I (Name of proposed Director), hereby give my consent to act as director of M/S. (Company Name), pursuant to sub-section (5) of section 152 of the Companies Act, 2013 and certify that I am not disqualified to become a director under the Companies Act, 2013.
1. Director Identification Number (DIN) : xxx
2. Name (in full): xxx
3. Father’s Name (in full): xxx
4. Address: xxx
5. E-mail id: xxx
6. Mobile no.: xxx
7. Income-tax PAN : xxx
8. Occupation: xxx
9. Date of birth: xxx
10. Nationality: xxx
11. No. of companies in which I am already a Director and out of such companies the names of the companies in which I am a Managing Director, Chief Executive Officer, Whole time Director, Secretary, Chief Financial Officer, and Manager: xxx
| S.no | Name of the company | Designation |
12. Particulars of membership No. and Certificate of practice No. if the applicant is a member of any professional Institute. : xxx
DECLARATION
i. I declare that I have not been convicted of any offence in connection with the promotion, formation or management of any company or LLP and have not been found guilty of any fraud or misfeasance or of any breach of duty to any company under this Act or any previous company law in the last five years. I further declare that if appointed my total Directorship in all the companies shall not exceed the prescribed number of companies in which a person can be appointed as a Director.
ii. I further declare that –
I am not required to obtain the security clearance from the Ministry of Home Affairs, Government of India before seeking appointment as director of M/S. xxxx.
I am required to obtain the security clearance from the Ministry of Home Affairs, Government of India before seeking appointment as director of M/S. xxxx as attached.
(Name of Director)
Attachments:
1. Proof of identity: PAN CARD
2. Proof of residence: AADHAR CARD