FORM No. 39

Registration No. of Company___________________..

THE COMPANIES ACT, 1956
Registration’ of an existing company

List of Members
[Pursuant to section 5671

Name of Company_______________________
Presented for filing by_______________.
Name in
full

Address Occupation Number of
shares or
amount of
stock held

Distinctive
number of
shares

1 2 3 4 5

Signature
Designation

Dated the_________________day
of_______________..19__________.

We______________.. of_________________ and

___________..being two of the_______________..
0f________________. do solemnly and, sincerely
declare that the particulars set forth in the several
documents accompanying this declaration are true to our
knowledge in regard to the particulars
_______________and true to the best of our information
and belief in regard to the other particulars.

Signature

Designation

Dated the______________. day of______________ 19
1 Not more than six clear days before delivery for
registration.
2 State whether Director, Managing Director, Manager or
Secretary.
3 State whether Directors, or other principal officers.
4 Insert name of the company.