Fillable PSC04 Change the details of your person with (Cabinet Office)

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PSC04 Change the details of your person with (Cabinet Office)

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  • 25 check-boxes
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Change the details of
your person with
significant control (PSC)
PSC04
Use the online service to update your information as quickly
as possible.
Or visit:
www.gov.uk/le-changes-to-a-company-with-companies-house
It takes longer to
process paper forms
sent to us by post
11/17 Version 3.0
1
Company details
Company name in full
Company number
PSC04
Change of details of individual person with
significant control (PSC)
What this form is for
You may use this form to give
notice of a change to the details
of an individual who is a person
with significant control (PSC).
What this form is NOT for
You cannot use this form to change
the details of a relevant legal
entity RLE (use PSC05) or an other
registrable person (ORP) (use PSC06).
For further information, please
refer to our guidance at
www.gov.uk/companieshouse
Filling in this form
Please complete in typescript or in
bold black capitals.
All fields are mandatory unless
specified or indicated by *
5
Change of service address
Current details
This information is used to identify
the details on the public record.
This is voluntary information and if
completed it will be placed on the
public record.
2
Individual's current details
1
Title*
Full forename(s)
Surname
5
Building name/number
Street
Post town
County/Region
Country
Postcode
Service address
This is the address that will appear
on the public record. This does
not have to be the individual's
residential address.
If you provide the individual's
residential address here it will
appear on the public record.
Please complete Section 5a if the
individual's usual residential address
has changed.
3
Date of change of details
5
d d
m m
y y y y
Date of change of
details
4
Change of name
Title*
Full forename(s)
Surname
Please complete the appropriate sections to indicate which details have changed
on this date.
4
New name
Please enter the new name.
4
1
4
2
Month/year of birth*
m m y y y y
X X
2
In accordance with
sections 790VA & 790ZA
of the Companies Act
2006.
3
Please enter the date that the
change occurred.
Give details of all of the changes
that occurred on this date. If you
need to enter more than one date,
please use a separate form.
3
Go online to file this information
www.gov.uk/companieshouse
Don’t use this form if any individual PSC is applying or has applied for protection
from having their details disclosed on the public register.
Contact secureforms@companieshouse.gov.uk to get the correct form.
11/17 Version 3.0
Section 790ZF exemption
PSC04
Change of details of individual person with significant control (PSC)
This page is not shown on the public record
5a
Change of usual residential address
Change of PSC's usual residential
address
You can state ‘Same as service
address’ in this section if the usual
residential address is same as the
service address.
You cannot state 'Same as service
address’ if the service address has
been stated in Section 5 as ‘The
Company’s Registered Office’. You
will need to complete the address
in full.
This address cannot be a PO Box,
DX or LP (Legal Post in Scotland)
number.
1
1
Do not cover this barcode
X
X
Please complete this section if the usual residential addresss has changed.
Only tick the box below if the individual is in the process of applying for, or
has been granted, exemption by the Registrar from disclosing his or her usual
residential address to credit reference agencies under section 790ZF of the
Companies Act 2006.
Different postal address:
If the individual is applying for, or has been granted, a section 790ZF exemption,
please post this whole form to the different postal address below:
The Registrar of Companies, PO Box 4082, Cardiff, CF14 3WE.
Where the individual is applying for a section 790ZF exemption with this form,
the application and this form must be posted together.
If the individual is currently in the
process of applying for or has been
granted a section 790ZF exemption,
you may wish to check you have
not entered the individual's usual
residential address in section 5 as
this will appear on the public record.
2
Section 790ZF of
Companies Act 2006
2
Building name/number
Street
Post town
County/Region
Country
Postcode
11/17 Version 3.0
PSC04
Change of details of individual person with significant control (PSC)
6
Change of other details
Change of Country/
State of residence
Change of nationality
7
Change of nature of control
Please indicate how the individual is a person with significant control over the
company
Ownership of shares
The individual holds, directly or indirectly, the following percentage of shares
in the company (tick only one):
more than 25% but not more than 50%
more than 50% but less than 75%
75% or more
Ownership of voting rights
The individual holds, directly or indirectly, the following percentage of voting
rights in the company (tick only one):
more than 25% but not more than 50%
more than 50% but less than 75%
75% or more
Ownership of right to appoint/remove directors
The individual holds, directly or indirectly, the right to appoint or remove
a majority of the board of directors of the company.
Significant influence or control (Only tick if none of the above apply)
The individual has the right to exercise, or actually exercises, significant
influence or control over the company.
Tick each that apply
Tick any new conditions that apply
to the individual, as well as any
which continue to apply.
Only tick the 4th statement
(Significant influence or control) if
none of the previous statements
apply
1
1
11/17 Version 3.0
8
Change of nature of control by a firm over which the individual has
significant control
PSC04
