## Report on Notification S.O. 995(E) Regarding Declaration and Registration of Beneficial Interests in Life Insurance Corporation Shares
**1. Executive Summary:**
This report analyzes Notification S.O. 995(E), issued by the Ministry of Finance, Department of Financial Services, Government of India, and published in the Gazette of India on March 4, 2022. This notification outlines the form, manner, period, and details for declarations and registration of beneficial interests in shares of the Life Insurance Corporation (LIC) under Section 5C of the Life Insurance Corporation Act, 1956. Key findings include the establishment of specific declaration requirements for registered holders and beneficial owners of shares, the introduction of corresponding forms for these declarations, and the designation of the LIC as the responsible entity for maintaining related registers.
**2. Introduction:**
The purpose of this report is to provide an informative overview of Notification S.O. 995(E) regarding the declaration and registration of beneficial interests in shares of the Life Insurance Corporation (LIC), as detailed in the provided text from the Gazette of India. This report focuses solely on the information contained within the provided document.
**3. Policy Overview:**
This notification introduces regulations concerning the declaration and registration of beneficial ownership of LIC shares.
* **Core Objective(s):** The core objective, as inferred from the text, is to ensure transparency and accountability regarding the ownership of LIC shares by mandating the declaration and registration of beneficial interests. This aims to identify individuals or entities who ultimately benefit from the shares, even if they are not the registered holders.
**4. Background and Rationale:**
* **Likely problem/issue the policy addresses:** The policy likely addresses concerns about hidden or undisclosed ownership in LIC shares. The registration of beneficial owners ensures transparency, preventing potential misuse of shares and facilitating accountability. This is aligned with broader efforts to promote corporate governance and prevent financial irregularities.
**5. Key Provisions:**
This notification mandates the following:
1. **Declaration by Registered Holder (Non-Beneficial Owner):** Individuals whose names are registered as shareholders but do not hold beneficial interest must declare this in Form I within 30 days of registration or any change in beneficial interest.
2. **Declaration by Beneficial Owner (Non-Registered Holder):** Individuals holding beneficial interest in LIC shares but not registered as shareholders must declare this in Form III within 30 days of acquiring such interest or any change.
3. **Declaration by Significant Beneficial Owner:** Every individual who is a significant beneficial owner must make a declaration in Form IV within ninety days from the date of publication of this notification and within a period of thirty days from the date of such acquisition or change.
4. **LIC Responsibilities:** LIC must enter the details from Forms I, III and IV into the register of members within 30 days of receipt and issue an acknowledgment in Form II.
5. **Register Maintenance:** LIC must maintain a register (Form V) of significant beneficial owners as per Section 5C(7) of the Life Insurance Corporation Act, 1956.
6. **Forms:** The notification prescribes specific forms (Form I, Form II, Form III, Form IV, and Form V) to be used for declarations, acknowledgments, and register maintenance. These forms require detailed information about the registered holder, the beneficial owner, and the specifics of the shares and the nature of the beneficial interest.
**6. Target Audience and Stakeholders:**
The direct target audience and stakeholders include:
* Registered holders of LIC shares who do not hold beneficial interest.
* Beneficial owners of LIC shares who are not registered as shareholders.
* The Life Insurance Corporation of India (LIC).
**7. Implementation Aspects (Inferred):**
* **Responsible agency/bodies:** The Life Insurance Corporation of India (LIC) is responsible for receiving declarations, maintaining registers, and issuing acknowledgments. The Ministry of Finance, Department of Financial Services, is the issuing authority.
* **Timelines:**
* Declaration by registered holder/beneficial owner: within 30 days of registration/acquiring interest or change in beneficial interest.
* Declaration by significant beneficial owner: within 90 days from the date of publication of this notification or within 30 days from the date of such acquisition or change.
* LIC action: within 30 days of receiving a declaration.
* **Procedures:**
* Shareholders and beneficial owners must fill out and submit the prescribed forms (I, III, or IV) to the LIC.
* LIC must maintain the register of members, and the register of significant beneficial owners, and issue acknowledgments (Form II).
**8. Expected Outcomes / Impact of Changes:**
The likely intended outcomes of this notification include:
* Increased transparency in the ownership structure of LIC shares.
* Enhanced monitoring of beneficial ownership, enabling better corporate governance.
* Reduced potential for misuse of shares due to undisclosed ownership.
* Improved compliance with regulatory requirements related to beneficial ownership.
**9. Conclusion:**
Notification S.O. 995(E) is a significant policy that seeks to enhance transparency and accountability in the ownership of LIC shares. By mandating the declaration and registration of beneficial interests, the notification aims to provide a clearer picture of who ultimately benefits from LIC shares, thereby contributing to better corporate governance and regulatory compliance. The successful implementation of this notification is crucial for maintaining the integrity of LIC and its operations.
Key Entities Referenced
Life Insurance Corporation Act, 1956: A law that empowers the Central Government to prescribe regulations related to declarations and registers maintained under the Companies Act, applicable to the Corporation (Life Insurance Corporation of India) with modifications.
Central Government: The governing body authorized to make notifications regarding the Life Insurance Corporation Act.
Companies Act: A law under which the declaration and register maintenance guidelines are being applied to the Life Insurance Corporation with certain modifications.
Corporation: Refers to the Life Insurance Corporation of India, which is subject to the regulations described in the notification.
New Delhi: City in India where the notification was issued.
Ministry of Finance: The government ministry responsible for the Department of Financial Services, which issued the notification.
Department of Financial Services: A department under the Ministry of Finance that is issuing the notification.
Form I: A declaration form to be used by a registered holder of shares who does not hold beneficial interest in such shares, as per subsection 1 of section 5C of the Act.
Form II: An acknowledgment form issued by the Corporation upon receiving declarations related to beneficial interests in shares.
Form III: A declaration form to be used by a beneficial owner who holds or acquires beneficial interest in shares but whose name is not entered in register of members, as per subsection 2 of section 5C of the Act.
Form IV: A declaration form to be used by an individual who is a significant beneficial owner, as per subsection 6 of section 5C of the Act.
Form V: A register to be maintained by the Corporation under subsection 7 of section 5C of the Act, for recording details of significant beneficial owners.
Life Insurance Corporation of India Central Office Yogakshema Jeevan Bima Marg Nariman Point Mumbai: The address of the Life Insurance Corporation of India's central office in Mumbai, Maharashtra, used for submitting declaration forms.
Mumbai, Maharashtra: City in Maharashtra where Life Insurance Corporation of India's central office is located.
