Ultimate Beneficial Ownership Declaration

__/_____/2024

M/s Bank Name,

Branch & Address

Dear Sir,
We hereby declare that following person/s own/s 10% or more interest in Company
Name
Unique No of % of
an interest
Name and
Sr Beneficial Owner identification Nation /owner
Address of DOB
No Type document ality ship in
Beneficial Owners
(Aadhaar the
Card) entity
1

(If the beneficial owner exercises control through other means like voting rights, agreements,
arrangements etc., this may please be specified)

We have not and will not undertake a “Benami” transaction lending our name with
a view to hide the true identity of any other person who is/are the beneficial
owner/s.

We further declare that there is no other natural person(s), who, whether acting
alone or together or through one or more juridical persons, has/have a controlling
ownership interest or who exercise control through other means.

Name: Name Name

Designation: MANAGING PARTNER PARTNER

Encl: PAN/Voter ID/Adhaar Card