ADDITIONAL INFORMATION REGARDING EXISTING REGISTRATION IN BLUE STAR LIMITED

Constitution:

Type of Organization (Strike out those not Documents to be enclosed

applicable)
Sole Proprietorship PAN and address proof (Driving License or
Aadhaar or passport)
Partnership Firm Registered Partnership Deed, PAN and address
proof (Driving License or Aadhaar or passport) of
existing partners.
Company (Private or Public) Certificate of Incorporation, Memorandum and
Articles of Association, List of Directors along
with DIN and PAN and details of directors,
shareholders holding majority shareholding or
shareholding pattern
HUF Deed of declaration of HUF/ List of coparceners,
PAN and Address proof (Driving License or
Aadhaar or passport)of coparceners.
Other PAN and List of Partner/Owners along with PAN
and percentage of interest, address proof
(Driving License or Aadhaar or passport)

Disclosure*

I am/my relative isrelated to an employee/director of Blue YES/NO (If Yes, pls. provide details:
Star or its subsidiary company or associate company in
India or overseas (Blue Star Group). Name of the employee/director:
Relationship:
I /my relative am/is a partner in a partnership firm in which
an employee/director of Blue Star Group and/or his
relative(s) is a partner.
I/my relative am/is a director/member of a private
company in which an employee/director of Blue Star
Group and/or his/her relative(s) is a director or member.
I/my relative am/is a director/member of a public company
in which employee/director of Blue Star Group and/or
his/her relative (s) is holding 2% of paid-up share capital.
I/my relative am/is a member of HUF in which
employee/director of Blue Star Group and/or his relative(s)
is Karta or Coparceners
I/ my relative am/is associated with any other entity(ies) in
which employee/director of Blue Star Group and/or his
relative(s) is a partner, owner or member, as the case may
be.
*This disclosure is also required to be given in case any person is interested or concerned through relative(s) in the aforesaid entity(ies).
“Relative” meansaspouse of a person, and includes parents, siblings and child of such person or of the spouse.
 DECLARATION BY THE APPLICANT

I/We hereby by my/our own volition grant my consent to Blue Star Group to make use of the
information provided by me in this declaration and hereby authorize Blue Star Group or any
agencyappointed by Blue Star Group or their representatives to verify information
presented/furnished and to procure an investigative report for that purpose.

I/ We hereby confirm that the above information is true and verified by me as validly obtained. I /
We also undertake that, if at any stage, the above information are found to be incorrect, Blue Star
Group shall reserve the right to cancel my/our registration, at any time, without notice, at its
discretion. Further Blue Star Group shall be free and entitled to initiate appropriate legal
proceedings/actionsdue to damages whether monetary or otherwise caused by such
misrepresentation.

SIGNATURES OF DIRECTORS / PROPRIETOR / ALL PARTNERS/KARTA

(NAME IN BLOCK LETTERS) (SIGNATURE)

1. VISHWAJIT SHRIPAD KULKARNI

(ATTACH PHOTOGRAPHS OF DIRECTOR/ ALL PARTNERS/ PROPRIETOR/KARTA)

(COMPANY / FIRM SEAL)

DATE: 28/10/2019

PLACE: PUNE