SPICe + Part B Form Language

Simplified Proforma for Incorporating Company English Hindi

Electronically
[Purusant to sections 4, 7, 8(1) 12, 152 and 153 of the
Companies Act, 2013 read with rules made there under]
- Form No. INC-32

Refer instruction kit for filling the form

1-9760574212_SRN_FORM
All fields marked in * are mandatory.

Structure of the Company

1(a) *Whether AOA is entrenched? Yes No

(b) Number of Articles to which provisions of enternchment

Details of such articles

Sr. No Article Number Short description on entrenchment of the clause

1
2 *Company is

Having Share Capital

Not having share capital

Total authorized share capital (in INR) 100000

Total classified authorized share capital (in INR) 100000

Total subscribed share capital (in INR) 100000

*Total unclassified authorized share capital (in INR) 0

3A(i) *Equity share capital

Number of classes 1
Description of Equity share capital

3A *Capital structure of the company

Class of shares
Authorized capital Subscribed capital
1
Number of equity shares
10000 10000
Nominal amount per share (in INR)
10 10
Total amount (in INR)
100000 100000

3A(ii) *Preference share capital

Number of classes 0

Page 1 of 32
Description of Preference share capital

Class of shares
Authorized capital Subscribed capital

Number of preference shares

0
Nominal amount per share (in INR)

Total amount (in INR)

3B *Details of number of members

(a) Enter the maximum number of members

(b) Maximum number of members excluding proposed employees

(c) Number of members 2

(d) number of members excluding proposed employee(s)

4 Address of the Company

4A *Correspondance Address

*Line 1 66 SHIV ANAND BUNGLOW

Line 2 near Shiv Shanti Society

*Pin code 382418

Contact Details : Mobile No. 9099065258

Contact Details: Phone No. (with STD code)

*State/UT Gujarat

*District Ahmedabad

*City Daskroi

*Area/Locality Vastral

Fax

email ID of the company shivani.mudaliar19@gmail.com

Page 2 of 32
4B *Whether the address for correspondence is the address of registered Yes No
office of the company

(In case Yes is selected, please provide Longitude and Latitude details)
Longitude 23.00236

Latitude 72.65747

Attachments:

1. Proof of Office address along with NOC,

1NOC PHEUMA_merged.pdf
if applicable (Conveyance/ Lease deed
/Rent Agreement along with rent receipts);

UTILITY BILL.pdf
2. Copy of the utility bills (not older than two months);

4C *Name of the office of the Registrar of

Companies Registrar of Companies, Gujarat, Dadra and Nagar Havelli
in which the proposed company is to be registered

5 *Number of first subscriber(s) to MOA and directors of the company

Having valid DIN Not having valid DIN

(a) Total number of first subscribers 2
0
(non-individual + individual)
(b) Number of non -individual first 0
subscriber(s)
(c) Number of individual first subscriber(s) 0 2
cum director(s)
(d) Total number of directors (director(s)
who Is/are not subscriber(s) + subscriber(s) 0 2
cumdirector(s) as mentionedin aboveRow
no. 3)

Page 3 of 32
6 Particulars of Non- Individual Subscribers / Individual Subscribers other than Subscriber(s) cum Directors
6A *Particulars of non-individual first
6A(i) Particulars of entity
*Category
Company/Foreign company/ Company incorporated outside India Body Corporate/Others)

*Corporate identity number (CIN) or foreign company registration

number (FRCN) or any othr registration number

*Name of the body corporate

Registered office address or Principal place of business in India or
Principal place of business outside India

*Line 1

Line 2

*Country

*Pin code

Area/Locality

*City

District

*State/UT

*Phone (with STD/ISD code)

Fax

*email ID of the company

6A(ii) Particular of the person authorized by the

Director Identification number (DIN)

*First Name

Middle Name

*Surname

*Father's First Name

Father's Middle Name

*Father's Surname

*Gender
(Male/Female/Transgender)

Page 4 of 32
*Date of Birth (DD/MM/YYYY)

*Nationality

Income tax-PAN

*Place of Birth (District & State)

*Occupation type
(Business/Professional/Goverment/Employment/Private Employment/Housewife
/Student/Others)

*Area of Occupation

*If 'Others' selected, please specify

*Educational Qualification
Primary education/Secondary education/Vocational qualification
Bachelor's degree/Master's degree/Doctorate or higher/Professional
Diploma/Others)

If 'Others' selected, please specify

Present Address
*Line 1

Line 2

*Country

*Pin code

*Area/Locality

*City

District

*State/UT

*Phone (with STD/ISD code)

Fax

email ID of the company

*Identity Proof

*Identity Proof No.

