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Form No.DIR-5

Application for surrender of Director Identification Number [Pursuant to section 153 of the Companies Act, 2013 and rule 11 of the Companies (Appointment and Qualification of Directors) Rules, 2014]

Refer instruction kit for filing the form

Tab1
Declaration & Attachments

Attachments

(a) Proof of Identity of the applicant

(b) Proof of residence of the applicant

(c) Affidavit including declaration that retained DIN will be updated with all CIN/LLPIN association

(d) Copy of court order declaring DIN holder as insolvent/unsound mind

(e) Copy of death certificate

Sr. No

(f) Optional Attachment(s) - if any

1.

Declaration

*I hereby declare that Information and other particulars given in this form are true and correct.

I further declare that I have never been appointed as director in any companv/LLP and the DIN has never been used for filing of any document with any authority.

*Name

*DIN / PAN / Passport / Membership number

Certificate by Practicing Professional

*I declare that I have been duly engaged for the purpose of certification of this form.

*I have satisfied myself about the identity of the applicant based on perusal of the original of the attached document.

Note - In case where the applicant is residing outside India the particulars have to be verified from the documents duly attested by the attesting authority as prescribed.

*I have gone through the provisions of the Companies Act, 2013 and Rules thereunder for the subject matter of this form and matters incidental thereto and I have verified the above particulars (including attachment(s)) from the original records maintained by the applicant which is subject matter of this form and found them to be true, correct and complete and no information material to this form has been suppressed.

*I further certify that all the required attachments have been completelv and legibly attached to this form and it is understood that I shall be liable for action under Section 449 of the Companies Act, 2013 for wrong certification, if any found at any stage.

Category [In whole time practice]

Chartered Accountant Cost Accountant or Company Secretary

Company Secretary

Whether associate or fellow

Associate Fellow

Membership number or Certificate of practice number

Reason for Surrender

Photograph of the DIN holder

1. *Reason for surrender of DIN

Having multiple DINs
DIN was obtained in a wrongful manner or by fraudulent means
Death of the concerned individual
Concerned individual is declared as a person of unsound mind by a competent court
Concerned individual has been adjudicated as insolvent
Concerned individual is/was not associated with any company/LLP and the DIN has never been used for filing of any document with any authority

Retained DIN details

2 (a) *Whether DIN holder is retaining any DIN Yes No

(b) Mention the DIN to be retained

(Note: DIN mentioned aforesaid will be replaced with all the other DINs for which surrender application is filed by the user)

(c) Name of the DIN holder

(i) First Namee

(ii) Middle Name

(iii) last Name

(d) Father's Name

(i) First Namee

(ii) Middle Name

(iii) last Name

(e) Date of Birth (DD/MM/YYYY)

10 *Date of birth

Surrendered DIN details

3 *Specify the number of DIN(s) being surrendered by the applicant

Applicant's Details

4 (a) *Whether the application is being digitally signed by the holder of DIN himself Yes No

Other Details

6 Other information, if any, which the applicant intends to submit with regard to this application