Election Commission of India: An organization that issues Electoral photo identity card which can be used as proof of identity
International Organisation for Standardization: An organization that assignes country code.
Registrar of Companies: Entity to which significant beneficial owners may have submitted online returns.
Section 90 of the Companies Act, 2013: Section related to declaration under the Companies Act, 2013.
रजिस्ट्री स.ं डी.एल.- 33004/99 REGD. No. D. L.-33004/99
सी.जी.-डी.एल.-अ.-04032022-233917
xxxGIDHxxx
CG-DL-E-04032022-233917
xxxGIDExxx
असाधारण
EXTRAORDINARY
भाग II—खण् ड 3—उप-खण्ड (ii)
PART II—Section 3—Sub-section (ii)
प्राजधकार स ेप्रकाजित
PUBLISHED BY AUTHORITY
स.ं 965] नई दिल्ली, िुक्रिार, ंाच च4, 2022/ फाल्ग नु 13, 1943
No. 965] NEW DELHI, FRIDAY, MARCH 4, 2022/PHALGUNA 13, 1943
जित्त ं्ं ाल
(जित्ती सिे ा जिभाग)
अजधसचू ना
नई दिल् ली, 3 ंाच,च 2022
का.आ. 995(अ).—केंद्री सरकार, िीिन बींा जनगं अजधजन ं, 1956 (1956 का 31) की धारा 50 द्वारा
प्रित् त िजत क का प्र ग करते एए, ह अजधसूजचत करती ह ै दक दकए िाने िाली घ षणा के संबंध ं ें जिजहत दकए गए
प्ररूप, रीजत, अिजध और ब् ौरे तथा कंपनी अजधजन ं के अधीन रख े िान े िाल े रजिस्ट्टर ं ें िाजंल की िान े िाली
जिजिजि ां जनम्नजलजखत उपांतरणक, अपिािक और ितों के साथ अजधजन ं की धारा 5ग के अधीन जनगं क लागू ह गी,
अथाचत ् :--
1. रजिस्ट्रीकृत ि े र धारक ि ऐस ेि े रक ं ेंलाभप्रि जहत नहीं रखत ेहै द्वारा घ षणा--(1) क ई व्यजि, जिसका नां
जनगं ंें िे र धारक के रूप ं ें जनगं के सिस्ट् क के रजिस्ट्टर ंें प्रजिि ह ै लेदकन ि ऐसे िे रक ं ें लाभप्रि जहत नहीं रखता
ह,ै उस तारीख स े तीस दिनक के भीतर, जिसक ऐसे व्यजि का नां उस रजिस्ट्टर ं ें प्रजिि दक ा ग ा ह,ै अजधजन ं की
धारा 5ग की उपधारा (1) ं ेंजनदिि प्ररूप 1 ं ें घ षणा करेगा ।
(2) िहां जनगं के िे रक ं ें लाभप्रि जहत ं ें क ई पररितचन ह ता ह ै िहां उप परै ा (1) ं ें जनर्ििच व्यजि ऐसे पररितचन की
तारीख से तीन दिनक की अिजध के भीतर अजधजन ं की धारा 5ग की उपधारा (3) ंें जनर्ििच प्ररूप 1 ंें घ षणा करेगा ।
(3) जनगं उप पैरा (1) ा उप परै ा (2) के अधीन घ षणा की प्राजि की तारीख स े तीस दिनक के भीतर उसं ें अंतर्िचि
ब् ौरक की प्रजिजि सिस्ट् क के रजिस्ट्टर ं ेंकरेगा और प्ररूप 2 ं ेंएक अजभस्ट्िीकृजत िारी करेगा ।
1515GI/2022 (1)2 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
2. लाभप्रि स्ट्िांी, ि ि े रक ं ें लाभप्रि जहत धारण ा अर्ितच करता ह,ै जिसका नां सिस्ट् क के रजिस्ट्टर ं ें प्रजिि
नहीं ह,ै द्वारा घ षणा—(1) प्रत् ेक व्यजि, ि जनगं के िे रक ं ें लाभप्रि जहत धारण ा अर्िचत करता है, उस तारीख स,े
जिस पर िह जनगं के िे रक ं ेंऐसे लाभप्रि जहत अर्िचत करता है, तीस दिनक की अिजध के भीतर अजधजन ं की धारा 5ग
की उपधारा (2) ं ेंजनर्ििच प्ररूप 3 ं ेंघ षणा करेगा ।
(2) िहां जनगं के िे रक ं ें लाभप्रि जहत ं ें क ई पररितचन ह ता ह ै िहां उप परै ा (1) ं ें जनर्ििच व्यजि ऐसे पररितचन की
तारीख से तीन दिनक की अिजध के भीतर अजधजन ं की धारा 5ग की उपधारा (3) ंें जनर्ििच प्ररूप 1 ंें घ षणा करेगा ।
(3) जनगं उप पैरा (1) ा उप परै ा (2) के अधीन घ षणा की प्राजि की तारीख स े तीस दिनक के भीतर उसं ें अंतर्िचि
ब् ौरक की प्रजिजि सिस्ट् क के रजिस्ट्टर ं ेंकरेगा और प्ररूप 2 ं ेंएक अजभस्ट्िीकृजत िारी करेगा ।
3. लाभप्रि स्ट्िांी, ि ि े रक ं ें ंहत्िपणू चलाभप्रि स्ट्िाजंत्ि धारण ा अर्ितच करता ह,ै द्वारा घ षणा—(1) प्रत् ेक व्यजि,
ि अजधजन ं की धारा 5 की उपधारा (6) ंें था जिजनर्ििच ंहत्िपूणच लाभप्रि स्ट्िांी ह,ै इस अजधसूचना के प्रकािन की
तारीख से नब्ब ेदिन की अिजध के भीतर प्ररूप 4 ं ें घ षणा करेगा ।
(2) प्रत् ेक व्यजि, ि अजधजन ं की धारा 5ग की उपधारा (6) ं ें जनर्ििच लाभप्रि जहत ा अजधकार अर्िचत करता ह ै ा
उसके जहत की प्रकृजत और उप पैरा (1) के अधीन की गई घ षणा ंें जिजनर्ििच अन् जिजिजि ां पररितचन के अधीन ह ै त
ऐसे अिचन ा पररितनच की तारीख से तीस दिनक की अिजध के भीतर प्ररूप 4 ंें घ षणा करेगा ।
(3) जनगं उप पैरा (1) ा उप परै ा (2) के अधीन घ षणा की प्राजि की तारीख स े तीस दिनक के भीतर उसं ें अंतर्िचि
ब् ौरक की प्रजिजि सिस्ट् क के रजिस्ट्टर ं ेंकरेगा और प्ररूप 2 ं ेंएक अजभस्ट्िीकृजत िारी करेगा ।
4. रजिस्ट्टर—जनगं प्ररूप 5 ं ें अजधजन ं की धारा 5ग की उपधारा (7) ं ेंजनर्ििच रजिस्ट्टर रखेगा ।
प्ररूप 1
(धारा 5ग(1) िेखें)
ि े रक के रजिस्ट्रीकृत धारक, ि ऐस ेि े रक ं ेंलाभप्रि जहत नहीं करत ेह,ैं द्वारा घ षणा
सेिा ंें :
भारती िीिन बींा जनगं,
केंद्री का ाचल
‘ गक्षें’
िीिन बींा ंागच
नरींन पाइंट
ंुंबई-400021
1. ि े रक के रजिस्ट्रीकृत स्ट्िांी की जिजिजि ा ं
(i) नां : ........................................................
