(On letter head of Company)

Annexure 1
Current Details of Shareholders & Beneficial Owners of M/s_____________________________________________________________________
I / we hereby confirm that the details of shareholders / beneficial owners in the captioned company are given below. We also confirm that names of all the
shareholders and/or beneficial owners, holding not less than 25% shareholding / beneficial interest, both directly & indirectly, are given below:

Date of Birth / Whether

Name of shareholders & Date of % of PAN No. /
S. No. Nationality shareholder or Address
beneficial owners Incorporation Shareholding Registration No.
beneficial owner
(dd/mm/yyyy)

For

Signature  Company Seal

Director Name
Date (dd/mm/yyyy) Place
Note: In case of non individual shareholding, similar list of shareholders of such non individual shareholder is also required.
1. If shareholder is a Company, provide details of shareholders holding 25% or more in similar format.
2. If shareholder is a Firm/Trust/Society, provide details of shareholders holding 15% or more in similar format.
 (On letter head of Company)
Annexure - 2
Details of Individual Promoters holding control, either directly or indirectly of M/s
Whether Politically
Exposed Person
PAN (PEP) / Related to Photograph with across
S No Name Citizenship Residential Address Politically Exposed signatures
Person (RPEP)
(Please tick)

PEP

RPEP Photograph size : 3.5cm x 2.5cm

No

PEP

RPEP Photograph size : 3.5cm x 2.5cm

No

PEP

RPEP Photograph size : 3.5cm x 2.5cm

No

For

Signature  Company Seal

Director Name
Date (dd/mm/yyyy) Place
 (On letter head of Company)

Annexure - 3

Details of Directors of M/s ____________________________________________________________________________________________________________

Whether Politically
Exposed Person (PEP) /
S.No Name Citizenship PAN / DIN Related to Politically Residential Address
Exposed Person (RPEP)
(Please tick)

PAN: PEP

RPEP
DIN:
No

PAN:
PEP

RPEP
DIN:
No

PAN:
PEP

RPEP
DIN:
No

PAN:
PEP

RPEP
DIN:
No

For

Signature  Company Seal

Director Name

Date (dd/mm/yyyy) Place

 (On letter head of Company)
Annexure - 4
Details of Whole time Director / Directors in-charge of day to day operations of
M/s. _________________________________________________________________________________________________________________________________________

Whether Politically
Exposed Person
Contact (PEP) / Related to Photograph with across
S No Name Citizenship Residential Address PAN / DIN
Number Politically Exposed signatures
Person (RPEP)
(Please tick)

PAN:
PEP

RPEP Photograph size : 3.5cm x 2.5cm

DIN:

No

PAN:
PEP

DIN: RPEP Photograph size : 3.5cm x 2.5cm

No

PAN:
PEP

RPEP Photograph size : 3.5cm x 2.5cm

DIN:

No

For

Signature  Company Seal

Director Name
Date (dd/mm/yyyy) Place
 (On letter head of Company)

List of Authorized Signatories

Whether Politically
Exposed Person
Name and Contact (PEP) / Related to Photograph with across
S No Residential Address Number Email Address
Designation Politically Exposed signatures
Person (RPEP)
(Please tick)

PEP

RPEP Photograph size : 3.5cm x 2.5cm

No

PEP

RPEP Photograph size : 3.5cm x 2.5cm

No

PEP

RPEP Photograph size : 3.5cm x 2.5cm

No

For

Signature  Company Seal

Director Name
Date (dd/mm/yyyy) Place