Fillable Form 1: SCHEDULE NOTICE OF BENEFICIAL OWNER PARTICULARS*

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Form 1: SCHEDULE NOTICE OF BENEFICIAL OWNER PARTICULARS*

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The Form 1: SCHEDULE NOTICE OF BENEFICIAL OWNER PARTICULARS* form is 3 pages long and contains:

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  • 12 check-boxes
  • 25 other fields

Country of origin: OTHERS
File type: PDF

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SCHEDULE
Form 1
NOTICE OF BENEFICIAL OWNER PARTICULARS*
[Section 6 of the AMLA, 2017]
Name of company/partnership:
...............................................................................................................................................
Number of company/partnership: ..........................................................................................
To the Registrar of Companies/Business names:
The above company /partnership hereby gives a notice in accordance with Section 6 of the AMLA,
2017 that the following person is a beneficial owner of the company/partnership.
Date that the person became a beneficial owner: ____/____/________ [dd/mm/yyyy]
BENEFICIAL OWNER
Full Name………………………………………………………………………………….
National identity card number/ Passport number/driving license/NSSF Card
Nationality(ties)
Date of birth [dd/mm/yyyy]
Residential address
Postal address
Visa number (Applicable to foreign persons)
Residence Permit Number (Applicable to foreign persons)
Work Permit Number (Applicable to foreign persons)
Current Email address
Current Telephone number
Occupation
NATURE OF OWNERSHIP OR CONTROL
Nature of ownership or control the beneficial owner has in the company/partnership
The percentage of shares a person holds in the company/partnership
Directly ………% of shares
Indirectly ……...% of shares
Unknown
The percentage of voting rights a person holds in the company/partnership
Directly ………% of voting rights
Indirectly ……...% of voting rights
Unknown
A person holds a right to appoint or remove a majority of the board of directors of the
company/partnership; and/or
Directly
Indirectly
Unknown
Whether a person exercises significant influence or control over the company/partnership.
Directly
Indirectly
Unknown
[Note: Please enter particulars of each and every beneficial owner in a separate form]
UNSPECIFIED OR UNKNOWN BENEFICIAL OWNER
Reason;
[Note: Please give a description and attach evidence of the steps taken to acquire the particulars]
LINK OF BENEFICIAL OWNER WITH THE COMPANY/partnership
Specify how the beneficial owner is linked to the company
(a) Name of shareholder/partner;
(b) Names of directors appointed by the beneficial owner;
Lodged on behalf of the company/partnership by:
Name:
ID/ Passport number
Address:
Signature:
Capacity****:
Source***
Date:
Notes
****Please indicate whether director, secretary or advocate of the company.
****Please indicate whether the information obtained was (a) provided by the beneficial owner or
their authorized representative; or (b) provided by a third party not directly related to the
beneficial owner.
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Form 1: SCHEDULE NOTICE OF BENEFICIAL OWNER PARTICULARS*

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Completed 27 May 2021

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