(ii) ंाता ा जपता ा पजत ा पत्नी का नां : .................................................
(iii) व्यिसा : ........................................................
(iv) ा भारती नागररक ह ैं
हां
नहीं
(v) राष्ट्री ता (जििेिी नागररकता के ंांले ं)ें : .................................................
(vi) िन्ं की तारीख ा आ ु: .................................................[भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 3
(vii) ललगं :
पुरुष
स्त्री
थड चिेंडर
(viii) आ -कर स्ट्था ी खाता संख् ा (पेन) : .................................................
(ix) पहचान का सबूत
(क) भारती क के जलए (जनम्न ं ेंसे क ई)
आ -कर पेन काड च
भारत जनिाचचन आ ग द्वारा िारी जनिाचचन फ ट पहचान काडच
पासप टच
ड्राइलिंग लाइसेंस
जिजिि पहचान संख् ा (आधार) काडच
(ख) जििेिी और अजनिासी भारती क के जलए
पासप टच
अन्
(x) स्ट्था ी आिासी पत ेका ब् ौरा :
(क) अंतराष्ट्रच ी ंानकीकरण संगठन (आईएसओ) द्वारा जन त ििे क ड : ....................................
(ख) िेि : ....................................
(ग) लैंडलाइन फ न नंबर : ....................................
(घ) ं बाइल नंबर : ....................................
(ङ) फैस नंबर : ....................................
(च) ई-ंेल पता : ....................................
(xi) ा ितचंान आिासी पता िही ह,ै ि स्ट्था ी आिासी पता ह ै
हा ं
नहीं
(xii) दि नहीं त ितचंान आिासी पत ेका ब् ौरा :
(क) अंतराष्ट्रच ी ंानकीकरण संगठन (आईएसओ) द्वारा जन त ििे क ड : ....................................
(ख) िेि : ....................................
(ग) लैंडलाइन फ न नंबर : ....................................
(घ) ं बाइल नंबर : ....................................
(ङ) फैस नंबर : ....................................
(च) ई-ंेल पता : ....................................
2. ि े रक की जिजिजि ा,ं जिसके सबं धं ं ेंरजिस्ट्रीकृत ि े र धारक द्वारा घ षणा की गई ह ै:
(i) िे रक का िगच : ....................................4 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
(ii) िे रक की संख् ा : ....................................
(iii) सुजभन्न संख् ाएं ........... से .......... तक
(iv) प्रंाण-प्: ........................................
(v) फ जल संख् ा : ....................................
(vi) िे रक का अजभजहत ंूल् : ....................................
(vii) िे रक का संाित्त ंल्ू : ....................................
3. घ षणा :
िीिन बींा जनगं अजधजन ं, 1956 की धारा 5ग की उपधारा (1) के अनुसरण ं,ें ंैं .................. घ षणा करता ह ं
दक नीचे नाजंत व्यजि ( क) उपर ि उजल्लजखत िे रक ंें लाभप्रि जहत धाररत करता ह/ैंकरते हैं, ि जनगं के सिस्ट् क के
रजिस्ट्टर ं ेंंेरे नां स ेरजिस्ट्रीकृत ह ै:
क्रं सं. लाभप्रि पता और िन्ं की जपता ा ंाता
स्ट्िांी का ईंेल पता तारीख ा ा पजत ा
नां आ ु पत्नी का नां
व्यिसा राष्ट्री ता
(1) (2) (3) (4) (5) (6) (7)
कंपनी के ंांल े ं,ें जनगं पहचान संख् ा (सीआईएन) ा सीजंत पासप टच संख् ा सुजभन्न संख् ा ( दि
िाज त्ि भागीिारी के ंांले ंें, सीजंत िाज त्ि भागीिारी पहचान (जििेिी नागररक के लाग ूह )
संख् ा (एलएलपीआईएन) ा आ -कर स्ट्था ी खाता संख् ा ा आधार ंांले ंें)
संख् ा
(8) (9) (10)
4. लाभप्रि जहत के ब् ौरे :
(i) लाभप्रि जहत की प्रकृजत : ....................................
(ii) लाभप्रि जहत के सृिन की तारीख : ....................................
(iii) लाभप्रि स्ट्िांी के नां स ेिे र रजिस्ट्रीकृत न करने के कारण : ....................................
(iv) जलखत ा िस्ट्तािेि की जिजिजि ां, दि क ई ह , ऐसे लाभप्रि जहत के सृिन क दिखान े के जलए : .......
5. लाभप्रि जहत ं ेंपररितनच की जिजिजि ा ं:
(i) पररितचन की तारीख : ....................................
(ii) लाभप्रि जहत ंें पररितचन की प्रकृजत : ....................................
(iii) ऐसे पररितचन की संजक्षि जिजिजि ां : ....................................
(iv) ऐसे पररितचन के जलए कारण : ....................................
(v) जलखत ा िस्ट्तािेि की जिजिजि ां, दि क ई ह , ऐसे लाभप्रि जहत के सृिन क दिखान े के जलए : .......
स्ट्थान : .............
तारीख : ..............
रजिस्ट्रीकृत िे र धारक के हस्ट्ताक्षर[भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 5
संलग्न :
(1) रजिस्ट्रीकृत िे र धारक और लाभप्रि स्ट्िांी की पहचान का सबूत ।
(2) उस लाभप्रि जहत के अधीन जलखत ा िस्ट्तािेि, ि सृजित ा अंतररत ा पररिर्तचत दक ा ग ा ह ै।
प्ररूप 2
घ षणा की प्राजि की अजभस्ट्िीकृजत
तारीख : ..............