*Residential Proof

Page 5 of 32
(Voter Identity Card/Passport/Driving License/Aadhaar)

*Residential Proof No.

Submit the proof of identity and proof of
address
(a) *Proof of identity

(b) *Residential Proof

Description of Share capital

Total subscribed share capital (in INR)

Description of equity share capital

*Number of classes

Class of shares
Subscribed capital

Number of equity shares

Nominal amount per share (in INR)

Total amount (in INR)

Description of preference share capital

*Number of classes

Class of shares
Subscribed capital

Number of preference shares

Nominal amount per share (in INR)

Total amount (in INR)

Page 6 of 32
6B Particulars of individual first subscriber(s) other than subscriber cum director (having valid DIN)

*Director Identification Number (DIN)

*Name

Description of Share capital

Total subscribed share capital (in INR)

Description of equity share capital

*Number of classes

Class of shares
Subscribed capital

Number of equity shares

Nominal amount per share (in INR)

Total amount (in INR)

Description of preference share capital

*Number of classes

Class of shares
Subscribed capital

Number of preference shares

Nominal amount per share (in INR)

Total amount (in INR)

Page 7 of 32
6C *Particulars of individual first subscriber(s) other than subscriber cum director (Not having valid
DIN)
*First Name

Middle Name

*Surname

*Father's First Name

Father's Middle Name

*Father's Surname

*Gender
(Male/Female/Transgender)

*Date of Birth (DD/MM/YYYY)

*Nationality

*Place of Birth (District & State)

*Occupation type
(Business/Professional/Goverment/Employment/Private Employment/Housewife
/Student/Others)

Area of Occupation

If 'Others' selected, please specify

*Educational Qualification
Primary education/Secondary education/Vocational qualification
Bachelor's degree/Master's degree/Doctorate or higher/Professional
Diploma/Others)

If 'Others' selected, please specify

PAN

*email ID

Page 8 of 32
Permanent
*Line 1

Line 2

*Country

*Pin code

*Area/Locality

*City

District

State/UT

*Phone (with STD/ISD code)

*Whether present residential address same as permanent residential address Yes No

*Present
*Line 1

Line 2

*Country

*Pin code

Area/Locality

*City

District

*State/UT

*Phone (with STD/ISD code)

Duration of stay at present address (Years/Month)

(Years -> 0 to 99
Month -> 0 to 11)
*If Duration of stay at present addressis less than a one year then address of previous
residence

*Identity Proof
(Voter Identity Card/Passport/Driving License/Aadhaar)

*Residential Proof
(Voter Identity Card/Passport/Driving License/Aadhaar)

*Identity Proof No.

Page 9 of 32
*Residential Proof No.
*Submit the proof of identity and proof of
address
(a) *Proof of identity

(b) *Residential Proof

Description of Share capital

Total subscribed share capital (in INR)

Description of equity share capital

*Number of classes

Class of shares
Subscribed capital

Number of equity shares

Nominal amount per share (in INR)

Total amount (in INR)

Description of preference share capital

*Number of classes

Class of shares
Subscribed capital

Number of preference shares

Nominal amount per share (in INR)

Total amount (in INR)

Page 10 of 32
7 Particulars of Subscriber(s) cum Directors/Director of the Company

7A Particulars of Subscriber(s) cum Directors (having valid DIN)

7A(i) Basic detail of Subscriber(s) cum Directors

Director Identification Number (DIN)

*Name

*Designation
(Director/Managing Director/Whole time director/Nominee director)

*Category
(Promoter/Professional/Independent/Nominee)

Whether
Chairman
Executive Director
Non-executive Director

*Name of the company or institution whose nominee the apointee is

*email ID

Description of Share capital

Total subscribed share capital (in INR)

Description of equity share capital

*Number of classes

Class of shares
Subscribed capital

Number of equity shares

Nominal amount per share (in INR)

Total amount (in INR)

Description of preference share capital

*Number of classes

Page 11 of 32
 Class of shares
Subscribed capital

Number of preference shares

Nominal amount per share (in INR)

