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BO Declaration Forms Company

This document is a declaration of beneficial owners for a private company. It requests information such as the company name and address, shareholder details including name, address, number of shares held, and whether ownership is direct or indirect. It also requests information on board of directors and their details, as well as identification of beneficial owners and how their ownership or control over the company is exercised, directly through shares or voting rights, or indirectly through another company. The declaration needs to be signed and dated by an authorized person, with proof of statements attached if necessary.

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Narirwanenaramabuye Joseph
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55 views

BO Declaration Forms Company

This document is a declaration of beneficial owners for a private company. It requests information such as the company name and address, shareholder details including name, address, number of shares held, and whether ownership is direct or indirect. It also requests information on board of directors and their details, as well as identification of beneficial owners and how their ownership or control over the company is exercised, directly through shares or voting rights, or indirectly through another company. The declaration needs to be signed and dated by an authorized person, with proof of statements attached if necessary.

Uploaded by

Narirwanenaramabuye Joseph
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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DECLARATION OF BENEFICIAL OWNERS OF PRIVATE C0MPANIES

Identification of the Company


Type of Company
Limited by Shares Private Limited by Shares Public
Limited by Shares and Guarantee Private Limited by Shares and Guarantee Private
Limited by Guarantee Private Unlimited Company
Foreign Company

Tax regime Real Micro


Tax Identification Number(TIN)
Company's registered name
Address of the Head office:
Town District Quarter
P.O. Box Tel Fix
E-mail
Business Activity
Date of registration of the Company Registration Code
Full name of the Secretary of the Company
Residential address of Company Secretary

OWNERSHIP STRUCTURE
Share Capital
Class and Number of shares
Number of shareholders

Identification of Shareholders(s)
Where the Shareholder is a natural person
Name and Surname
Gender: Male Female
Date of birth Place of birth
Tax Identification Number(TIN)
Country of Residence Town
Nationality Tel Fix
National ID/Passport Number Occupation
Email P.O. Box
Effective date when the person became a Shareholder
Class and Number of shares held Percentage of shares
Type of shares held: Ordinary Redeemable
Rights to distribution of capital or income

Add other Shareholder(Natural Person)

Where the Shareholder is a legal entity


Full Name Abbreviation
Date of creation Registration Number
Tax Identification Number(TIN)
Country of Residence Town
P.O. Box Tel
Email
Effective date when the entity became a Shareholder
Class and Number of shares held Percentage of shares
Type of shares: Ordinary Redeemable
Rights to distribution of capital or income

Add Shareholder(Legal entity)

Identification of Members of Board of Directors


Name and Surname
Gender: Male Female
Date of birth Place of birth
Tax Identification Number(TIN)
Country of Residence Town
Nationality Tel Fixed
National ID/Passport Number
Email P.O. Box
Effective date when the person became a Board Member
Add Board Members

Identification of Beneficial owners


Name and Surname
Gender: Male Female
Date of birth Place of birth
Tax Identification Number(TIN)
Country of Residence Town
Nationality Tel Fix
National ID/Passport Number Occupation
Email P.O. Box
How is ownership held or control over the company is exercised by this person?
By Direct Shares: By Direct Shares:
By Indirect shares: By Indirect voting:

1. In case of Direct Shares:


Number of shares held % of shares

2. In case of Direct Voting:


Number of votes % of votes

3. In case of Indirect shares:


Number of Indirect Shares % of indirect shares
Full name of intermediate Company
Address of intermediate Company

4. Indirect voting:
Number of indirect votes % of Indirect votes
Full name of intermediate company

5. By other means Select from list

Add beneficial owner

Declaration of Company Assets


Description of assets Value of assets Location

Add rows

I
the information provided is accurate and up-to-date. If found to be false or untrue or misleading, we are
aware that we are liable for it.

Authorised Signature Date


Name

Note: Where necessary proof of statements made in this form should be submitted in attachment.
RIVATE C0MPANIES

any
s Public
s and Guarantee Private
any

Abbreviation

Street
Tel Mobile
Fax

gistration Code

ers(s)

Street
Tel Mobile

rcentage of shares
Voting rights
Street

rcentage of shares
Voting rights

of Directors

Street
Tel Mobile

wners

Street
Tel Mobile

By Direct Voting:
By other means

of indirect shares
of Indirect votes

m list

Location

, hereby declare that


r untrue or misleading, we are

ubmitted in attachment.

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