Declaration by registered holder/beneficial owner of shares under LIC Act, 1956

MINISTRY OF FINANCE
(Department of Financial Services)
NOTIFICATION
New Delhi, the 3rd March, 2022

S.O. 995(E).—In exercise of the powers conferred by section 50 of the Life Insurance Corporation Act, 1956 (31 of 1956), the Central Government hereby notifies that the form, manner, period and details prescribed in respect of declaration to be made and particulars to be included in the register to be maintained under the Companies Act shall apply to the Corporation under section 5C of the Act with the following modifications, exceptions and conditions, namely:—

1. Declaration by registered holder of shares who does not hold beneficial interest in such shares.—(1) A person whose name is entered in the register of members of the Corporation as the holder of shares in the Corporation but who does not hold beneficial interest in such shares shall, within a period of thirty days from the date on which the name of such person is entered in that register, make a declaration in Form I, referred to in sub-section (1) of section 5C of the Act.

(2) Where any change occurs in the beneficial interest in shares of the Corporation, the person referred to in sub­paragraph (1) shall, within a period of thirty days from the date of such change, make a declaration in Form I, referred to in sub-section (3) of section 5C of the Act.

(3) The Corporation shall, within thirty days of receipt of a declaration under sub-paragraph (1) or sub-paragraph (2), enter the details contained therein in the register of members, and issue an acknowledgment in Form II.

2. Declaration by beneficial owner who holds or acquires beneficial interest in shares but whose name is not entered in register of members.—(1) Every person who holds or acquires beneficial interest in shares of the Corporation shall, within a period of thirty days from the date on which he acquires such beneficial interest in shares of the Corporation, make a declaration in Form III, referred to in sub-section (2) of section 5C of the Act.

(2) Where any change occurs in the beneficial interest in shares of the Corporation, the person referred to in sub­paragraph (1) shall, within a period of thirty days from the date of such change, make a declaration in Form III, referred to in sub-section (3) of section 5C of the Act.

(3) The Corporation shall, within thirty days of receipt of a declaration under sub-paragraph (1) or sub-paragraph (2), enter the details contained therein in the register of members, and issue an acknowledgment in Form II.

3. Declaration by beneficial owner who holds or acquires significant beneficial ownership in shares.—(1)

Every individual who is a significant beneficial owner as referred to in sub-section (6) of section 5C of the Act shall, within a period of ninety days from the date of publication of this notification, make a declaration in Form IV .

(2) Every individual who acquires the beneficial interest or rights referred to in sub-section (6) of section 5C of the Act, or the nature of whose interest and other particulars specified in a declaration made under sub-paragraph (1) undergo a change shall, within a period of thirty days from the date of such acquisition or change, make a declaration in Form IV.

(3) The Corporation shall, within thirty days of receipt of a declaration under sub-paragraph (1) or sub-paragraph (2), enter the details contained therein in the register to be maintained under sub-section (7) of section 5C of the Act, and issue an acknowledgment in Form II.

4. Register.—The Corporation shall maintain the register referred to in sub-section (7) of section 5C of the Act in Form V.

FORM I

[See section 5C(1)]

Declaration by the registered holder of shares who does not hold beneficial interest in such shares

To:

Life Insurance Corporation of India
Central Office
‘Yogakshema’
Jeevan Bima Marg
Nariman Point
Mumbai – 400 021

1. Particulars of the registered owner of the shares

(i) Name:____________________________

(ii) Name of the father or mother or spouse:___

(iii) Occupation:____________________

(iv) Whether citizen of India

Yes

No

(v) Nationality (in case of foreign national):_____________________

(vi) Date of birth or Age:_____________________

(vii) Gender:

•  Male
•  Female
•  Third gender

(viii) Income-tax Permanent Account Number (PAN):_______________________

(ix) Proof of identity:

(a) For Indian nationals (any of the following):

