CM 23 Annual Return
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Form CM23
REPUBLIC OF NAMIBIA
BUSINESS AND INTELLECTUAL PROPERTY AUTHORITY - BIPA
COMPANIES ACT 2004
(Sections 181, 182 and 336) (Regulations 39 and 40))
And
The Financial Intelligence Act 2012
(Section 4, Regulation 2)
ANNUAL RETURN
Name and postal address of Company
__________________________________________________________________________________________________________________________________________________________________________________________
PART A
Name And Number Of Holding Company
Registration Number of Company
Day
Month
Year
For office use
Annual return for calendar year
DATA PROCESSING
Date incorporated/registered/established
1 Recorded
Date and Initials............................
(c) Annual General Meeting
Date of annual general meeting held in respect
2. Corrections
of previous financial year (if an extension of time was applied for a statement in that regard)
Codes.............................................
(d) End of Financial year
Date and initials..................................
Summary of total issued capital as at end of Financial Year
Total Amount of issued share capital…………………………………………………………………………………………………………………… (1) N$ …………………………………………………….……………
Total amount of share premium account ……………………………………………………………………………………………………………. (2) N$......................................................................
Total………………………………………………………………………………………………………………………………………………………………….… N$......................................................................
Total stated capital in respect of no par value shares ………………………………………………………………………………………... (3) N$.....................................................................
_______________________________________________________________________________________________________________________________________
Annual duty paid on (1), (2) and (3) above………………………………………………………………………………………………………………… N$......................................................................
Situation of Registered Office
Postal address
Description of main business actually carried on by company
Email:
Telephone Number/
Mobile Number:
Perforated) (To be completed by company)
ANNUAL RETURN FOR CALENDAR YEAR........
Return received
Name of company
Date stamp of Business
Registration Office
Postal address
Email:
Registrar of Business
Invalid unless stamped by the Registrar of Business
PART B
LIST OF DIRECTORS, OFFICERS AND AUDITORS OF THE COMPANY
Directors
Surname_______________________________ Forenames_________________________________ ____________ Director Alternate Director
Former surnames and forenames______________________________________________________________ _____________________________________________
State whether shareholder (if yes, kindly complete Part C below) Yes/No _________
Contact details Tick if new director
Residential Address
Business address & Email
Postal Address
Nationality (If not Namibian)
Date of birth/
ID number/
Passport number
Occupation
Date of appointment
Telephone Number/
Mobile Number
Email Address
Other Directorships
Surname_______________________________forenames_________________________________ ____________ Director Alternate Director
Former surnames and forenames______________________________________________________________ _____________________________________________
State whether shareholder (if yes, kindly complete Part C below) Yes/No _________
Contact details Tick if new director
Residential Address
Business address & Email
Postal Address
Nationality (If not Namibian)
Date of birth/
ID number/
Passport number
Occupation
Date of appointment
Telephone Number/
Mobile Number
Email Address
Other Directorships
Surname_______________________________forenames_________________________________ ____________ Director Alternate Director
Former surnames and forenames______________________________________________________________ _____________________________________________
State whether shareholder (if yes, kindly complete Part C below) Yes/No _________
Contact details Tick if new director
Residential Address
Business address & Email
Postal Address
Nationality (If not Namibian)
Date of birth/
ID number/
Passport number
Occupation
Date of appointment
Telephone Number/
Mobile Number
Email Address
Other Directorships
OFFICERS/SECRETARY
(If external company give particulars of local manager and secretary here)
MANAGER
Surname ______________________________________________ Full forenames_________________________________ ____________
Former surnames and forenames/If corporate body, its name ____________________________________________________________________________________
Contact details
Residential Address
Business address & Email
Postal Address
Nationality (if not Namibian)
Registration number
Date of birth/
ID number/
Passport number
Occupation
Date of appointment
Telephone / Mobile Number
SECRETARY
Surname/Business Name __________________________________________________Forenames_________________________________ ____________
Former surnames and forenames______________________________________________________________ ___________________________________________
Contact details
Residential Address
*Business address & Email
Postal Address
Nationality (if not Namibian)
Date of birth/
ID number/
Passport number/
+Registration number
Occupation
Date of appointment
Telephone / Mobile Number
*Business address, if corporate body (Additional sheets to be attached if necessary).
