BO2 ANNUAL CONFIRMATORY BENEFICIAL OWNERSHIP DECLARATION FORM

BO2 ANNUAL CONFIRMATORY DECLARATION FORM
Name of Person completing Form:

First NameLast Name
Email address of Person Completing Form:
example@example.com
PART A - ENTITY PARTICULARS & INFORMATION
FULL LEGAL NAME OF ENTITY
(Entity Information)
ENTITY REGISTRATION NUMBER:
(Entity Information)
1. DIRECTOR / SHAREHOLDER / MEMBER / BENEFICIAL OWNER DECLARATION:

I, the undersigned, for and on behalf of the reporting entity confirm that all information provided previously, remain the same and is accurate, adequate and up to date.
NAME OF DIRECTOR / SHAREHOLDER / MEMBER /BENEFICIAL OWNER
Full Name

DATE (DDMMYYY)

Rows	D	D	M	M	Y	Y	Y	Y
Date

2. ACCOUNTABLE INSTITUTION DECLARATION:

I, the undersigned, for and on behalf of the reporting entity confirm that to the best of my knowledge all information provided previously remain the same and is accurate, adequate and up to date.
NAME OF ACCOUNTABLE INSTITUTION
NAME OF AUTHORISED STAFF
POSITION

DATE (DDMMYYY)

Rows	D	D	M	M	Y	Y	Y	Y
Date

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NB: UPON COMPLETION FORM MUST BE DOWNLOADED AND SIGNED BEFORE SUBMISSION TO BIPA.
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BO2 ANNUAL CONFIRMATORY DECLARATION FORM