Form 3

(Regulation 4)
(In typescript and completed in duplicate)

THE PATENTS AND COMPANIES REGISTRATION AGENCY

The Companies Act, 2017

(Act No. 10 of 2017)
____________

The Companies (Prescribed Forms) Regulations, 2018

(Section 12, 13 and 94)
Available at www.pacra.org.zm

APPLICATION FOR INCORPORATION

PART A
COMPANY DETAILS
Private Company Limited By Shares X Ensure that the
members of the
Type of Company Private Company Limited By Guarantee company understand
• Select one type of Company by Public Limited Company the kind of company
marking with “X” being incorporated
Unlimited Private Company and the liability it
carries
Local Bank
Foreign Bank
Insurance Company
Company Category
• Select category of Company by Re-Insurance Company
marking with “X”
Bureau De Change
Financial Institution
Other (Specify) X
Company Name
• Ensure that the name is
captured exactly as approved MAGFEED ZAMBIA LTD
by Company Registry and has
not expired
Principal Business Business activity to
• Activity MANUFACTURING be classified in
accordance with the
ISIC Classification. A
full list of the trade
Other Business MANUFACTURING OF PROCESSED
• classification codes is
Activities FEED available on our
website:
www.pacra.org.zm
Whether Articles
• Restrict Nature of NO YES X
Business
Mark with “X”As Appropriate

• Type of Articles NON-

STANDARD X
Mark With “X”As Appropriate STANDARD

Plot/House/
Physical Village
PLOT 3
• Address Street MUTANDA
State the Area CHIKOLA B
registered office Town CHINGOLA
of the Company
Province COPPERBELT
• Postal Post Box NIL
Address Area
State the Town
 Province
notification
address of the
Phone Mobile +260961382060
Number
• Include the
international Land-line
code (e.g. +260
for Zambia)
• Email Address
Nominal Capital or
• Guaranteed Amount
Nominal Capital or Guaranteed 15,000.00
amount must not be less than
the prescribed minimum
Class of Shares
• If other indicate the specific
ORDINARY PREFERENTIAL OTHER
Not applicable to
class of shares.
companies limited by
• Number of Shares 15,000.00 guarantee
• Par Value 1
Financial Year End
The first financial year end
• must not be more than 12 12/02/2022
months from the date of
incorporation
Pledged Investment
Amount
• In case of Foreign Investors
state the amount and period for
pledged investment

PART B
FIRST DIRECTORS
Note: Minimum of two Directors for private and three for public limited companies. The number of directors resident in Zambia shall
not be less than half the number of directors appointed
PARTICULARS OF DIRECTOR
•
First Name JOSEPHINE ALBINA

Surname
KAWAYO MWANSA
FEMALE FEMALE
Gender

Date of Birth
24/08/1994 10/07/1973
ZAMBIAN ZAMBIAN
Nationality
Identity Type
For Zambians: NRC
NRC NRC
For non-Zambians: NRC/Passport/
Driver’s Licence/Resident Permit

Identity Number
334841/64/1 245026/66/1
Phone Number
Mobile
Include the +260961382060 +260966621354
international code
(e.g. +260 for Land line
Zambia)

Email Address
Physical Plot/House/
Address Village PLOT 3 PLOT 3
Street MUTANDA MUTANDA
 CHIKOLA B CHIKOLA B
Area

CHINGOLA CHINGOLA
Town

COPPERBELT COPPERBELT
Province

ZAMBIA ZAMBIA
Country

DECLARATION FOR CONSENT TO ACT AS DIRECTOR:

We, whose name(s) and particulars appear above, consent to act as director(s) for the above
mentioned company:
•
Signature: Date: 12/02/2021

