FORM I : Declaration by the person referred to in section 187C(1) of the Companies Act, 1956 (1 of 1956)

[See rule 3(1)]

To

____________________________

(Name of the company)

____________________________

(Address of the registered office)

In pursuance of sub-section (1) of section 187C of the Companies Act, 1956 (1 of 1956), I hereby declare that ______________________ hold(s) the beneficial interest in ______________________________ shares bearing Nos. ____________

                                 (number)          (kind)

________________ which are entered in my name in the register of members of the company as the holder of such shares. The particulars of such person(s) who hold the beneficial interest in the said shares are given below:

 

1. Sl. No.	Name	Father’s/ Husband’s Name	Age	Occupation	Address	Nationality

 

2. Nature of the beneficial interest:

3. Date of acquisition of the beneficial interest:

4. Reasons why the shares have not been registered in the name of the person(s) holding the beneficial interest in the register of the company:

5. Paid-up value of such share(s):

Place ___________

Date ___________                     

__________________________

Signature of the person making the declaration

___________________________

Name and address

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