+ Registration number, if corporate body
AUDITORS
Name __________________________________________________________________________________________________________________________________
Address ________________________________________________________________________________________________________________________________
Was there any change of an auditor made during the financial year? Yes/No ________________________________________________________________________
If yes, name of previous auditor ____________________________________________________________________________________________________________
Reasons for change ______________________________________________________________________________________________________________________
Date of receipt of advice of change of auditor by Registrar ______________________________________________________________________________________
PART C
SHAREHOLDERS/BENEFICIAL OWNERS
Shareholder Nominee Shareholder
Shareholder’s details
Nominee’s details
Tick if new shareholder:
Tick if new nominee:
Full name/Entity name:
Full name/Entity name:
Date of birth/ ID number/
Passport number/
Entity registration number:
(i) Date of birth/ ID number/
Passport number/
Entity registration number:
(ii) Residential address:
(ii) Residential address:
(iii) Business address:
(iii) Business address:
(iv) Postal address
(iv) Postal address
(v) Telephone / Mobile Number:
(v) Telephone / Mobile Number:
(vi) Nationality/
Place of incorporation:
(vi) Nationality/
Place of incorporation:
(vii) Occupation/
Nature of business:
(vii) Occupation/
Nature of business:
(viii) Number of shares:
(viii) Number of shares:
(ix) Type of shares (ordinary/preference):
(ix) Type of shares (ordinary/preference):
(x)Nominal value:
(x)Nominal value:
(xi) Date shareholder subscribed:
(xi) Date shareholder subscribed:
(xii) Email address:
(xii) Email address:
Shareholder Nominee Shareholder
Shareholder’s details
Nominee’s details
Tick if new shareholder:
Tick if new nominee:
Full name/Entity name:
Full name/Entity name:
Date of birth/ ID number/
Passport number/
Entity registration number:
(i) Date of birth/ ID number/
Passport number/
Entity registration number:
(ii) Residential address:
(ii) Residential address:
(iii) Business address:
(iii) Business address:
(iv) Postal address
(iv) Postal address
(v) Telephone / Mobile Number:
(v) Telephone / Mobile Number:
(vi) Nationality/
Place of incorporation:
(vi) Nationality/
Place of incorporation:
(vii) Occupation/
Nature of business:
(vii) Occupation/
Nature of business:
(viii) Number of shares:
(viii) Number of shares:
(ix) Type of shares (ordinary/preference):
(ix) Type of shares (ordinary/preference):
(x)Nominal value:
(x)Nominal value:
(xi) Date shareholder subscribed:
(xi) Date shareholder subscribed:
(xii) Email address:
(xii) Email address:
PART D
TO BE COMPLETED BY EXTERNAL COMPANY ONLY
Names and addresses of persons resident in Republic authorised to accept on behalf of the company service of process and any notices required to be served on the company:
Surname_________________________________________ Full forenames_________________________________________________________________________
Contact details
Residential Address
Business address & email
Date of birth/
ID number/
Passport number
Postal Address
Telephone Number/
Mobile Number:
CERTIFICATES TO BE GIVEN BY ALL COMPANIES
We hereby certify that the information furnished on this form is correct to the best of our knowledge and belief.
Date__________________________________________________________ Signature ____________________________________________________________ Director
Name in block capitals _________________________________________________
Date _________________________________________________________ Signature ____________________________________________________________ Secretary (if any)
Rubber stamp of company, if any, or of secretaries. Name in block capitals _________________________________________________
CERTIFICATE TO BE GIVEN BY PRIVATE COMPANY
I hereby certify that the company has during the period covered by this return complied with the requirements of section 22(1)(b) and (c) of the Act.
Date ________________________________________________________ Signature ____________________________________________________________ Director
Rubber stamp of company, if any, or of secretaries. Name in block capitals ________________________________________________
Printing specifications: Size A4; good quality paper; adequate spacing to be allowed for typewritten information to be inserted under appropriate headings; tear off portion to fit Companies Office window envelope; complete Form to be printed on only completed pages; pages 2 and 4 to be duplicated where more than the amount of directors/shareholders are appointed than provided for; printer’s proofs and sample paper to be approved by Registrar of Business, Windhoek
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Copyright: Business and Intellectual Property Authority, Namibia
N$ 160.00 payable in terms of the Act and as set out in the Regulations.
Plus annual duty under section 182 and 183 and Regulation 40