficiaries, trustees, settlor and authors of the trust/society and KYC of the Trustee
The customer undertakes that the facts stated above are true and correct. The customer also undertakes and agrees that
it will notify Star Health and Allied Insurance Co Ltd., without delay of any changes in the controlling persons, person
exercising control or having controlling ownership interest in the Partnership / LLP / AOP / Society / Trust / Club / University
/ Institution, as declared in the table above.
For and on behalf of [ name of Entity ]:
Signature of the Authorized Official*:
Full Name of the Authorized official:
Designation / Position: ___
Authorized Official is Politically Exposed : Yes / No
Date : _
(* The declaration should be signed by an active/designated partner in case of Partnership Firm/LLP, a trustee in
case of Trust, a senior member in case of AOP, Society, Club and member of the Managing Committee in case of
University and Institution)
For STAR Branch Use Only
We have made best efforts to identify the beneficial owner(s) of the said firm. The details furnished above have
been verified from information, wherever available, in public domain.
(Signature of the Branch Head/Branch Operations Head)
Name:
Employee No.:
Date:
As per Ministry of Finance [Department of Revenue] Gazette notification # CG-DL-E-04092023-248537 dated 04-Sep-23,
Beneficial Owner (BO) is defined as:
a. Where the customer is a Company, the beneficial owner is the natural person(s), who, whether acting alone or
together, or through one or more juridical persons, has/have a controlling ownership interest or who exercise
control through other means.
Explanation- For the purpose of this sub-clause-
i) “Controlling ownership interest” means ownership of/entitlement to more than 10 per cent of the shares
or capital or profits of the company.
ii) “Control” shall include the right to appoint majority of the directors or to control the management or
policy decisions including by virtue of their shareholding or management rights or shareholder’s
agreements or voting agreements.
b. Where the customer is a Partnership firm, the beneficial owner is the natural person(s), who, whether acting
alone or together, or through one or more juridical person, has/have ownership of/entitlement to more than 10 %
of capital or profits of the partnership or who exercises control through other means.
Explanation: For the purpose of this clause, “Control” shall include the right to control the management or policy
decision”.
c. Where the customer is an unincorporated association or Body of individuals, the beneficial owner is the
natural person(s), who, whether acting alone or together, or through one or more juridical person, has/have
ownership of/entitlement to more than 15 per cent of the property or capital or profits of the unincorporated
association or body of individuals.
Explanation: Term ‘body of individuals’ includes societies.
Where no natural person is identified under (a), (b) or (c) above, the beneficial owner is the relevant natural person
who holds the position of senior managing official.
d. Where the customer is a Trust, the identification of beneficial owner(s) shall include identification of the author
of the trust, the trustee, the beneficiaries with 10% or more interest in the trust and any other natural person
exercising ultimate effective control over the trust through a chain of control or ownership.
e. Where the client or the owner of the controlling interest is a company listed on a stock exchange, or is a
subsidiary of such a company, it is not necessary to identify and verify the identity of any shareholder or beneficial
owner of such companies.
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