..................................................................................................
(घ षणा करन े िाले सिस्ट् /व्यजि का पता)
..................................................................................................
(सिस्ट् /व्यजि का पता)
भारती िीिन बींा जनगं, िीिन बींा जनगं अजधजन ं, 1956 की जनम्नजलजखत धारा 5ग की उपधारा (ओ) के अधीन
तुम्हारे द्वारा की गई घ षणा की प्राजि की अजभस्ट्िीकृजत :
उपधारा (1)
उपधारा (2)
उपधारा (3)
उपधारा (6)
................ (तारीख अतं र्िचि करें) पर हंन े उि घ षणा प्राि की और जिसके ब् ौरे जनम्नजलजखत रजिस्ट्टर (रजिस्ट्टरक) ं ें
ररकाडच दकए गए ह ैं:
सिस्ट् क का रजिस्ट्टर
ंहत्िपूणच लाभप्रि स्ट्िांी द्वारा घ जषत जहत का रजिस्ट्टर
प्राजधकृत व्यजि के हस्ट्ताक्षर
नां : ........................
भारती िीिन बींा जनगं
केंद्री ‘ गक्षें’ िीिन बींा ंागच
नरींन पाइंट, ंुंबई – 400021
प्ररूप 3
(धारा 5ग(2) िेखें)
लाभप्रि स्ट्िांी, ि ि े रक ं ेंलाभप्रि जहत धारण ा अर्ितच करता ह ैलदे कन उसका नां सिस्ट् क के रजिस्ट्टर ं ेंप्रजिि नहीं
ह,ै द्वारा घ षणा
सेिा ंें :
भारती िीिन बींा जनगं,
केंद्री का ाचल6 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
‘ गक्षें’
िीिन बींा ंागच
नरींन पाइंट
ंुंबई-400021
1. ि े रक की जिजिजि ा ंजिनं ेंलाभप्रित जहत घ षणा करन ेिाल ेव्यजि द्वारा धाररत ह :
(i) िे रक का िगच : ........................................................
(ii) िे रक की संख् ा : ....................................
(iii) सुजभन्न संख् ाएं ........... से .......... तक
(iv) प्रंाणप् संख् ा : ....................................
(v) फ जल संख् ा : ....................................
(vi) िे रक का अजभजहत ंूल् : ....................................
(vii) िे रक का संाित्त ंल्ू : ....................................
2. लाभप्रि स्ट्िांी की जिजिजि ा ं:
क्रं सं. लाभप्रि पता और िन्ं की जपता ा ंाता व्यिसा राष्ट्री ता
स्ट्िांी का ईंेल पता तारीख ा ा पजत ा
नां आ ु पत्नी का नां
1 2 3 4 5 6 7
कंपनी के ंांल े ं,ें जनगं पहचान संख् ा (सीआईएन) ा सीजंत पासप टच संख् ा (जििेिी नागररक के ंांल े ंें)
िाज त्ि भागीिारी के ंांले ंें, सीजंत िाज त्ि भागीिारी पहचान
संख् ा (एलएलपीआईएन) ा आ -कर स्ट्था ी खाता संख् ा ा आधार
संख् ा
8 9
3. घ षणा :
िीिन बींा जनगं अजधजन ं, 1956 की धारा 5ग की उपधारा (1) के अनुसरण ं,ें ंैं .................. घ षणा करता ह ं
दक नीचे नाजंत व्यजि ( क) उपर ि उजल्लजखत िे रक ंें लाभप्रि जहत धाररत करता ह/ैंकरते हैं, ि जनगं के सिस्ट् क के
रजिस्ट्टर ं ेंंेरे नां स ेरजिस्ट्रीकृत ह ै ।
4. रजिस्ट्रीकृत ि े र धारक (ि े र धारकक) की जिजिजि ा ं
क्रं सं. लाभप्रि पता और िन्ं की जपता ा ंाता व्यिसा राष्ट्री ता
स्ट्िांी का ईंेल पता तारीख ा ा पजत ा
नां आ ु पत्नी का नां
1 2 3 4 5 6 7[भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 7
कंपनी के ंांल े ं,ें जनगं पहचान संख् ा (सीआईएन) ा सीजंत पासप टच संख् ा (जििेिी नागररक के ंांल े ंें)
िाज त्ि भागीिारी के ंांले ंें, सीजंत िाज त्ि भागीिारी पहचान
संख् ा (एलएलपीआईएन) ा आ -कर स्ट्था ी खाता संख् ा ा आधार
संख् ा
8 9
5. लाभप्रि जहत के ब् ौरे :
(i) लाभप्रि जहत के सृिन की तारीख : ....................................
(ii) लाभप्रि जहत के अिचन की रीजत : ....................................
आबंटन
अंतरण
अन्
दि अन् , जिजनर्ििच : ......................................................
(iii) लाभप्रि जहत की प्रकृजत : ....................................
(iv) ंेरे नां से िे र रजिस्ट्रीकृत न दकए िाने के कारण : ....................................
(v) जलजखत ा िस्ट्तािेि की जिजिजि ां, दि क ई ह , ऐसे लाभप्रि जहत के सृिन क दिखाने के
जलए:...........................................................................
6. व्यजि जिसस ेफा िाप्रि जहत अर्ितच दक ा िाता है, की जिजिजि ा ं( दि लाग ूह ) :
(i) फा िाप्रि जहत के अंतरक का नां :--------------------------
(ii) ा उसके नां पर िे र रजिस्ट्रीकृत दकए गए थ े :
O हा ं
O नहीं
दि नहीं, त िीिन बींा जनगं अजधजन ं, 1956 की धारा 5ग की उपधारा (2) के अधीन क ई घ षणा ह ैि जनगं क
उनके द्वारा फाइल की गई थी ?