Signature: Date: 12/02/2021

Replicate Part B to add more first directors

PART C
SHAREHOLDERS
Applicable to Public Company, Private Company Limited by Shares and Unlimited Private Company
PARTICULARS OF SHAREHOLDERS
• First Name
JOSEPHINE ALBINA
Surname
KAWAYO MWANSA
Gender
FEMALE FEMALE
Date of Birth
24/08/1994 10/07/1973
Nationality
ZAMBIAN ZAMBIAN
Identity Type
For Zambians: NRC
For non-Zambians: NRC NRC
NRC/Passport/ Driver’s
Licence/Resident Permit

Identity Number
334841/64/1 245026/66/1
Name of Body Corporate
Where applicant is a Body
Corporate
NIL NIL
Nature of Body Corporate
Where applicant is a Body
Corporate, indicate whether NIL NIL
applicant is a Company, Co-
operative, Trust, Society, Etc.
Registration Number, Date
and Country of
Incorporation of Body NIL NIL
Corporate
Where applicant is a Body
Corporate

Mobile
Phone Number +260961382060 +260966621354
Land-line
 Email Address

Plot/House/
Village PLOT 3 PLOT 3
Street
MUTANDA MUTANDA
Area
Physical CHIKOLA B CHIKOLA B
Address
Town
CHINGOLA CHINGOLA
Province
COPPERBELT COPPERBELT
Country
ZAMBIA ZAMBIA
Number of Shares
7500 7500
•
Class of Shares
ORDINARY ORDINARY

Signature: Date:12/02/2021
•
Signature: Date:12/02/2021
Legal owner(s) to sign if not the Beneficial Owner

Replicate Part C to add more Shareholders

PART D
BENEFICIAL OWNERSHIP
Applicable to Public Company, Private Company Limited by Shares and Unlimited Private Company

PARTICULARS OF BENEFICIAL OWNERSHIP

• First Name
JOSEPHINE ALBINA
Surname
KAWAYO MWANSA
Gender
FEMALE FEMALE
Date of Birth
24/08/1994 10/07/1973
Nationality
ZAMBIAN ZAMBIAN
Identity Type
For Zambians: NRC
For non-Zambians: NRC NRC
NRC/Passport/ Driver’s
Licence/Resident Permit

Identity Number
334841/64/1 245026/66/1
Occupation
BUSINESSLADY BUSINESSLADY
Name of Body Corporate
Where applicant is a Body
Corporate
Nature of Body Corporate
Where applicant is a Body
Corporate, indicate whether
applicant is a Company, Co-
operative, Trust, Society, Etc.
 Registration Number, Date
and Country of
Incorporation of Body
Corporate
Where applicant is a Body
Corporate

Mobile
Phone Number
Land-line

Email Address

Plot/House/
Village

Street

Physical/ Area
Registered
Office Address
Town

Province

Country

DIRECTOR/TRUSTEE OF BODY CORPORATE

No First Name: Identity Number: Physical Address: Date
Surname: Gender: Appointed:
Email:
Phone Number:
Nationality:
Date of Birth:
• Occupation:
1

2
3

SHAREHOLDER/SETTLER OF BODY CORPORATE

No First Identity Physical Number of Shares: Class of Number of
Name: Number: Address Shares: Paid Up
Surname: Gender: Shares:
Email:
Phone
Number:
Nationality:
• Date of Birth:
Occupation:
1

2
3

BENEFICIAL OWNER/BENEFICIARY OF BODY CORPORATE

• No First Name: Identity Number: Physical Address Nature of
Surname: Gender: Interest
Email:
Phone Number:
Nationality:
 Date of Birth:
Occupation:
1

2
3

Number of Shares (if any)

7500
7500
Class of Shares (if any)
ORDINARY
ORDINARY
Nature of Beneficial
Ownership
Briefly explain the nature of
beneficial ownership (whether LEGAL ARRANGEMENT
• trust, legal arrangement etc.)
including how ownership control or
economic interest is maintained
Date when beneficial
interest was acquired 12/02/2021
If beneficial owner is
politically exposed person
(PEP) as defined in the
Financial Intelligence Act
No. 46 of 2010, provide
details (e.g. position held)