Change of details of individual person with significant control (PSC)
Tick each that apply
Tick any new conditions that apply
to the members of the firm, as well
as any which continue to apply.
1
1
The individual has the right to exercise or actually exercises significant
influence or control over the activities of a firm that is not a legal person under
its governing law, and:
the members of that firm (in their capacity as such) hold, directly or indirectly,
the following percentage of shares in the company (tick only one):
more than 25% but not more than 50%
more than 50% but less than 75%
75% or more
the members of that firm (in their capacity as such) hold, directly or indirectly,
the following percentage of voting rights in the company (tick only one):
more than 25% but not more than 50%
more than 50% but less than 75%
75% or more
the members of that firm (in their capacity as such) hold the right, directly
or indirectly, to appoint or remove a majority of the board of directors of
the company
the members of that firm (in their capacity as such) have the right to
exercise, or actually exercise, significant influence or control over the
company.
11/17 Version 3.0
PSC04
Change of details of individual person with significant control (PSC)
9
Change of nature of control by a trust over which the individual has
significant control
Tick each that apply
Tick any new conditions that apply
to the trustees of the trust, as well
as any which continue to apply.
1
1
The individual has the right to exercise or actually exercises significant
influence or control over the activities of a trust and:
the trustees of that trust (in their capacity as such) hold, directly or indirectly,
the following percentage of shares in the company (tick only one):
more than 25% but not more than 50%
more than 50% but less than 75%
75% or more
the trustees of that trust (in their capacity as such) hold, directly or indirectly,
the following percentage of voting rights in the company (tick only one):
more than 25% but not more than 50%
more than 50% but less than 75%
75% or more
the trustees of that trust (in their capacity as such) hold the right, directly
or indirectly, to appoint or remove a majority of the board of directors of
the company
the trustees of that trust (in their capacity as such) have the right to
exercise, or actually exercise, significant influence or control over the
company.
10
Register entry date
d d
m m
y y y y
Date
Give the date on which you made this update to the company’s PSC register.
2
I am signing this form on behalf of the company.
If the form is being filed on behalf
of a Societas Europaea (SE), please
delete ‘director’ and insert details
of which organ of the SE the person
signing has membership.
Person authorised
Under either section 270 or 274 of
the Companies Act 2006.
You must have obtained
confirmation from the individual
person with significant control that
their particulars are correct before
sending this form to Companies
House.
This form may be signed by:
Director , Secretary, Person authorised , Administrator, Administrative receiver,
Receiver, Receiver manager, Charity commission receiver and manager, CIC
manager, Judicial factor.
Signature
Signature
2 3
3
11
Signature
11/17 Version 3.0
Where to send
You may return this form to any Companies House
address, however for expediency we advise you to
return it to the appropriate address below:
For companies registered in England and Wales:
The Registrar of Companies, Companies House,
Crown Way, Cardiff, Wales, CF14 3UZ.
DX 33050 Cardiff.
For companies registered in Scotland:
The Registrar of Companies, Companies House,
Fourth floor, Edinburgh Quay 2,
139 Fountainbridge, Edinburgh, Scotland, EH3 9FF.
DX ED235 Edinburgh 1
or LP - 4 Edinburgh 2 (Legal Post).
For companies registered in Northern Ireland:
The Registrar of Companies, Companies House,
Second Floor, The Linenhall, 32-38 Linenhall Street,
Belfast, Northern Ireland, BT2 8BG.
DX 481 N.R. Belfast 1.
Section 790ZF exemption
If you are applying for, or have been granted a section
790ZF exemption, please post this whole form to the
different postal address below:
The Registrar of Companies, PO Box 4082,
Cardiff, CF14 3WE.
For further information, please see the guidance notes
on the website at www.gov.uk/companieshouse
or email enquiries@companieshouse.gov.uk
This form is available in an
alternative format. Please visit the
forms page on the website at
www.gov.uk/companieshouse
Further information
i
Checklist
We may return forms completed incorrectly or
with information missing.
Please make sure you have remembered the
following:
The company name and number match the
information held on the public Register.
You have completed in Section 3 the date of change
of details.
Any new address must be a physical location. They
cannot be a PO Box number (unless part of a full
service address), DX or LP (Legal Post in Scotland)
number.
You have entered the relevant change of details.
You have given the register entry date.
You have signed the form.
Important information
All information on this form will appear on the
public record, apart from information relating to
usual residential addresses.
!
Presenter information
You do not have to give any contact information, but if
you do it will help Companies House if there is a query
on the form. The contact information you give will be
visible to searchers of the public record.
Contact name
Company name
Address
Post town
County/Region
Postcode
DX
Telephone
Country
This form has been provided free of charge by Companies House.
PSC04
Change of details of individual person with significant control (PSC)
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PSC04 Change the details of your person with (Cabinet Office)

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Completed 10 February 2022

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