O हा ं
O नहीं
दि हां, त ऐसी घ षणा की तारीख --------------------
(iii) ऐसे फा िाप्रि जहत ंें पररितचन ििाचन े िाल ेजलखत ा िस्ट्तािेि, दि क ई ह , की जिजिजि ां:------
7. फा िाप्रि जहत ं ेंपररितचन की जिजिजि ां :
(i) पररितचन की तारीख:--------------------------
(ii) फा िाप्रि जहत ंें पररितचन की प्रकृजत:--------------------------
(iii) ऐसे पररितचन की संजक्षि जिजिजि ां:--------------------------
(iv) ऐसे पररितचन के जलए कारण:--------------------------8 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
(v) ऐसे फा िाप्रि जहत ंें पररितचन ििाचने िाले जलखत ा िस्ट्तािेि, दि की ह , की जिजिजि ां:-
___________________________________________
स्ट्थान:----------------
तारीख:---------------
जहताजधकारी स्ट्िांी के हस्ट्ताक्षर
प्रंाणप्
ंैं एतिद्वारा प्रंाजणत करता ह ं दक ऊपर उजल्लजखत िे रक ंें फा िाप्रि जहत ंेरे द्वारा -------- क अंतररत कर दि ा ग ा
ह ै।
स्ट्थान:----------------
तारीख:---------------
व्यजि जिसने िे रक ं ेंफा िाप्रि जहत
अंतररत दक ा ह ैके हस्ट्ताक्षर
संलग्नक:
(1) िे र के रजिस्ट्रीकृत धारक और जहताजधकारी स्ट्िांी के पहचान के सबूत
(2) जलखत ा िस्ट्तािेि जिसके अधीन फा िाप्रि जहत सृजित ा अतं ररत ा पररिर्तचत दक ा िाता है
प्ररुप IV
[धारा 5ग(6) िेंखे]
जहताजधकारी स्ट्िांी द्वारा घ षणा ि ि े रक ं ेंंहत्िपणू चफा िाप्रि स्ट्िाजंत्ि धारण करता
ा अिनच करता ह ै
सेिा ंें,
भारती िीिन बींा जनगं
केन्द्री का ाचल
‘ गक्षें’
िीिन बींा ंागच
नरींन पॉइंट
ंुम्बई – 400021
1. प्ररुप फाइल करन ेका प्र िन (क ई एक चनु )ें :
O धारा 5ग की उपधारा (6) के अधीन ंहत्िपूण च जहताजधकारी स्ट्िाजंत्ि की घ षणा के जलए
O धारा 5ग की उपधारा (6) के अधीन ंहत्िपूण च जहताजधकारी स्ट्िाजंत्ि ंें पररितचन के जलए[भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 9
दि ंहत्िपूण च जहताजधकारी स्ट्िांी ने कंपनी अजधजन ं, 2013 की धारा 90 के अधीन घ षणा के संबंध ं ें कंपनी के
रजिस्ट्रार क क ई जििरणी ऑनलाइन प्रस्ट्ततु की ह,ै त ऐसे प्रस्ट्तुत करने पर उत्पन्न ंहत्िपूण च जहताजधकारी स्ट्िांी पहचान
संख् ा (“एसबीओआईडी”):---------------------
2. ंहत्िपणू चफा िाप्रि जहत के धारक की जिजिजि ा:ं
ंहत्िपूणच जहताजधकारी स्ट्िांी का नां
(नां और उपनां ि)ें
पता और ईंेल पता
िन्ं की तारीख और आ ु
जपता ा ंाता ा पजत/पत्नी का नां
व्यिसा
राष्ट्री ता
पासप टच संख् ा (जििेिी राजष्ट्रक की ििा ं)ें
3. जनगं के सिस्ट् के ंाध् ं स े जनगं ं ें अप्रत् क्ष धरण की प्रकृजत ा अजधकार का प्र ग (िहा ं एक स े अजधक हक, प्ररुप
के इस परै ा क ि हराए)ं :
(क) सिस्ट् के प्रकार {कंपनी ा सीजंत िाज त्ि भागीिारी (एलएलपी) ा जहन्ि ूअजिभि कुटुंब (एच ूएफ) ा भागीिारी
फंच ा िैिेदकक न् ास ा पूत च न् ास ा जिजनर्िचि न् ास ा प्रजतसंहरणी न् ास ा पल्ू ड इन्िेस्ट्टंेंट जहहकल (पीआईिी) ा
पीआईिी द्वारा जन ंज्त इकाई ा क ई अन् जनगं जनका } :---------------------
(ख) सुसंगत जिजध के अधीन आबंरटत, जनगं पहचान संख् ा (सीआईएन) ा सीजंत िाज त्ि भागीिारी पहचान संख् ा
(एलएलपीआईएन) ा क ई अन् रजिस्ट्रीकरण संख् ा:---------------------
(ग) सिस्ट् का नां:---------------------
(घ) पता:
---------------------
----------------------
िहर:---------------------
राज् :---------------------
ििे :---------------------
डाक सूचकांक संख् ा(जपन) :---------------------
(ङ) जनगं ंें अप्रत् क्ष धरण की प्रकृजत ा अजधकार का प्र ग:
िे रक के आधार पर:---------------------%
िे रक ं ेंंतिान के अजधकार के अधार पर:---------------------%
जितरणी लाभांि ा दकसी अन् जितरण पर अजधकारक के अधार पर:---------------------%
जन ं्ण के प्र ग के आधार पर (करार की प्रजत संलग्न करें)
ंहत्िपूणच प्रभाि के प्र ग के आधार पर (करार की प्रजत सलं ग्न करें)
(च) जनगं के सिस्ट् ंें ंहत्िपणू च जहताजधकारी स्ट्िांी की प्राजस्ट्थजत (क ई एक चुने) :
0 भागीिार, भागीिारी फंच ा एलएलपी की ििा ं ें10 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
0 कताच, एच ूएफ न् ासी ा िैिेदकक न् ास ा पूत च न् ास की ििा ंें
0 जहताजधकारी, जिजनर्ििच न् ास की ििा ं ें
0 लेखक ा व्यिस्ट्थापक, प्रजतसंहरणी न् ास की ििा ं ें
0 साधारण भागीिार, जनिेि प्रबंधक ा ंख्ु का चपालक अजधकारी, पीआईिी ा पीआईिी द्वारा जन ंज्त इकाई
की ििा ं ें
0 व्यजि, कंपनी ा क ई अन् जनगं जनका की ििा ं ें
(छ) दि सिस्ट् भागीिारी फं च ा एलएलपी ह,ै त जिजनर्ििच करें दक ा ंहत्िपूण च जहताजधकारी स्ट्िांी-------
भागीिार ह;ैं
जनगं जनका भागीिार ं ेंबएसंख् ा पण* धारण करता ह;ै
जनगं जनका भागीिार की क्रंांजतं जन ं्ी कंपनी ं ें बएसंख् ा पण* धारण करता ह ै।
(ि) दि सिस्ट् कंपनी ा क ई अन् जनगं जनका ह ै त जिजनर्ििच करें दक ा ंहत्िपूण च जहताजधकारी स्ट्िांी (क ई एक
चुनें)-----
0 ऐसी कंपनी ा जनगं जनका ंें बएसंख् ा पण*;
0 ऐसी कंपनी ा जनगं जनका की क्रंांजतं जन ं्ी कंपनी ंें बएसंख् ा पण*
धारण करता ह ै।
(i) ा ंहत्िपणू च जहताजधकारी स्ट्िांी का जनगं ंें क ई प्रत् क्ष धरण ा अजधकार ह ै(क ई एक चुन)ें :
O हा ं
O नहीं
दि हां, नीच ेब् ौरे प्रजिि करें:
िे रक के आधार पर:---------------------%
िे रक ं ेंंतिान के अजधकार के अधार पर:---------------------%
जितरणी लाभांि ा दकसी अन् जितरण पर अजधकारक के अधार पर:---------------------%
जन ं्ण के प्र ग के आधार पर (करार की प्रजत संलग्न करें)
ंहत्िपूणच प्रभाि के प्र ग के आधार पर# (करार की प्रजत सलं ग्न करें)
स्ट्थान:----------------
