Annexure- I

Beneficial ownership details - Private Limited Cos (to be obtained on letterhead of the company)
To
Branch Manager
HDFC Bank Ltd

Date:

Name of Pvt Ltd Co. __________________________________________________

Section A
I/We the undersigned hereby declare the below details of shareholders/beneficial owners holding more than 20% shareholding
in the captioned company.
Sr.
No.

Name of
Shareholders /
Beneficial holders*

Date of Birth /
Date of
Incorporation

Nationality

Mention
if
Shareholder /
Beneficiary

%
of
Shareholding

Pan No. /
Regn. No. /
Passport No.#

Residence Address

Section B
Applicable only if there is/are non-individual shareholder(s) holding more than 20% stake as declared in Sec A.
Following to be declared in case of any shareholder/beneficiary being non-individual entity (Any one A or B)
I.

Sr.
No.

The following individual person(s), directly or indirectly, holds more than 20% stake/control in the above
captioned company

Name of
Shareholders /
Beneficial holders*

II.

Date of Birth

Nationality

Mention
if
Shareholder /
Beneficiary

%
of
Shareholding

Pan No. /
Passport No.#

Residence Address

We declare that no individual person holds directly or indirectly more than 20% stake/control in the captioned
company

For ______________________ (Name of Company)

_________________________________
Signature & Designation
(To be signed by Director)

Refer to following instruction while filling details in above format:i.

For the column marked with #
a. Pan Number to be provided for Resident. In absence of it, valid ID document to be submitted. If minor, then age proof to be
provided.
b. For Non-Individual Entity Registration Number to be mentioned.
c. Passport Number to be provided for Foreign National/NRI.
ii.
Address mentioned should be of Residence for Individuals and Registered Office for Non-Individuals entity.
iii.
Date of Incorporation should be the date when entity was registered/formed.