I, ————————-, hereby give my consent to act as Company Secretary of “The Company”——————–, according to Section 170(2) and 203(1) of the Companies Act, 2013 and certify that I am not interested in any way in any of the Company(s)/Body Corporate(s)/firm(s) or any other Entity/Association of Individuals.
1. Membership Number: —————-
3. Father’s Name (in full): ——————————-
4. Address: —————————————————-
5. E-mail ID: ————————————————–
6. Mobile No.: ————————————————
8. Occupation: ———————————————–
9. Date of birth: ———————————————
10. Nationality: ———————————————
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, Company Secretary, Chief Financial Officer, Manager: NIL
12. Particulars of membership No. and Certificate of practice No. if the applicant is a member of any professional Institute. Specifically state NIL if none: Associate Member of Institute of Company Secretaries of India (Membership No. —————–)
Declaration:
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 any breach of duty to any Company under this Act or any previous company law.
Signature
Designation: Company Secretary
Date:
Place:
Attachments:
1. Proof of identity: Copy of PAN Card
2. Proof of residence: Copy of Aadhar Card