तारीख:---------------
ंहत्िपूणच जहताजधकारी स्ट्िांी
के धारक के हस्ट्ताक्षर
* “बएसंख् ा पण” से अजभप्रेत ह ै–
(क) जनगं जनका ंें साधारण अंि पूंिी के आध े से अजधक धारण करना; ा
(ख) जनगं जनका ंें आध े से अजधक ंतिान अजधकार रखना; ा
(ग) जनगं जनका द्वारा जितरणी लाभांि ा क ई अन् जितरण के आध े से अजधक प्राि करने ा उसंें भाग लेन े
का अजधकार ह ना ।[भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 11
# “ंहत्िपूणच प्रभाि” से अजभप्रते ह ै भारती िीिन बींा जनगं के जित्ती और प्रचालन नीजत जिजनश्च क ंें प्रत् क्ष ा
अप्रत् क्ष रूप स े भाग लेन े की िजि, दकन्त ुउन नीजत क का जन ्ं ण ा सं ुि जन ं्ण नहीं ह ै।
संलग्नक:
(1) ---------------------
(2) ---------------------
प्ररुप V
[धारा 5ग(7) िेंखे]
भारती िीिन बींा जनगं के ि े रक ं ेंंहत्िपणू चजहताजधकारी
स्ट्िाजं क द्वारा घ जषत जहत का रजिस्ट्रर
क्र.सं. जहताजधकारी पता और िन्ं की तारीख जपता ा ंाता ा व्यिसा राष्ट्री ता
स्ट्िाजं क के नां ईंेल पता ा आ ु पजत/पत्नी का नां
(1) (2) (3) (4) (5) (6) (7)
जनगं पहचान संख् ा (सीआईएन), कंपनी ा सीजंत िाज त्ि भागीिारी पहचान पासप टच संख् ा (जििेिी राजष्ट्रक की
संख् ा (एलएलपीआईएन) की ििा ंें, सीजंत िाज त्ि भागीिारी ा आ कर ििा ंें)
स्ट्था ी खाता संख् ा ा आधार संख् ा की ििा ं ें
(8) (9)
भारती िीिन बींा ंहत्िपूणच फा िाप्रि इस रजिस्ट्टर ं ें क ई अन् प्राजस्ट्थजत अजधप्रंाणन
जनगं अजधजन ं, 1956 जहत की संाजि की प्रजिजि की जहत ( दि ा हस्ट्ताक्षर
की धारा 5ग(6) के अधीन तारीख तारीख क ई हक)
घ षणा की तारीख
(10) (11) (12) (13) (14) (15)
[फा.सं. I-13011/03/2021-बींा. II]
सौरभ जंश्रा, सं ुि सजचि
MINISTRY OF FINANCE
(Department of Financial Services)
NOTIFICATION
New Delhi, the 3rd March, 2022
S.O. 995(E).—In exercise of the powers conferred by section 50 of the Life Insurance Corporation Act, 1956
(31 of 1956), the Central Government hereby notifies that the form, manner, period and details prescribed in respect of
declaration to be made and particulars to be included in the register to be maintained under the Companies Act shall12 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
apply to the Corporation under section 5C of the Act with the following modifications, exceptions and conditions,
namely:—
1. Declaration by registered holder of shares who does not hold beneficial interest in such shares.—(1) A
person whose name is entered in the register of members of the Corporation as the holder of shares in the Corporation
but who does not hold beneficial interest in such shares shall, within a period of thirty days from the date on which the
name of such person is entered in that register, make a declaration in Form I, referred to in sub-section (1) of section
5C of the Act.
(2) Where any change occurs in the beneficial interest in shares of the Corporation, the person referred to in sub-
paragraph (1) shall, within a period of thirty days from the date of such change, make a declaration in Form I, referred
to in sub-section (3) of section 5C of the Act.
(3) The Corporation shall, within thirty days of receipt of a declaration under sub-paragraph (1) or sub-paragraph (2),
enter the details contained therein in the register of members, and issue an acknowledgment in Form II.
2. Declaration by beneficial owner who holds or acquires beneficial interest in shares but whose name is
not entered in register of members.—(1) Every person who holds or acquires beneficial interest in shares of the
Corporation shall, within a period of thirty days from the date on which he acquires such beneficial interest in shares
of the Corporation, make a declaration in Form III, referred to in sub-section (2) of section 5C of the Act.
(2) Where any change occurs in the beneficial interest in shares of the Corporation, the person referred to in sub-
paragraph (1) shall, within a period of thirty days from the date of such change, make a declaration in Form III,
referred to in sub-section (3) of section 5C of the Act.
(3) The Corporation shall, within thirty days of receipt of a declaration under sub-paragraph (1) or sub-paragraph
(2), enter the details contained therein in the register of members, and issue an acknowledgment in Form II.
3. Declaration by beneficial owner who holds or acquires significant beneficial ownership in shares.—(1)
Every individual who is a significant beneficial owner as referred to in sub-section (6) of section 5C of the Act shall,
within a period of ninety days from the date of publication of this notification, make a declaration in Form IV .
(2) Every individual who acquires the beneficial interest or rights referred to in sub-section (6) of section 5C of the
Act, or the nature of whose interest and other particulars specified in a declaration made under sub-paragraph (1)
undergo a change
shall, within a period of thirty days from the date of such acquisition or change, make a declaration in Form IV.