Total amount (in INR)

7A(ii) Declaration of entities in which Subscribers cum directors have interest

Number of entities in which director has interest

*CIN/LLPIN/FCRN/Registration Number

*Name

*Address

*Designation Other(specify)
*Nature Of
interest
Percentage of Shareholding 0 Amount (in INR)

Page 12 of 32
7B Particulars of Subscriber(s) cum Directors (Not having valid

7B(i) Basic detail of Subscriber(s) cum Directors

*First Name SHIVANI

Middle Name ARUNKUMAR

*Surname MUDALIAR

*Father's First Name ARUNKUMAR

Father's Middle Name GOVINDBHAI

*Father's Surname MUDALIAR

*Gender Female

*Date of Birth (DD/MM/YYYY) 26/11/1991

*Nationality India

*Place of Birth (District & State) Gujarat

Whether citizen of India Yes No

Whether resident in India Yes No

*Occupation type Business

(Business/Professional/Goverment/Employment/Private Employment/Housewife
/Student/Others)

*Area of Occupation Business

If 'Others' selected, please specify

*Educational Qualification Bachelor's degree

If 'Others' selected, please specify

Primary education/Secondary education/Vocational qualification
Bachelor's degree/Master's degree/Doctorate or higher/Professional
Diploma/Others)

PAN BSOPM4061N

*Designation Director
(Director/Managing Director/Whole time director/Nominee director)

*Category Promoter

Page 13 of 32
(Promoter/Professional/Independent/Nominee)

Whether
Chairman
✔ Executive Director
Non-executive Director

*Name of the company or institution whose nominee the apointee is

*Mobile No 09099065258

*email ID shibani.mudaliar19@gmail.com
Permanent
*Line 1 G/1 nr. BSNL customer service centre bhairavnath road

Line 2

*Country India

*Pin code 380008

*Area/Locality

*City Ahmadabad City

District Ahmedabad

*State/UT Gujarat

Phone (with STD/ISD code)

*Whether present residential address same as permanent residential address Yes No

*Present
*Line 1 G/1 nr. BSNL customer service centre bhairavnath road

Line 2

*Country India

*Pin code 380008

*Area/Locality

*City Ahmadabad City

District Ahmedabad

State/UT Gujarat

Phone (with STD/ISD code)

Page 14 of 32
Duration of stay at present address (Years/Month) 18/8
(Years -> 0 to 99
Month -> 0 to 11)
*If Duration of stay at present addressis less than a one year then address of previous
residence

*Identity Proof Aadhar Card

(Voter Identity Card/Passport/Driving License/Aadhaar)

*Residential Proof Bank Statement

(Voter Identity Card/Passport/Driving License/Aadhaar)

*Identity Proof No. 641263551654

Residential Proof No. 3311889456

*Submit the proof of identity and proof of
address
(a) *Proof of identity BSOPM4061N_adhaar shivani.pdf

(b) *Residential Proof BSOPM4061N_SHIVANI (1) (1).pdf

Description of Share capital

Total subscribed share capital (in INR) 50000

Description of equity share capital

*Number of classes 1

Class of shares
Subscribed capital
1
Number of equity shares
5000
Nominal amount per share (in INR)
10
Total amount (in INR)
50000

Description of preference share capital

*Number of classes

Class of shares
Subscribed capital

Number of preference shares

Nominal amount per share (in INR)

Total amount (in INR)

Page 15 of 32
7B(ii) Declaration of entities in which Subscribers cum directors have interest
*Number of entities in which director has interest 0

*CIN/LLPIN/FCRN/Registration Number

*Name

*Address

*Designation Other(specify)
*Nature Of
interest
Percentage of Shareholding Amount (in INR)

7B Particulars of Subscriber(s) cum Directors (Not having valid

7B(i) Basic detail of Subscriber(s) cum Directors

*First Name SALISH

Middle Name BALAN

*Surname EZHAVA

*Father's First Name BALAN

Father's Middle Name VAMADEVAN

*Father's Surname EZHAVA

*Gender Male

*Date of Birth (DD/MM/YYYY) 26/07/1991

*Nationality India

*Place of Birth (District & State) Gujarat

Whether citizen of India Yes No

Page 16 of 32
Whether resident in India Yes No

*Occupation type Business

(Business/Professional/Goverment/Employment/Private Employment/Housewife
/Student/Others)

