DECLARATION BY THE BENEFICIAL OWNER WHO HOLDS BENEFICIAL INTEREST IN SHARES
Form MGT-5 · Section 89(2) read with Rule 9(2) of the Companies (Management and Administration) Rules, 2014
To,
The Board of Directors,
[Company Name]
CIN: [CIN]
I, [Beneficial Owner Name], resident of [Address], PAN [PAN], do hereby declare that I hold or acquired beneficial interest in the following shares of the Company, which stand registered in the name of another person:
| Class of Shares | No. of Shares | Registered Owner Name | Date Beneficial Interest Created / Acquired |
|---|---|---|---|
| [Equity/Preference] | [Number] | [Registered Owner] | [DD/MM/YYYY] |
The nature of my interest in the said shares is [nature of interest] and the consideration paid for acquiring such beneficial interest is Rs. [amount]. I undertake to declare any change in beneficial interest within thirty days of such change.
Signature: __________________
Name: [Beneficial Owner Name]
PAN: [PAN]
Name: [Beneficial Owner Name]
PAN: [PAN]
Place: [Place]
Date: [DD/MM/YYYY]
Date: [DD/MM/YYYY]