(3) The Corporation shall, within thirty days of receipt of a declaration under sub-paragraph (1) or sub-paragraph (2),
enter the details contained therein in the register to be maintained under sub-section (7) of section 5C of the Act, and
issue an acknowledgment in Form II.
4. Register.—The Corporation shall maintain the register referred to in sub-section (7) of section 5C of the Act
in Form V.
FORM I
[See section 5C(1)]
Declaration by the registered holder of shares who does not hold beneficial interest in such shares
To:
Life Insurance Corporation of India
Central Office
‘Yogakshema’
Jeevan Bima Marg
Nariman Point
Mumbai – 400 021[भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 13
1. Particulars of the registered owner of the shares
(i) Name: ____________________________
(ii) Name of the father or mother or spouse: ______________________
(iii) Occupation: ______________________
(iv) Whether citizen of India
Yes
No
(v) Nationality (in case of foreign national): ______________________
(vi) Date of birth or Age: ______________________
(vii) Gender:
Male
Female
Third gender
(viii) Income-tax Permanent Account Number (PAN): ______________________
(ix) Proof of identity:
(a) For Indian nationals (any of the following):
Income-tax PAN card
Electoral photo identity card issued by the Election Commission of India
Passport
Driving licence
Unique identification number (Aadhaar) card
(b) For foreign nationals and non-resident Indians
Passport
Other
(x) Permanent residential address details:
(a) Country code assigned by the International Organisation for Standardization (ISO):
______________
(b) Country: ______________
(c) Landline phone number: ______________
(d) Mobile number: ______________
(e) Fax number: ______________
(f) Email address: ______________
(xi) Whether the present residential address is same as the permanent residential address
Yes
No
(xii) If no, details of the present residential address:14 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
(a) Country code assigned by the International Organisation for Standardisation (ISO):
______________
(b) Country: ______________
(c) Landline phone number: ______________
(d) Mobile number: ______________
(e) Fax number: ______________
(f) Email address: ______________
2. Particulars of the shares in respect of which declaration is being made by the registered holder of shares:
(i) Class of shares: _______________
(ii) Number of shares: _______________
(iii) Distinctive numbers: From _______________ to _______________
(iv) Certifícate number: _______________
(v) Folio number: _______________
(vi) Nominal value of shares: _______________
(vii) Paid-up value of shares: _______________
3. Declaration:
In pursuance of sub-section (1) of section 5C of the Life Insurance Corporation Act, 1956, I, _______________,
hereby declare that the person(s) named below hold(s) beneficial interest in the shares mentioned above which are
registered in my name in the register of members of the Corporation:
Name of the
Name of Address and Date of father or
S. No. Occupation Nationality
beneficial owner email address birth or Age mother or
spouse
(1) (2) (3) (4) (5) (6) (7)
Corporate Identity Number (CIN), in case of company or Limited Liability Passport number Distinctive
Partnership Identification Number (LLPIN), in case of limited liability (in case of foreign number (if
partnership or Income-tax Permanent Account Number or Aadhaar number national) applicable)
(8) (9) (10)
4. Details of beneficial interest:
(i) Nature of the beneficial interest: _______________
(ii) Date of creation of the beneficial interest: _______________
(iii) Reasons for not registering shares in the name of the beneficial owner: _______________
(iv) Particulars of the instrument or document, if any, showing the creation of such beneficial interest:
__________________________________________________[भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 15
5. Particulars of change in beneficial interest:
(i) Date of change: _______________
(ii) Nature of the change in the beneficial interest: _______________
(iii) Brief particulars of such change: _______________
(iv) Reason for such change: _______________
(v) Particulars of the instrument or document, if any, showing the change in such beneficial interest:
___________________________________________________
Place: _______________
Date: _______________
Signature of the registered holder of shares
Attachments:
(1) Proof of identity of the registered holder of shares and the beneficial owner
(2) Instrument or document under which the beneficial interest is created or transferred or changed
FORM II
Acknowledgment of receipt of declaration
Date: ________________
______________________________________________________
[Name of the member/ person making the declaration]
___________________________________________________________________________
___________________________________________________________________________
[Address of the member/person]
The Life Insurance Corporation of India hereby acknowledges receipt of the declaration made by you under the
following sub-section(s) of section 5C of the Life Insurance Corporation Act, 1956:
Sub-section (1)
Sub-section (2)
Sub-section (3)
Sub-section (6)
We have received the said declaration on __________ [insert date] and the details have been recorded in the following
register(s):
Register of members
Register of interest declared by significant beneficial owner
Signature of authorised person
Name: _______________________
Life Insurance Corporation of India
Central Office, ‘Yogakshema’, Jeevan Bima Marg
Nariman Point, Mumbai – 400 02116 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
FORM III
[See section 5C(2)]
Declaration by the beneficial owner who holds or acquires beneficial interest in shares but whose name is not
entered in the register of members
To:
Life Insurance Corporation of India
Central Office
‘Yogakshema’
Jeevan Bima Marg
Nariman Point
Mumbai – 400 021
1. Particulars of the shares in which beneficial interest is held by the person making declaration:
(i) Class of shares: _______________
(ii) Number of shares: _______________
(iii) Distinctive numbers: From _______________ to _______________
(iv) Certifícate number: _______________
(v) Folio number: _______________
(vi) Nominal value of shares: _______________
(vii) Paid-up value of shares: _______________
2. Particulars of the beneficial owner:
Name of the
Name of
Address and Date of father or
S. No. beneficial Occupation Nationality
email address birth or Age mother or
owner(s)
spouse
(1) (2) (3) (4) (5) (6) (7)
Corporate Identity Number (CIN), in case of company or Limited Liability Passport number (in
Partnership Identification Number (LLPIN), in case of limited liability partnership or case of foreign
Income-tax Permanent Account Number or Aadhaar number national)
(8) (9)
3. Declaration:
In pursuance of sub-section (2) of section 5C of the Life Insurance Corporation Act, 1956, I, _______________,
hereby declare that I hold or have acquired beneficial interest in the share mentioned above, which are registered in
the name of the person whose particulars are furnished in item 4 below.