*Area of Occupation Business

If 'Others' selected, please specify

*Educational Qualification Bachelor's degree

If 'Others' selected, please specify

Primary education/Secondary education/Vocational qualification
Bachelor's degree/Master's degree/Doctorate or higher/Professional
Diploma/Others)

PAN AASPE9244N

*Designation Director
(Director/Managing Director/Whole time director/Nominee director)

*Category Promoter
(Promoter/Professional/Independent/Nominee)

Whether
Chairman
✔ Executive Director
Non-executive Director

*Name of the company or institution whose nominee the apointee is

*Mobile No 09099019670

*email ID salish8216@gmail.com

Page 17 of 32
Permanent
*Line 1 66 SHIV ANAND BUNGLOW NEAR SHIV SANTI SOCIETY

Line 2 Ratanapura Gam

*Country India

*Pin code 382418

*Area/Locality Vastral

*City Daskroi

District Ahmedabad

*State/UT Gujarat

Phone (with STD/ISD code)

*Whether present residential address same as permanent residential address Yes No

*Present
*Line 1 66 SHIV ANAND BUNGLOW NEAR SHIV SANTI SOCIETY

Line 2 Ratanapura Gam

*Country India

*Pin code 382418

*Area/Locality Vastral

*City Daskroi

District Ahmedabad

State/UT Gujarat

Phone (with STD/ISD code)

Duration of stay at present address (Years/Month) 16/8

(Years -> 0 to 99
Month -> 0 to 11)
*If Duration of stay at present addressis less than a one year then address of previous
residence

*Identity Proof Aadhar Card

(Voter Identity Card/Passport/Driving License/Aadhaar)

*Residential Proof Bank Statement

Page 18 of 32
(Voter Identity Card/Passport/Driving License/Aadhaar)

*Identity Proof No. 724239605066

Residential Proof No. 1711333654

*Submit the proof of identity and proof of
address
(a) *Proof of identity AASPE9244N_salish adhaar.pdf

(b) *Residential Proof AASPE9244N_salish address pruf.pdf

Description of Share capital

Total subscribed share capital (in INR) 50000

Description of equity share capital

*Number of classes 1

Class of shares
Subscribed capital
1
Number of equity shares
5000
Nominal amount per share (in INR)
10
Total amount (in INR)
50000

Description of preference share capital

*Number of classes

Class of shares
Subscribed capital

Number of preference shares

Nominal amount per share (in INR)

Total amount (in INR)

7B(ii) Declaration of entities in which Subscribers cum directors have interest

*Number of entities in which director has interest 0

*CIN/LLPIN/FCRN/Registration Number

*Name

*Address

Page 19 of 32
 *Designation Other(specify)
*Nature Of
interest
Percentage of Shareholding Amount (in INR)

Page 20 of 32
7C Particulars of Directors (having valid DIN)

7C(i) Basic Details of Directors

*Director Identification Number (DIN)

*Name

*Designation
(Director/Managing Director/Whole time director/Nominee director)

*Category
(Promoter/Professional/Independent/Nominee)

Whether
Chairman
Executive Director
Non-executive Director

Name of the company or institution whose nominee the apointee is

*email ID

7C(ii) Declaration of entities in which Subscribers cum directors have interest

Number of entities in which director has interest

*CIN/LLPIN/FCRN/Registration Number

*Name

*Address

*Designation Other(specify)
*Nature Of
interest
Percentage of Shareholding 0 Amount (in INR)

Page 21 of 32
7D Particulas of Directors (Not having DIN)

7D(i) Basic detail of Directors

*First Name

Middle Name

*Surname

*Father's First Name

Father's Middle Name

*Father's Surname

*Gender

*Date of Birth (DD/MM/YYYY)

*Nationality

*Place of Birth (District & State)

Whether citizen of India Yes No

Whether resident in India Yes No

*Occupation type
(Business/Professional/Goverment/Employment/Private Employment/Housewife
/Student/Others)

*Area of Occupation

If 'Others' selected, please specify

*Educational Qualification

If 'Others' selected, please specify

Primary education/Secondary education/Vocational qualification
Bachelor's degree/Master's degree/Doctorate or higher/Professional
Diploma/Others)

