Form Cac 10b - Annual Return For A Company Limited By Guarantee - Corporate Affairs Commission Page 2

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Surname:
Others Names:
Nationality:
Age
Tel. No.
Residential Address
City
State
P.O. Box
Email
Business Occupation
Particulars of other directorships
Surname:
Others Names:
Nationality:
Age
Tel. No.
Residential Address
City
State
P.O. Box
Email
Business Occupation
Particulars of other directorships
Surname:
Others Names:
Nationality:
Age
Tel. No.
Residential Address
City
State
P.O. Box
Email
Business Occupation
Particulars of other directorships
5.
Particulars of person who is Secretary of the Company at the date of this return.
Full Name (registered name for
Residential Address (In case of
Particular of Registration (if a
Date of Appointment
Body Corporate or Firm) &
Corporate the Registered or
Firm or Company)
Tel. No.
Principal Address)
We certify that the excess of the number of members of the company over fifty (where number exceeds fifty) consists wholly of
persons, who under Section 22(3) of the Companies and Allied Matters Act, 1990 are not to be included in reckoning the
number of fifty.
___________________________
_________________________
Signature of Director
Name of Director
___________________________
_________________________
Signature of Secretary
Name of Secretary
Note:
i.
If there is insufficient space on the form to provide any information required, please attach a separate sheet containing the information set
out in the prescribed form.
ii.
This return should be accompanied by Audited Account of Company for the year in which the return is made.
Presented for filing by:
Name: __________________________________________________ Accreditation Number: ________________________________
Address: ____________________________________________________________________________________________________
Tel. No. & E-mail: ________________________________________________ Signature & Date: ____________________________

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