• • Income-tax PAN card
  • Electoral photo identity card issued by the Election Commission of India
  • Passport
  • Driving licence
  • Unique identification number (Aadhaar) card

(b) For foreign nationals and non-resident Indians

• • Passport
  • Other

(x) Permanent residential address details:

(a) Country code assigned by the International Organisation for Standardization (ISO):

(b) Country:

(c) Landline phone number:

(d) Mobile number:

(e) Fax number:

(f) Email address:_____________

(xi) Whether the present residential address is same as the permanent residential address

O Yes

O No

(xii) If no, details of the present residential address:

(a) Country code assigned by the International Organisation for Standardisation (ISO):

(b) Country: ______________

(c) Landline phone number: ______________

(d) Mobile number: ______________

(e) Fax number: ______________

(f) Email address: ______________

2. Particulars of the shares in respect of which declaration is being made by the registered holder of shares:

(i) Class of shares: _______________

(ii) Number of shares: _______________

(iii) Distinctive numbers: From _______________ to _______________

(iv) Certifícate number: _______________

(v) Folio number: _______________

(vi) Nominal value of shares: _______________

(vii) Paid-up value of shares: _______________

3. Declaration:

In pursuance of sub-section (1) of section 5C of the Life Insurance Corporation Act, 1956, I, ___________________ , hereby declare that the person(s) named below hold(s) beneficial interest in the shares mentioned above which are registered in my name in the register of members of the Corporation:

S. No.	Name of beneficial owner	Address and email address	Date of birth or Age	Name of the father or mother or spouse	Occupation	Nationality
(1)	(2)	(3)	(4)	(5)	(6)	(7)

–

Corporate Identity Number (CIN), in case of company or Limited Liability Partnership Identification Number (LLPIN), in case of limited liability partnership or Income-tax Permanent Account Number or Aadhaar number	Passport number (in case of foreign national)	Distinctive number (if applicable)
(8)	(9)	(10)

4. Details of beneficial interest:

(i) Nature of the beneficial interest: _______________

(ii) Date of creation of the beneficial interest: _______________

(iii) Reasons for not registering shares in the name of the beneficial owner: _______________

(iv) Particulars of the instrument or document, if any, showing the creation of such beneficial interest:

5. Particulars of change in beneficial interest:

(i) Date of change: _______________

(ii) Nature of the change in the beneficial interest: _______________

(iii) Brief particulars of such change: _______________

(iv) Reason for such change: _______________

(v) Particulars of the instrument or document, if any, showing the change in such beneficial interest: ___________________________________________________

Place: _____

Date:_____

Signature of the registered holder of shares

Attachments:

(1) Proof of identity of the registered holder of shares and the beneficial owner

(2) Instrument or document under which the beneficial interest is created or transferred or changed

FORM II

Acknowledgment of receipt of declaration

Date: ________________
______________________________________________________

[Name of the member/ person making the declaration]
___________________________________________________________________________
___________________________________________________________________________

[Address of the member/person]

The Life Insurance Corporation of India hereby acknowledges receipt of the declaration made by you under the following sub-section(s) of section 5C of the Life Insurance Corporation Act, 1956:

• Sub-section (1)
• Sub-section (2)
• Sub-section (3)
• Sub-section (6)

We have received the said declaration on__________ [insert date] and the details have been recorded in the following register(s):

• Register of members
• Register of interest declared by significant beneficial owner

Signature of authorised person
Name:_________________________________
Life Insurance Corporation of India
Central Office, ‘Yogakshema’, Jeevan Bima Marg
Nariman Point, Mumbai – 400 021

FORM III

[See section 5C(2)]

Declaration by the beneficial owner who holds or acquires beneficial interest in shares but whose name is not entered in the register of members

To:

Life Insurance Corporation of India
Central Office
‘Yogakshema’
Jeevan Bima Marg
Nariman Point
Mumbai – 400 021