Income tax-PAN

*Designation
(Director/Managing Director/Whole time director/Nominee director)

*Category
(Promoter/Professional/Independent/Nominee)

Page 22 of 32
Whether
Chairman
Executive Director
Non-executive Director

*Name of the company or institution whose nominee the apointee is

*Mobile No

*email ID
Permanent
*Line 1

Line 2

*Country

*Pin code

Area/Locality

*City

District

*State/UT

Phone (with STD/ISD code)

*Whether present residential address same as permanent residential address Yes No

*Present
*Line 1

Line 2

*Country

*Pin code

*Area/Locality

*City

District

*State/UT

Phone (with STD/ISD code)

Duration of stay at present address (Years/Month)

Page 23 of 32
(Years -> 0 to 99
Month -> 0 to 11)
If Duration of stay at present addressis less than a one year then
address of previous residence

*Identity Proof
(Voter Identity Card/Passport/Driving License/Aadhaar)

*Residential Proof
(Voter Identity Card/Passport/Driving License/Aadhaar)

*Identity Proof No.

Residential Proof No.

*Submit the proof of identity and proof of
address
(a) *Proof of identity

(b) *Residential Proof

7D(ii) Declaration of entities in which directors have interest

Number of entities in which director has interest

*CIN/LLPIN/FCRN/Registration Number

*Name

*Address

*Designation Other(specify)
*Nature Of
interest
Percentage of Shareholding 0 Amount (in INR)

Page 24 of 32
8 OPC Nomination
8A *Nomination
I* the subscribertothe memorandum of association of

do hereby nominate * *

who shall become the member of the company in the event of my death or incapacity to contract. I declare that the nominee is

eligible for nomination within the meaning of Rule 3 of the Companies (Incorporation) Rules, 2014.

8B *Particulars of the Nominee

Director Identification number (DIN)

*First Name

Middle Name

*Surname

*Father’s First Name

Father’s Middle Name

*Father’s Surname

*Gender

*Date of Birth (DD/MM/YYYY)

*Nationality

*Income tax-PAN

*Place of Birth (District & State)

*Occupation type

Business/Professional/Government /Employment/Private Employment /Housewife

Student/Others

*Area of Occupation

Page 25 of 32
If ‘Others’ selected, please specify

*Educational Qualification

(Primary education/Secondary education/Vocational qualification

Bachelor's degree/master’s degree/Doctorate or higher/Professional
Diploma/Others)

If ‘Others’ selected, please specify

*Mobile No

*Email Id

Permanent address

*Line 1

Line 2

*Country

*Area/ Locality

*Pin code / Zip Code

*State/UT

*City

District

Phone (with STD/ISD code)

Fax

Whether present residential address same as permanent residential address Yes No

*Present Address

Page 26 of 32
*Line 1

Line 2

*Area/Locality

*Pin code

*Country

*City

State / UT

District

Phone(with STD/ISD code)

Fax

Duration of stay at present address (Years/Month)

(Year -> 0 to 99) (Month -> 0 to 11)

*If Duration of stay at present address is less than one year then
address of previous residence

*Identity Proof

(Voters Identity Card/ Passport/Driving License/Aadhaar)

*Residential Proof

(Voters Identity Card/ Passport/Driving License/Aadhaar)

Page 27 of 32
*Identity Proof No.

*Residential Proof No.

*Submit the proof of identity and proof of address

(a) *Proof of identity MAX 2MB

(b) *Residential proof MAX 2MB

Declaration by Nominee

I do solemnly declare that I am an Indian citizen and resident in India and 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 or LLP Act in the last five years. I further
declare that

I am not a nominee in any other One Person Company and I shall comply with the eligibility criteria specified in Rule 3(3) within the
prescribed period. I understand that the person nominating me may withdraw my nomination without my consent.

To be digitally signed by Nominee

9 Particulars of payment of stamp duty

9A State or union territory in respect of which stamp duty is paid or to be paid Gujarat

9B *Whether stamp duty is to be paid electronically through MCA 21 system

● Yes No Not applicable

9B(i) Details of stamp duty to be paid

Type of document/ Particulars Form Memorandum of

association Articles of association

Amountof stampdutyto be paid(in

Rs.) 20 100 500

Page 28 of 32
 9B(ii) Provide details of stamp duty already paid

Type of document/ Form Memorandum of Articles of Others

Particulars association association

Total amount of stamp

duty paid (in Rs.)

