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| Question | Answer |
|---|---|
| Form Name | Dir 5 Form |
| Form Length | 5 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 15 sec |
| Other names | UID, affidavit for surrender of din, DIR-5, form dir 5 |
Form
Application for surrender of Director Identification Number
[Pursuant to section 153 & rule 11(f) of Companies (Appointment
and Qualification of Directors) Rules, 2014]
Photograph
1. Applicant’s name (Enter full name and do not use abbreviations)
(a)First name:
(b)Last name:
(c)Middle name:
2.DIN of the applicant:
3.Reasons for surrender of DIN: ___________________
4.
5.And any one of the following a. Voter’s identity card number
b.Passport number
c.Driving licence number
d.UID
6. Permanent residential address:
(a) Address Line I
Line II
(b)City
(c)State
(d)Country
(e)Pin code
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(f)Phone
(g)Fax
(h)
7. Whether present residential address is same as permanent residential address:
OYes
ONo
8. Present residential address: (previous residential address, if not
residing at the present residential address for more than 1 year)
(a) Address |
Line I |
|
Line II |
(b)City
(c)State
(d)Country
(e)Pin code
(f)Phone
(g)Fax
(h)
9.Other information, if any, which the applicant intends to submit with regard to this application:
10. Whether the application is being digitally signed by the applicant himself:
OYes
ONo
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I hereby also declare that
(a)the information and other particulars given in this Form are true and correct.
(b)I have never been appointed as director in any company and the DIN has never been used for filing of any document with any authority.
Signature of the applicant:
Date:
Place:
Certification
I declare that I have been duly engaged for the purpose of certification/verification of this form. It is hereby certified that:
a. I have satisfied myself about the identity of the applicant based on the perusal of the original of the attached document
Note: In case where the applicant is residing outside India the particulars have to be verified from the documents duly attested by the attesting authority as prescribed.
b. I also verify having attested the photograph of the said person:
(i)who is personally known to me; or
(ii)who met me in person along with the original of the attested documents
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c. It is further certified that all required attachments have been completely attached to this application
d. 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 records maintained by the Company/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:-
a. All the required attachments have been completely and legibly attached to this form;
b. I have kept a copy of this form and attachments thereto, in my records for future reference.
c. It is understood that I shall be liable for action under section 448 and 449 of the Companies Act, 2013 for wrong certification, if any found at any stage.
Verified by
Company Secretary in practice / Chartered Accountant in practice / Cost Accountant in practice Or Managing Director / Director / Secretary
Mandatory Attachments:
(1)Proof of Identity:
For Indian Nationals:
(Any one of the following):
OIncome tax Permanent Account Number Card
OVoter’s identity card
OPassport
ODriving licence
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OUnique Identity Number (UIN)
For Foreign Nationals and Non Resident Indians:
OPassport
OOthers
(2)Proof of residence: (tick against the document being enclosed)
O Voter’s identity card
O Passport
O Driving license O Electricity bill O Telephone bill
O Bank account statement
OOthers - Please specify
(3)Optional attachment(s), if any.
_____________________________________________________
Note:. Attention is also drawn to provisions of Section 448 and 449 which provide for punishment for false statement and false evidence.
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