1. Particulars of the shares in which beneficial interest is held by the person making declaration:

(i) Class of shares: _______________

(ii) Number of shares: _______________

(iii) Distinctive numbers: From _______________ to _______________

(iv) Certifícate number: _______________

(v) Folio number: _______________

(vi) Nominal value of shares: _______________

(vii) Paid-up value of shares: _______________

2. Particulars of the beneficial owner:

S. No.	Name of beneficial owner(s)	Address and email address	Date of birth or Age	Name of the father or mother or spouse	Occupation	Nationality
(1)	(2)	(3)	(4)	(5)	(6)	(7)

–

Corporate Identity Number (CIN), in case of company or Limited Liability Partnership Identification Number (LLPIN), in case of limited liability partnership or Income-tax Permanent Account Number or Aadhaar number	Passport number (in case of foreign national)
(8)	(9)

3. Declaration:

In pursuance of sub-section (2) of section 5C of the Life Insurance Corporation Act, 1956, I, ___________________ , hereby declare that I hold or have acquired beneficial interest in the share mentioned above, which are registered in the name of the person whose particulars are furnished in item 4 below.

4. Particulars of the registered holder of share(s):

S. no.	Name of registered holder of share	Address and email address	Date of birth or Age	Name of the father or mother or spouse	Occupation	Nationality
(1)	(2)	(3)	(4)	(5)	(6)	(7)

–

Corporate Identity Number (CIN), in case of company or Limited Liability Partnership Identification Number (LLPIN), in case of limited liability partnership or Income-tax Permanent Account Number or Aadhaar number	Passport number (in case of foreign national)
(8)	(9)

5. Details of the beneficial interest:

(i) Date of creation of the beneficial interest: _____________

(ii) Mode of acquisition of beneficial interest:

•  Allotment
•  Transfer
•  Other

If other, specify:____________________________________________

(iii) Nature of the beneficial interest:______________

(iv) Reasons for not registering shares in my name:______________

(v) Particulars of the instrument or document, if any, showing the creation of such beneficial interest:

Particulars of the person from whom the beneficial interest is acquired (if applicable):

(i) Name of the transferor of beneficial interest: ____________________________

(ii) Whether shares were registered in his name:

• • Yes
  • No

If no, whether any declaration under sub-section (2) of section 5C of the Life Insurance Corporation Act, 1956 was filed by him to the Corporation?

• • Yes
  • No

If yes, the date of such declaration: _________________

(iii) Particulars of the instrument or document, if any, showing the change in such beneficial interest:

7. Particulars of change in beneficial interest:

(i) Date of change: _______________

(ii) Nature of the change in the beneficial interest: _______________

(iii) Brief particulars of such change: _______________

(iv) Reason for such change: _______________

(v) Particulars of the instrument or document, if any, showing the change in such beneficial interest: ___________________________________________________

Place: ____________

Date: ____________

Signature of the beneficial owner

CERTIFICATE

I hereby certify that the beneficial interest in the shares mentioned above has been transferred by me on         .

Place:______________

Date:

Signature of the person who has transferred the

beneficial interest in the shares

Attachments:

(1) Proof of identity of the registered holder of share and the beneficial owner

(2) Instrument or document under which the beneficial interest is created or transferred or changed

FORM IV

[See section 5C(6)]

Declaration by the beneficial owner who holds or acquires significant beneficial ownership in shares

To:

Life Insurance Corporation of India
Central Office
‘Yogakshema’
Jeevan Bima Marg
Nariman Point
Mumbai – 400 021

1. Purpose of filing the form (choose any one):

• For declaration of significant beneficial ownership under sub-section (6) of section 5C
• For change in significant beneficial ownership under sub-section (6) of section 5C

In case the significant beneficial owner has earlier submitted online any return to the Registrar of Companies in respect of a declaration under section 90 of the Companies Act, 2013, the significant beneficial owner identity number (“SBO ID”) generated upon such submission:____________

2. Particulars of the holder of the significant beneficial interest:

Name of the significant beneficial owner (given name and last name)
Address and email address
Date of birth or Age
Name of the father or mother or spouse
Occupation
Nationality
Passport number (in case of foreign national)