Mode of payment of stamp

duty

Name of vendor or
treasury or Authority or
any other competent
agency authorized to
collect stamp duty or to
sell stamp papers or to
emboss the document or
to dispense stamp
vouchers on behalf of the
government

Serial number of
embossingor stampsor
stamppaper or treasury
challannumber
Registration number of
vendor
Date of purchase of stamps
or stamp paper or
payment of stamp duty
(DD/MM/YYYY)
Place of purchase of
stamps or stamp paper or
payment of stamp duty

10 *Additional Information for applying Permanent Account Number (PAN) and Tax Deduction Account Number
(TAN)

Information specific to PAN

Area Code AO type Range Code AO No.

GUJ W 108 1

Information specific to TAN

Area Code AO type Range Code AO No.

GUJ WT 147 1

*Source of Income

✔ Income from Business/profession Capital Gains Income from house property

Income fromother source No Income

Page 29 of 32
*Business/Profession code 20

Attachments

MAX 2MB
(a) Memorandum of association

(b) Articles of association MAX 2MB

(c) Declaration by first subscriber(s) and director(s);

MAX 2MB
(Affidavit is not required to be attached);

(d) Copy of certificate of incorporation of the foreign body corporate and MAX 2MB
resolution passed by foreign company or authority given through
constitutional document; MAX 2MB
(e) Resolution passed by promoter company;

(f) Interest of first director(s) in other entities MAX 2MB

(g) Optional attachment(s) (if any) MAX 2MB

Declaration
I have gone through the provisions of the Companies Act, 2013, the rules thereunder and prescribed guidelines framed
thereunder in respect of reservation of name, understood the meaning thereof and the proposed name is in conformity thereof.
I have used the search facilities available on the portal of the Ministry of Corporate Affairs (MCA) for checking the
resemblance of the proposed name with the companies and Limited Liability partnerships (LLPs) respectively already registered
or the names already approved. I have also used the search facility for checking the resemblances of the proposed name with
registered trademarks and trade mark subject of an application under the Trade Marks Act, 1999 and other relevant search for
checking the resemblance of the proposed name to satisfy myself with the compliance of the provisions of the Act for
resemblance of name and Rules thereof.
The proposed name is not in violation of the provisions of Emblems and Names (Prevention of Improper Use) Act, 1950 as
amended from time to time.
The proposed name is not offensive to any section of people, e.g. proposed name does not contain profanity or words or
phrases that are generally considered a slur against an ethnic group, religion, gender or heredity.
The proposed name is not such that its use by the company will constitute an offence under any law for the time being in
force.
I undertake to be fully responsible for the consequences in case the name is subsequently found to be in contravention of the
provisions of section 4(2) and section 4(4) of the Companies Act, 2013 and rules thereto and I have also gone through and
understood the provisions of section 4(5) (ii) (a) and (b) of the Companies Act, 2013 and rules thereunder and fully declare myself
responsible for the consequences thereof.
I * Salish Balan Ezhava
person named in the articles as a director of the company has been duly authorized by the promoters of the company to
sign this form and declare that all the requirements of the Companies Act, 2013 and the rules made thereunder in respect of
✔
Director Identification Number (DIN), registration of the company and matters precedent or incidental thereto have been
complied with.
✔ I am authorized by the promoter subscribing to the Memorandum of Association and Articles of Association and the first
director(s) to give this declaration and to sign and submit this Form.

✔ I further declare that, company shall not commence its business, unless all the required approval from the sectoral
Regulators such as RBI, SEBI etc. have been obtained.

I further declare that the company shall not commence the business of Nidhi, unless all the required approval including the
declaration be issued under section 406 of the Act have been obtained from Central Government;

Page 30 of 32
 ✔ I on behalf of the promoters and the first directors, hereby declare that the registered office is capable of receiving and
acknowledging all communications and notices addressed to the proposed company on incorporation, shall be maintained at the
given address at item 4 (a)of this form;

✔ *I, on behalf of all the first director(s) named in the Articles of Association of the proposed company, solemnly declare, that the
declaration given herein as stated above are true to the best of my knowledge and belief, the information given in this integrated
application form for incorporation and attachments thereto are correct and complete, and nothing relevant to this form has been
suppressed. All the required attachments have been completely, correctly and legibly attached to this form and are as per the
original records maintained by the promoters subscribing to the Memorandum of Association and Articles of Association.

