Declaration Form of Ultimate Beneficial Ownership [UBO] /

Controlling Persons
(Mandatory for Non-individual Investors)
I: Investor details:

Investor Name

PAN (Mandatory)

II: Category

Our company is a Listed Company on a recognized stock exchange in India / Subsidiary of a or Controlled
by a Listed Company [If this category is selected, no need to provide UBO details].

Name of the Stock Exchange where it is listed. _____________________________________

Security ISIN ______________________

Name of the Listed Company (applicable if the investor is subsidiary/associate): ____________________________

Unlisted Company Partnership Firm / LLP Unincorporated association / body of individuals

Public Charitable Trust Private Trust Religious Trust Trust created by a Will.

Others [please specify] ______________________________

Ultimate Beneficiary Owner (UBO) / Controlling Person(s) / Senior Managing Official details.

Does your company/entity have any individual person(s) who holds direct / indirect
controlling ownership above the prescribed threshold limit? # Yes No

If ‘YES’ - We hereby declare that the following individual person holds directly / indirectly controlling ownership
in our entity above the prescribed threshold limit. Details of such individual(s) are given below.

If ‘NO’ - declare that no individual person (directly / indirectly) holds controlling ownership in our entity above
the prescribed threshold limit. Details of the individual who holds the position of Senior Managing Official
(SMO) are provided below.
UBO-1 / Senior Managing UBO-2 UBO-3
Official (SMO)
Name of the UBO /
SMO#.

UBO / SMO PAN#.

For Foreign National,
TIN to be provided]

UBO / SMO
Country of Tax
Residency#.
UBO / SMO
Taxpayer
Identification
Number /
Equivalent ID
Number#.

UBO / SMO
Identity Type
UBO / SMO Place Place of Birth ___________ Place of Birth ___________ Place of Birth ____________
& Country of Birth#
Country of Birth _________ Country of Birth _________ Country of Birth __________

UBO / SMO
Nationality
UBO / SMO Date
of Birth [dd-mmm-
yyyy] #

UBO / SMO PEP# PEP. PEP. PEP.

Related to PEP. Related to PEP. Related to PEP.
Not a PEP. Not a PEP. Not a PEP.

UBO / SMO Residence Residence Residence

Address Type
Business Business Business
Registered Office. Registered Office. Registered Office.

UBO / SMO Public Service Public Service Public Service

Occupation
Private Service Private Service Private Service
Business Business Business
Others Others Others

SMO Designation#

UBO / SMO KYC Please attach the KYC Please attach the KYC Please attach the KYC
Complied**. acknowledgement. acknowledgement. acknowledgement.
If not complied, please complete
KYC process independently and
then submit the proof.

# Mandatory column.
** In case of Foreign Nationals, who are not KYC complied, they need to attach the ID proof in English along with the
Nationality proof, Address proof again in English. If the documentary proof is in Foreign Language, it should be translated
in English and should be attested by Indian Embassy of that country.

Note: If the given columns are not sufficient, required information in the given format can be enclosed as additional
sheet(s) duly signed by Authorized Signatory.
Participating Mutual Fund(s) / RTA may call for additional information/documentation wherever required or if the given
information is not clear / incomplete / correct and valid declaration should be submitted again with all the required
information.

Declaration

I/We acknowledge and confirm that the information provided above is true and correct to the best of my/our
knowledge and belief. In case any of the above specified information is found to be false, untrue, misleading,
or misrepresenting, I/We am/are aware that I/We may be liable for it including any penalty levied by the
statutory/legal/regulatory authority. I/We hereby confirm the above beneficial interest after perusing all
applicable shareholding pattern and MF/RTA/other registered intermediaries can make reliance on the same.
I/We hereby authorize you [RTA/Fund/AMC/Other participating entities] to disclose, share, rely, remit in any
form, mode or manner, all / any of the information provided by me, including all changes, updates to such
information as and when provided by me to any of the Mutual Fund, its Sponsor, Asset Management
Company, trustees, their employees / RTAs ('the Authorized Parties') or any Indian or foreign governmental or
statutory or judicial authorities / agencies including but not limited to the Financial Intelligence Unit-India (FIU-
IND), the tax / revenue authorities in India or outside India wherever it is legally required and other
investigation agencies without any obligation of advising me/us of the same. Further, I/We authorize to share
the given information to other SEBI Registered Intermediaries /or any regulated intermediaries registered with
SEBI / RBI / IRDA / PFRDA to facilitate single submission / update & for other relevant purposes. I/We also
undertake to keep you informed in writing about any changes / modification to the above information in future
within 30 days of such changes and undertake to provide any other additional information as may be required
at your / Fund’s end or by domestic or overseas regulators/ tax authorities.

