Declaration that a person has ceased to

be a director or secretary of a company CRO receipt date stamp

Companies Acts 1963 to 2012

B69
Company number

Please complete using black typescript or BOLD CAPITALS, referring to explanatory notes
Company name
in full Limited

Declaration I
name in bold capitals

of
residential address

do hereby declare that I ceased to be a Director Secretary

Day Month Year

of the above mentioned company on

and that I enclose all of the following documentary evidence of my having ceased to be
an officer of the aforementioned company:

A signed copy of notice of resignation to the company (letter marked “A”) on which I
have signed my name prior to the making of this declaration note two

and

A copy of the notice served by me on the company pursuant to section 195(11A) of the
Companies Act 1963 (letter marked “B”) on which I have signed my name prior to the
making of this declaration. note three

Declaration continued overleaf

Presenter details Person to whom queries can be addressed

Name
Address

DX number DX exchange
Telephone number Fax number
Email Reference number
Current officers I further declare that to the best of my knowledge information and belief the names and
addresses of the current officers of the company are as follows: note four

Surname
Forename

Residential address

Director Secretary note one

Surname
Forename

Residential address

Director Secretary note one

Surname
Forename

Residential address

Director Secretary note one

Surname
Forename

Residential address

Director Secretary note one

And I make this declaration conscientiously believing the same to be true. note five

Signature of declarant name of person completing form

This day of 20
NOTES ON COMPLETION OF FORM B69
These notes should be read in conjunction with the relevant legislation.

General This form must be completed correctly, in full and in accordance with the following notes.
Every section of the form must be completed. Where "not applicable", "nil" or "none" is appropriate,
please state.
Where the space provided on Form B69 is considered inadequate, the information should be
presented on a continuation sheet in the same format as the relevant section in the form. The use
of a continuation sheet must be so indicated in the relevant section and noted on the continuation
sheet.

note one Tick the relevant box(es).

note two Tick the box to state the letter marked “A” is attached. Letter "A" must be signed by the declarant
and attached to the form.

note three Tick the box to state the letter marked “B” is attached. Letter "B" must be signed by the declarant
and attached to the form. Letter "B" must specifically:

i. request the company to send notification of the fact of the resignation ie Form B10,
to the Registrar of Companies within 21 days;

ii. inform the company that failure to do this will result in Form B69 being filed in the
CRO and in the resigning officer sending a written request (enclosing a copy of his/her
letter of resignation) to every person who, to his/her knowledge, is an officer of the
company, that he/she will take such steps as will ensure that the failure of the company
to comply with the notice continues no further.

For further information see Information Leaflet No. 18, "Notification by Director/Secretary of
Resignation".

note four Where the declarant does not know the names and addresses of the current officers, this should
be stated on the form and entered as "Not Known".

note five The declaration is an unsworn declaration of compliance with all the legal requirements
relating to notification to the registrar of companies by a director/secretary of his/her own
resignation. It is a criminal offence pursuant to section 242 of the Companies Act 1990
for a person to knowingly or recklessly deliver a document to the CRO which is false in a
material particular.

Further information

CRO address When you have completed and signed the form, please file with the CRO.

The Public Office is at 14 Parnell Square, Dublin 1. The DX address for the CRO is 145001.

If submitting by post, please send with the prescribed fee to the Registrar of Companies at:

Companies Registration Office, O'Brien Road, Carlow, County Carlow

Payment If paying by cheque, postal order or bank draft, please make the fee payable to the Companies
Registration Office. Cheques or bankdrafts must be drawn on a bank in the Republic of
Ireland.
Online Option An alternative to completing this paper form is to notify us online at www.core.ie.
Submitting your application online is free, more secure and quicker than filing the paper
form.
Please carefully study the explanatory notes above. A Form B69 that is not completed correctly or is not
accompanied by the correct documents or fee will be rejected and returned to the presenter by the CRO.

FURTHER INFORMATION ON COMPLETION OF FORM B69, INCLUDING THE PRESCRIBED FEE, IS AVAILABLE
FROM WWW.CRO.IE OR BY EMAIL [email protected]