Form no. BEN-4
[Pursuant to section 90(5) ofthe Companies Act, 2013 and rule 6]
[<<Insert Company Name>>] (the "Company'')
<<Insert Date>>
[By post/email]
To:
Name and address of SBO/any other person
Date:
subject: Notice under sub-section (5) of Section 90 of the companies Act,20l3 and rules
made there under
The Company has reasonable cause to believe that*
- you are a significant beneficial owner of the company;
-have knowledge ofthe identity ofsignificant beneficial owner of.......... .. ... . ....likely
to have such knowledge;
-have been a significant beneficial owner of the company during tbe three years
immediatelv preceding the date of this notice, and
in respect of the above significant beneficial ownership the retum prescribed under Section 90
of the Act has not been filed in compliance with the Act.
You are accordingly advised to give the following information within 30 days of the date of
this notice in accordance with the section 90 of the Companies Act,2013 :
l. Name and Address of the Beneficial owner (B.o) (i.e. yourself or the significant BO if you are not the significant BO)
2. PAN of the B.O
3. Name of the person/entity/trust/body etc in whose name the shares/rights are registered/held
4. Folio number/DP and Client ID of the shares/securities
5. Nominal value of the shares/securities
6. Date of acquiring beneficial interest
7. Documents, terms and conditions or any other particulars regarding the BO ownership
8. Reason for not filing declaration in Form No. BEN-4.
9. Any other information incidental to or relevant or in your possession or knowledge to
enable the company to evaluate this matter
The abovementioned particulars should be submitted in writing to the registered address of the
company not later than 30 days of the date of this notice failing which the company shall
proceed in the matter without further notice as per the provisions ofthe Act.
Name & signature
(Person authorized to issue notice)
*Delete whichever is not applicable |