Signature with relevant seal:

Authorized Signatory Authorized Signatory Authorized Signatory

Name: Name: Name:

Designation: Designation: Designation:

Place: ______________________

Date: __/ ___/ ____

 Instructions on Controlling Persons / Ultimate Beneficial Owner

As per PMLA guidelines and relevant SEBI circulars issued from time to time, non-individuals and trusts are required to
provide details of controlling persons [CP] / ultimate beneficiary owner [UBO] and submit appropriate proof of identity of
such CPs/ UBOs. The beneficial owner has been defined in the circular as the natural person or persons, who ultimately
own, control or influence a client and/or persons on whose behalf a transaction is being conducted and includes a person
who exercises ultimate effective control over a legal person or arrangement.

A. For Investors other than individuals or trusts:

(i) The identity of the natural person, who, whether acting alone or together, or through one or more juridical person,
exercises control through ownership or who ultimately has a controlling ownership interest. Controlling
ownership interest means ownership of/entitlement to:
- more than 10% of shares or capital or profits of the juridical person, where the juridical person is a company.
- more than 10% of the capital or profits of the juridical person, where the juridical person is a partnership or or
who exercises control through other means.”
For the purpose of this clause, “Control” shall include the right to control the management or policy decision.
- more than 15% of the property or capital or profits of the juridical person, where the juridical person is an
unincorporated association or body of individuals.
(ii) In cases where there exists doubt under clause (i) above as to whether the person with the controlling ownership
interest is the beneficial owner or where no natural person exerts control through ownership interests, the identity
of the natural person exercising control over the juridical person through other means like through voting rights,
agreement, arrangements or in any other manner.
(iii) Where no natural person is identified under clauses (i) or (ii) above, the identity of the relevant natural person who
holds the position of senior managing official.

B. For Investors which is a trust:

The identity of the settler of the trust, the trustee, the protector, the beneficiaries with 10% or more interest in the trust
and any other natural person exercising ultimate effective control over the trust through a chain of control or
ownership.

Provided that in case of a trust, the reporting entity shall ensure that trustees disclose their status at the time of
commencement of an account-based relationship or when carrying out transactions as specified in clause (b) of sub-
rule (1) rule 9.

C. Exemption in case of listed companies / foreign investors

The client or the owner of the controlling interest is a company listed on a stock exchange or is a majority-owned
subsidiary of such a company, there is no need for identification and verification of the identity of any shareholder or
beneficial owner of such companies and hence exempted from UBO declaration provided other requisite information is
provided. Intermediaries dealing with foreign investors’ viz., Foreign Institutional Investors, Sub Accounts and
Qualified Foreign Investors, may be guided by the clarifications issued vide SEBI circular CIR/MIRSD/11/2012 dated
September 5, 2012 and other circulars issued from time to time, for the purpose of identification of beneficial
ownership of the client.

D. KYC requirements

Beneficial Owner(s) / Senior Managing Official (SMO) is/are required to comply with the prescribed KYC process as
stipulated by SEBI from time to time with any one of the KRA & submit the same to AMC. KYC acknowledgement
proof is to be submitted for all the UBO(s) / SMO(s).

In case of Foreign Nationals, who are not KYC complied, they need to attach the ID proof in English along with the
Nationality proof, Address proof again in English. If the documentary proof is in Foreign Language, it should be
translated in English and should be attested by Indian Embassy of that country.
Sample Illustrations for ascertaining beneficial ownership:

Illustration No. 1 – Company A

Company A

Individual 1 Individual2 Company Z Company Y Individual3

8% 7% 55% 25% 5%

Company Individual4 Individual5 Individual6 Individual7 Company W

25% 60% 15% 20% 20% 60%

Individual8 Individual9 Individual10 Individual11 Individual12 Individual13

50% 25% 25% 35% 35% 30%

For Applicant A, Individual 4 is considered as UBO as it holds effective ownership of 33% in Company A. Hence details of
Individual 4 must be provided with KYC proof, Shareholding pattern of Company A, Z & Y to be provided along with details
of persons of Company Y who are senior managing officials and those exercising control.

Illustration No. 2 – Partner ABC

Partnership Firm ABC

Partner1 Partner 2 Partner 3 Partner 4 Partner 5

40% 25% 20% 10% 5%

For Partnership Firm ABC, Partners 1, 2, 3 and 4 are considered as UBO as each of them holds >=10% of capital. KYC
proof of these partners needs to be submitted including shareholding.

Illustration No. 3 – Trustee ZYX

Trust ZYX

Beneficiary A Beneficiary B Beneficiary C Beneficiary D

50% 30% 12% 8%

For Trust ZYX, Beneficiaries A, B and C are considered as UBO as they are entitled to get benefitted for >=10% of funds
used. KYC proof for these beneficiaries needs to be submitted. Additionally, if they have nominated any person or group of
persons as Settlor of Trust / Protector of Trust, relevant information to be provided along with the proof indicated.