3. Nature of indirect holding or exercise of right in the Corporation through member of the Corporation (where more than one, repeat this paragraph of the form):

(a) Type of member {company or limited liability partnership (LLP) or Hindu undivided family (HUF) or partnership firm or discretionary trust or charitable trust or specific trust or revocable trust or pooled investment vehicle (PIV) or entity controlled by PIV or any other body corporate}: ___________

(b) Corporate Identity Number (CIN) or Limited Liability Partnership Identification Number (LLPIN) or any other registration number, allotted under the relevant law: ________

(c) Name of the member: _________

(d) Address:
___________________________________________
___________________________________________

City: _________

State: _________

Country: _________

Postal Index Number (PIN): _________

(e) Nature of indirect holding or exercise of right in the Corporation:

• By virtue of shares:________ %
• By virtue of voting rights in shares: _______%
• By virtue of rights on distributable dividend or any other distribution:__________ % D By virtue of exercise of control (attach copy of agreement)
• By virtue of exercise of significant influence^# (attach copy of agreement)

(f) Status of significant beneficial owner in the member of the Corporation (choose any one):

•  Partner, in case of a partnership firm or an LLP
•  Karta, in case of an HUF trustee or a discretionary trust or a charitable trust
•  Beneficiary, in case of a specific trust
•  Author or settlor, in case of a revocable trust
•  General Partner, Investment Manager or Chief Executive Officer, in case of PIV or entity controlled by PIV
•  Individual, in case of a company or any other body corporate

(g) In case the member is a partnership firm or LLP, specify whether the significant beneficial owner—

• is a partner;
•  holds majority stake^* in the body corporate partner;
•  holds majority stake^* in the ultimate holding company of the body corporate partner.

(h) In case the member is a company or any other body corporate, specify whether the significant beneficial owner holds (choose any one)—

• majority stake^* in such company or body corporate;
• majority stake^* in the ultimate holding company of such company or body corporate.

(i) Whether significant beneficial owner has any direct holding or right in the Corporation (choose any one):

•  Yes
•  No

If yes, enter details below:

By virtue of shares: _______%

By virtue of voting rights in shares: ______%

By virtue of rights on distributable dividend or any other distribution:_______ % 0 By virtue of exercise of control (attach copy of agreement)

By virtue of exercise of significant influence^# (attach copy of agreement)

Date:______________

Place:

Signature of the holder of the

significant beneficial interest

* “Majority stake” means—

(a) holding more than one-half of the equity share capital in the body corporate; or

(b) holding more than one-half of the voting rights in the body corporate; or

(c) having the right to receive or participate in more than one-half of the distributable dividend or any other distribution by the body corporate.

# “Significant influence” means the power to participate, directly or indirectly, in the financial and operating policy decisions of the Life Insurance Corporation of India but is not control or joint control of those policies. Attachments:

(1) ______________

(2) ______________

…

FORM V

[See section 5C(7)]

Register of interest declared by significant beneficial owners in shares of the Life Insurance Corporation of India

S. no.	Name of beneficial owner(s)	Address and email address	Date of birth or Age	Name of the father or mother or spouse	Occupation	Nationality
(1)	(2)	(0)	(0)	(4)	(0)	(1)

–

Corporate Identity Number (CIN), in case of company or Limited Liability Partnership Identification Number (LLPIN), in case of limited liability partnership or Income-tax Permanent Account Number or Aadhaar number	Passport number (in case of foreign national)
(8)	(9)

–

Date of declaration under section 5C(6) of the Life Insurance Corporation Act, 1956	Date of cessation of significant beneficial interest	Date of entry in this register	Any other interest (if any)	Status	Authentication or signature
(10)	(11)	(12)	(13)	(14)	(15)

[F. No. I-13011/03/2021-Ins.II]

SAURABH MISHRA, Jt. Secy.