DECLARATION OF BENEFICIAL OWNERSHIP:

We, whose names and particulars appear above, declare that I am the beneficial owner as indicated above.
•
Signature: Date:

Signature: Date:

Replicate Part D if the Beneficial Owners are more than two

PART E
GUARANTORS
Applicable to Companies Limited by Guarantee
GUARANTOR
• First Name

Surname

Gender

Date of Birth

Nationality
Identity Type
For Zambians: NRC
For non-Zambians: NRC/Passport/
Driver’s Licence/Resident Permit
Identity Number
 Name of Body Corporate
Where applicant is a Body
Corporate
Nature of Body Corporate
Where applicant is a Body
Corporate, indicate whether
applicant is a Company, Co-
operative, Trust, Society, Etc.
Registration Number, Date
and Country of
Incorporation of Body
Corporate
Where applicant is a Body
Corporate

Mobile
Phone Number
Land-line

Email Address

Plot/House/
Village

Street

Area
Physical
Address
Town

Province

Country

• Guaranteed Amount
GUARANTOR’S DECLARATION:

We, whose name(s) and particulars appear above, hereby undertake to contribute the
guaranteed amount(s) specified:

• Signature: Date:

Signature: Date:

Replicate Part E to add more Guarantors

PART F
COMPANY SECRETARY
SECRETARY
• First Name
HARRIET

CHILAMBWE
Surname
FEMALE
Gender

Date of Birth 21/09/1994

 ZAMBIAN
Nationality
Identity Type
For Zambians: NRC
NRC
For non-Zambians: NRC/Passport/
Driver’s Licence/Resident Permit
314603/64/1
Identity Number
Name of Body Corporate
Where applicant is a Body
Corporate
Nature of Body Corporate
Where applicant is a Body
Corporate, indicate whether
applicant is a Company, Co-
operative, Trust, Society, Etc.
Registration Number, Date
and Country of
Incorporation of Body
Corporate
Where applicant is a Body
Corporate

Mobile
+260963309010
Phone Number
Land-line

Email Address

Plot/House/
Village PLOT 18

Street LUKWANKWA STAGE

3
LULAMBA
Physical Area
Address
CHINGOLA
Town

COPPERBELT
Province

ZAMBIA
Country

DECLARATION FOR CONSENT TO ACT AS COMPANY SECRETARY:

I\We, whose name(s) and particulars appear above, consent to act as Company secretary(s)
for this Company:

Signature: Date: 12/02/2021

Signature: Date:

Replicate Part F to add more Secretaries

PART G
DECLARATION OF COMPLIANCE
JOSEPHINE KAWAYO
I, …………..…………..…………..…………..…………..do solemnly and sincerely declare that I am: a legal
practitioner engaged in the formation of the Company a first director named in the application for
incorporation or the first secretary named in the application for incorporation (delete whichever is
not applicable) and that all the requirements of the Companies Act, No 10 of 2017, in respect of
matters precedent to the incorporation of the Company and incidental thereto, have been complied
with. I make this solemn declaration conscientiously believing the same to be true.

CHILILABOMBWE 12 FEBRUARY
Declared at …………………………. the ………………… day of …………………………………………, 20…
21………..

Signature: ………………………………….

PART H
PARTICULARS OF PERSON LODGING APPLICATION
• First Name
JOSEPHINE
KAWAYO
• Surname
FEMALE
• Gender
24/08/1994
• Date of Birth
ZAMBIAN
• Nationality
Identity Type
• For Zambians: NRC
For non-Zambians: NRC/Passport/
NRC
Driver’s Licence/Resident Permit
334841/64/1
• Identity Number
+260961382060
Mobile
• Phone Number
Landline

• Email Address
Plot/House/
Village PLOT 3
MUTANDA
Street

CHIKOLA B
Area
Physical
• Address CHINGOLA
Town

COPPERBELT
Province

ZAMBIA
Country

• Signature: Date:12/02/2021