I, on behalf of the proposed Directors whose particulars for allotment of DIN are filled as above, hereby confirm and declare that
they are not restrained, disqualified, removed for being appointed as Director of a company under the provisions of the Companies
Act, 2013 including sections 164 and 169, and have not been declared as proclaimed offender by any Economic Offence Court or
Judicial Magistrate Court or High Court or any other Court, and not been already allotted a Director Identification Number (DIN)
under section 154 of the Companies Act, 2013, and I further declare that I have read and understood the provisions of Sections 154,
155, 447 and 448 read with Sections 449, 450 and 451 of the Companies Act, 2013.

✔ I, on behalf of the proposed directors, hereby declare that person seeking appointment is a national of a country which shares
a land border with India, necessary security clearance from Ministry of Home Affairs, Government of India shall be attached with
the consent.

The MoA and AoA attached to the form in hard copy is exactly similar to e-MoA and e-AOA to be attached with the form.
I hereby declare as per Rule 5(iv) of Companies (Authorised to Register) Rules that the said LLP applying for conversion in this
Part of the Act has filed all documents which are required to be filed under the LLP Act, 2008 with the Registrar LLP.

a
Shalini Somani Chartered Accountant having Membership number

and/or certificate of practice number

184465

has been engaged to give declaration under section 7(1) (b) and such declaration is provided below.
*To be digitally signed by director DIN1 AASPE9244N

*DIN/PAN AASPE9244N

11 Declaration and Certification by Professional

I Shalini Somani member of
having office at*
The Institute of Chartered Accountant of India
Who is engaged in the formation of the company
C 401, Sumel 11 Nr Namaskar Circle, Shahibaugh, Ahmedabad
- 380016
declare that I have been duly engaged for the purpose of certification of this form. It is hereby also certified that I have gone
through the provisions of the Companies Act, 2013 and rules thereunder for the subject matter of this form and matters
incidental thereto and I have verified the above particulars (including attachment(s)) from the original/certified records
maintained by the applicant which is subject matter of this form and found them to be true, correct and complete and no
information material to this form has been suppressed. I further certify that;

i The draft memorandum and articles of association have been drawn up in conformity with the provisions of sections 4
and 5 and rules made thereunder; and

ii All the requirements of Companies Act, 2013 and the rules made thereunder relating to registration of the company
under section 7 of the Act and matters precedent or incidental thereto have been complied with.

iii The said records have been properly prepared, signed by the required officers of the Company and maintained as per the
relevant provisions of the Companies Act, 2013 and were found to be in order;

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iv I have opened all the attachments to this form and have verified these to be as per requirements, complete and legible;

v I further declare that I have personally visited the premises of the proposed registered office given in the form at the address
mentioned herein above and verified that the said proposed registered office of the company will be functioning for the business
purposes of the company (wherever applicable in respect of the proposed registered office has been given).
vi It is understood that I shall be liable for action under Section 448 of the Companies Act, 2013 for wrong certification, if any
found at any stage.
vii The draft memorandum and articles of association have been drawn up in conformity with the provisions of section 8 and rules
made thereunder; and
viii All the requirements of Companies Act, 2013 and the rules made thereunder relating to registration of the company under
section 8 of the Act and matters precedent or incidental thereto have been complied with.

To be digitally signed by DIN2 184465

Chartered accountant (in whole-time practice) or

Company secretary (in whole-time practice)

Cost accountant (in whole-time practice) or

Advocate

Whether associate or fellow:

Associate Fellow

Membership number 184465

Certificate of practice number

Income-tax PAN BLLPR3974D

For office use only:

eForm Service request number (SRN)

eForm filing date (DD/MM/YYYY) 26/07/2023

Digital signature of the authorizing officer

This eForm is hereby registered

Date of signing (DD/MM/YYYY)

Note: Attention is drawn to the provisions of sections 7(5) and 7(6) which, inter-alia, provides that furnishing of any false or
incorrect particulars of any information or suppression of any material information shall attract punishment for fraud under
section 447. Attention is also drawn to provisions of section 448 and 449 which provide for punishment for false statement
and punishment for false evidence respectively

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