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    BNForm III

    Uploaded by

    Kasweka Mbumba
    pacra form 3

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    BNForm III

    Uploaded by

    Kasweka Mbumba
    54 views2 pages
    pacra form 3

    Original Title

    BNFormIII

    Copyright

    © © All Rights Reserved

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    DOC, PDF, TXT or read online from Scribd

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    pacra form 3

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    54 views2 pages

    BNForm III

    Uploaded by

    Kasweka Mbumba
    pacra form 3

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    Form III

    (Regulations 3(1) and 9)(To be completed in duplicate)

    (Act No. 16 of 2011)


    The Registration of Business Names Regulations, 2011

    Shaded fields for Certificate No.


    Please complete in block letters official use only Reference No.
    Date and Time

    Approved Name of Business: JOSEPHINES BUTCHERY


    Ö

    INDIVIDUAL/ FIRM
    1. (a) Present Name(s)
    JOSEPHINE
    (b) Surname(s) of Applicant(s) MUNUNKA

    (c) Former Name(s)

    (d) Age of applicant(s)


    57
    2. (a) Nationality of applicant(s)
    ZAMBIAN
    (b) Identity card - 305903/11/1
    - National Registration
    Card No.(s)
    - Passport No.(s)

    3. (a) Notification address


    SHIKOSWE,KAFUE,ZAMBIA
    Telephone/Cell No(s). +260977440951
    Fax No.
    Email address(es) [email protected]
    (b) Residential address(es) S7/4 SHIKOSWE,KAFUE,ZAMBIA.

    IF APPLICANT IS A CORPORATE BODY


    4. (a) Company name and No.

    (b) Business address


    (c) Notification/Postal address
    (d) Email address

    GENERAL INFORMATION
    5. Type of business or undertaking
    to be conducted
    6. Location of proposed business Plot No. Is premises owner occupier or rented premises?
    (state name of the owner, if rented)
    RENTED

    7. Proposed date of commencement 31 MARCH


    of business (dd/mm/yy)
    8. Financial year end (dd/mm/yy)
    30 MARCH 2024
    9. Have you previously held a
    certificate of registration which
    was suspended or cancelled by
    the Registrar
    If yes, specify details:………………………………………………………………………………………………………………
    Reason for cancellation:……………………………………………………………………………………………………………

    of cancellation:………………………………………………………………………………………………………………
    10. Do you have a valid registration in
    respect of any other business
    name?
    If yes, specify details:………………………………………………………………………………………………………………
    Other existing business name:……………………………………………………………………………………………………
    Date of registration:……………………………………………………………………………………………………………….
    11. Business names previously held by Certificate No. Location
    the applicant under the
    Registration of Business Names
    Act or similar legislation outside
    Zambia
    12. Do you have any interest by way of partnership/directorship/shareholding in any business or occupation other than
    the one in respect of which the application relates?
    If yes, specify details:………………………………………………………………………………………………………………
    Other existing business name:……………………………………………………………………………………………………
    Date of registration:…………………………………………………………………………………………………………………
    13. STATUTORY DECLARATION
    I/We ………JOSEPHINE MUNUNKA…………………………………. do solemnly declare as
    follows:
    (a) that the information provided in this Form is correct and true; and
    (b) that my certificate of registration has never been suspended or cancelled;

    and I /we make this solemn declaration conscientiously believing the same to be true to the
    best of my/our knowledge and belief.

    …………………………………………………. 31 MARCH 2024


    Applicant‘s signature(s) Date

    FOR OFFICIAL USE ONLY

    Received by: ………………………………………………………………... …………………………..…


    Officer Date

    Receipt No.: …………………………………………………………………


    OFFICAL
    Date Received: ……………………………………………………………… STAMP
    Amount Received: ………………………………………………………….
    Serial No. of application: …………………………………………………..

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