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    Annexure

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    pilesfistulasurgery

    Copyright:

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

    Annexure

    Uploaded by

    pilesfistulasurgery
    5 views1 page

    Original Title

    annexure

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    5 views1 page

    Annexure

    Uploaded by

    pilesfistulasurgery

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Annexure CA-4

    Format for details of Shareholders/Beneficial Ownership

    (On the Company/LLP Letter head)

    Name of the Entity: - PAN: -

    (A) Complete shareholding pattern of the Company, including details of ultimate natural persons
    ultimately holding more than 10% shares or exercising ultimate control over the company or more than
    10% shares or capital or profits or exercising ultimate control over the LLP*

    Sr.No Name of Shareholders % of share Mention reason if belongs exempted category#

    1)

    2)

    3)

    OR

    (B) I / We herby declare that no natural person is holding more than 10% shares/exercise control in the Company or more than
    10% shares or capital or profits or exercising ultimate control over the LLP* as per table (A) above or information about the
    ultimate beneficial ownership is not available with the Company/LLP. The details of senior managing official (e.g. Manging
    Director/Chief Executive Officer, etc) are as under:

    Name Designation Date of Birth Nationality Residential Address ID Proof

    Signature

    (Any Director/Authorised Signatory/Whole-time Company Secretary)

    Notes:
    In Table A, the details of natural person who exercises control over the entity needs to be furnished. The said
    natural person may act alone or together, or through one or more juridical person.

    *In case no such natural person is identifiable, indicate “Not identified” in Table A and provide details required as
    per Table B.

    A 701 Omkar Plaza, 90 Feet Road, Bhayandar (West) Thane 401101, Maharashtra India
    M: +91 9167 484860 | E: [email protected] | W: www.datasolutionsexperts.com

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