INC-4 - One Person Company - Change in Member/ Nominee

Company Information

Purpose of filing

1. *This form is for

Notice of withdrawal of consent by the nominee of OPC

Intimation about change in the name of the nominee of OPC

Intimation of Cessation

Company Information

2 *Corporate Identity Number (CIN)

2 *Corporate Identity Number (CIN) of company

2 *Corporate identity number(CIN) of the company

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Company Name	CIN Number

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Company Name	CIN Number

1. Company Information

Particulars of the company

2 *Corporate Identity Number (CIN) of the Company

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Company Search Box

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Company Name	CIN Number

(a) *Corporate Identity Number (CIN) of the Company

(b) *Name of the company

(d) *Email Id

3 (a) *Name of the one-person company

(b) *Registered office address

4 Notice of withdrawal of consent

Notice of Withdrawal of consent by Nominee (Following fields are applicable in case option 1 is selected in data field 1)

Notice is hereby given that

was nominated as the nominee of

has withdrawn his/her consent vide his/her notice dated

a copy of which is attached herewith.

Intimation about change in nomination (Following fields are applicable in case option 2 is selected in data field 1)

5 Intimation about change in nomination

Notice is hereby given that

member of

has nominated

vide intimation dated

as his/her nominee in place of

who shall become the member of the company in the event of his/her death or his/her incapacity to contract.

He/she declares that the nominee is eligible for nomination within the meaning of Rule 3 of the Companies (Incorporation) Rules,2014.

Intimation of Cessation of member (Following fields are applicable in case option 3 is selected in data field 1)

6 Intimation of Cessation of member

(a) Intimation is hereby given that

has ceased to be member of

w.e.f

due to

(Death of the member/ Incapacity of member to contract/ Change in ownership)

and

First Name

Middle Name

Last Name

(his/her nominee/ the transferee)

has become the sole member of the above

mentioned company.

(b) Whether the nominee is same (in case of change in ownership)

Yes

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Company Name	CIN Number

Nominee Details

Intimation about the change of nominee (Following fields are applicable in case option 1 or 3 is selected in data field 1)

7 Intimation about the change of nominee

Further notice is given that

(Member/ New member)

has nominated

First name/Name of the existing nominee

Middle name

Surname

as his nominee w. e. f.

who shall become the member of the company in the event his/her death or his/her incapacity

to contract. He/she declare that the nominee is eligible for nomination within the meaning of Rule 3 of the Companies (Incorporation) Rules 2014.

Particulars of the nominee (Following fields are applicable in all the cases except the case 'Yes' is selected in field 6(b))

8 Particulars of the nominee

Director Identification number (DIN)

Fetch from digi locker

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 and State)

Occupation type

Area of Occupation

If ‘Other’s , please specify

*Educational Qualification

If ‘Other’s , please specify

Permanent address

Address Line 1

Address Line 2

Country

Pin Code/Zip code

Area/Locality

City

District

State/Union territory

Phone (with STD/ISD code)

Mobile No.

Fax

email ID

Enter OTP

Whether present residential address same as permanent residential address

Yes

Present address

Address Line 1

Address Line 2

Country

Pin Code/Zip code

Area/Locality

City

District

State/Union territory

Duration of stay at present address

year(s)

month(s)

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

Previous address

Address Line 1

Address Line 2

Country

Pin Code/Zip code

Area/Locality

City

District

State/Union territory

*Proof of Identity

Proof of Identity Number

Identity Proof Document

Residential Proof

Residential Proof No.

Residential Proof Document

Consent along with declaration by Nominee

hereby give my consent to become the member of

in the event of death of

member of the company or his incapacity to contract.

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

New Member Details

Particulars of the new member (Following fields are applicable in case option 3 is selected in data field 1)

9 Particulars of the new member

Director Identification number (DIN)

Fetch from digi locker

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 and State)

Occupation type

Area of Occupation

If ‘Other’s , please specify

*Educational Qualification

If ‘Other’s , please specify

Permanent address

Address Line 1

Address Line 2

Country

Pin Code/Zip code

Area/Locality

City

District

State/Union territory

Phone (with STD/ISD code)

Mobile No.

Fax

email ID

Enter OTP

Whether present residential address same as permanent residential address

Yes

Present address

Address Line 1

Address Line 2

Country

Pin Code/Zip code

Area/Locality

City

District

State/Union territory

Duration of stay at present address

year(s)

month(s)

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

Previous address

Address Line 1

Address Line 2

Country

Pin Code/Zip code

Area/Locality

City

District

State/Union territory

Proof of Identity

Proof of Identity Number

Identity Proof Document

Residential Proof

Residential Proof No.

Residential Proof Document

Attachments & Declaration

Attachments

(a) *Notice of withdrawal of consent filed by the nominee

(a) *Copy of intimation given by member for change in nominee

(a) *Proof of Cessation of member

(b) Optional attachment(s) - if any

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Declaration

*To be digitally signed by member

*Income-tax PAN or Director identification number (DIN) of the member

*To be digitally signed by

*Designation

*DIN of the director or Income tax PAN of the manager or CEO or CFO or Membership number of the company secretary

Note: Attention is drawn to provisions of Section 448 and 449 of the Companies Act, 2013 which provide for punishment for false statement / certificate and punishment for false evidence respectively.

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eForm Service request number (SRN)

eForm filing date (DD/MM/YYYY)