4. Particulars of the registered holder of share(s):
Name of the
Name of
Address and Date of father or
S. no. registered holder Occupation Nationality
email address birth or Age mother or
of share
spouse
(1) (2) (3) (4) (5) (6) (7)[भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 17
Corporate Identity Number (CIN), in case of company or Limited Liability Passport number (in
Partnership Identification Number (LLPIN), in case of limited liability partnership or case of foreign
Income-tax Permanent Account Number or Aadhaar number national)
(8) (9)
5. Details of the beneficial interest:
(i) Date of creation of the beneficial interest: _______________
(ii) Mode of acquisition of beneficial interest:
Allotment
Transfer
Other
If other, specify: _______________________________________________
(iii) Nature of the beneficial interest: _______________
(iv) Reasons for not registering shares in my name: _______________
(v) Particulars of the instrument or document, if any, showing the creation of such beneficial interest:
__________________________________________________
6. Particulars of the person from whom the beneficial interest is acquired (if applicable):
(i) Name of the transferor of beneficial interest: ______________________________
(ii) Whether shares were registered in his name:
Yes
No
If no, whether any declaration under sub-section (2) of section 5C of the Life Insurance
Corporation Act, 1956 was filed by him to the Corporation?
Yes
No
If yes, the date of such declaration: ___________________
(iii) Particulars of the instrument or document, if any, showing the change in such beneficial interest:
___________________________________________________
7. Particulars of change in beneficial interest:
(i) Date of change: _______________
(ii) Nature of the change in the beneficial interest: _______________
(iii) Brief particulars of such change: _______________
(iv) Reason for such change: _______________
(v) Particulars of the instrument or document, if any, showing the change in such beneficial interest:
___________________________________________________
Place: _______________
Date: _______________
Signature of the beneficial owner18 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
CERTIFICATE
I hereby certify that the beneficial interest in the shares mentioned above has been transferred by me on ___________.
Place: _______________
Date: _______________
Signature of the person who has transferred the
beneficial interest in the shares
Attachments:
(1) Proof of identity of the registered holder of share and the beneficial owner
(2) Instrument or document under which the beneficial interest is created or transferred or changed
FORM IV
[See section 5C(6)]
Declaration by the beneficial owner who holds or acquires significant beneficial ownership in shares
To:
Life Insurance Corporation of India
Central Office
‘Yogakshema’
Jeevan Bima Marg
Nariman Point
Mumbai – 400 021
1. Purpose of filing the form (choose any one):
For declaration of significant beneficial ownership under sub-section (6) of section 5C
For change in significant beneficial ownership under sub-section (6) of section 5C
In case the significant beneficial owner has earlier submitted online any return to the Registrar of Companies in
respect of a declaration under section 90 of the Companies Act, 2013, the significant beneficial owner identity
number (“SBO ID”) generated upon such submission: ____________
2. Particulars of the holder of the significant beneficial interest:
Name of the significant beneficial owner
(given name and last name)
Address and email address
Date of birth or Age
Name of the father or mother or spouse
Occupation
Nationality
Passport number (in case of foreign national)[भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 19
3. Nature of indirect holding or exercise of right in the Corporation through member of the Corporation
(where more than one, repeat this paragraph of the form):
(a) Type of member {company or limited liability partnership (LLP) or Hindu undivided family (HUF) or
partnership firm or discretionary trust or charitable trust or specific trust or revocable trust or pooled
investment vehicle (PIV) or entity controlled by PIV or any other body corporate}: ___________
(b) Corporate Identity Number (CIN) or Limited Liability Partnership Identification Number (LLPIN) or any
other registration number, allotted under the relevant law: ________
(c) Name of the member: _________
(d) Address:
___________________________________________
___________________________________________
City: _________
State: _________
Country: _________
Postal Index Number (PIN): _________
(e) Nature of indirect holding or exercise of right in the Corporation:
By virtue of shares: ________%
By virtue of voting rights in shares: _______%
By virtue of rights on distributable dividend or any other distribution: __________%
By virtue of exercise of control (attach copy of agreement)
By virtue of exercise of significant influence# (attach copy of agreement)
(f) Status of significant beneficial owner in the member of the Corporation (choose any one):
Partner, in case of a partnership firm or an LLP
Karta, in case of an HUF trustee or a discretionary trust or a charitable trust
Beneficiary, in case of a specific trust
Author or settlor, in case of a revocable trust
General Partner, Investment Manager or Chief Executive Officer, in case of PIV or entity controlled by PIV
Individual, in case of a company or any other body corporate
(g) In case the member is a partnership firm or LLP, specify whether the significant beneficial owner—
is a partner;
holds majority stake* in the body corporate partner;
holds majority stake* in the ultimate holding company of the body corporate partner.
(h) In case the member is a company or any other body corporate, specify whether the significant beneficial owner
holds (choose any one)—
majority stake* in such company or body corporate;20 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(ii)]
majority stake* in the ultimate holding company of such company or body corporate.
(i) Whether significant beneficial owner has any direct holding or right in the Corporation (choose any one):
Yes
No
If yes, enter details below:
By virtue of shares: _______%
By virtue of voting rights in shares: ______%
By virtue of rights on distributable dividend or any other distribution: ________%
By virtue of exercise of control (attach copy of agreement)
By virtue of exercise of significant influence# (attach copy of agreement)
Date: _______________
Place: _______________
Signature of the holder of the
significant beneficial interest
* “Majority stake” means—
(a) holding more than one-half of the equity share capital in the body corporate; or
(b) holding more than one-half of the voting rights in the body corporate; or
(c) having the right to receive or participate in more than one-half of the distributable dividend or any other
distribution by the body corporate.
# “Significant influence” means the power to participate, directly or indirectly, in the financial and operating policy
decisions of the Life Insurance Corporation of India but is not control or joint control of those policies.
Attachments:
(1) _______________
(2) _______________
…
FORM V
[See section 5C(7)]
Register of interest declared by significant beneficial owners in shares of
the Life Insurance Corporation of India
Name of the
Name of
Address and Date of father or
S. no. beneficial Occupation Nationality
email address birth or Age mother or
owner(s)
spouse
(1) (2) (3) (4) (5) (6) (7)[भाग II—खण् ड 3(ii)] भारत का रािप् : असाधारण 21
Corporate Identity Number (CIN), in case of company or Limited Liability Partnership Passport number (in
Identification Number (LLPIN), in case of limited liability partnership or Income-tax case of foreign
Permanent Account Number or Aadhaar number national)
(8) (9)
Date of
Date of declaration under section Date of cessation of Any other
entry in Authentication or
5C(6) of the Life Insurance significant beneficial interest (if Status
this signature
Corporation Act, 1956 interest any)
register
(10) (11) (12) (13) (14) (15)
[F. No. I-13011/03/2021-Ins.II]
SAURABH MISHRA, Jt. Secy.
Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064
and Published by the Controller of Publications, Delhi-110054.