8/6/2019 FormDIN4

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1. Director Identification Number (DIN)

FORM NO. DIN-4Intimation of change in particulars of Directorto be given to the Central Government

[See Rule 7 of the Companies (DirectorIdentification Number) Rules, 2006]

Note - All fields marked in * are to be mandatorily filled.

*

2. Type of change:*

Enter information that needs to be corrected. Enter only the relevant field(s)

(a) First name

(b) Last name

(c) Middlename

4. Whether a citizen of India

3. DIrector's name (Enter full name and do not use abbreviations) Photograph

(Attach a latest passport sizephotograph by clicking onabove box)

6. Date of birth

5. Nationality

(DD/MM/YYYY)

(In case income-tax PAN is entered, directordetails should be as per Income-tax PAN)(refer instruction kit for details)

7. Income-tax permanent accountnumber (Income-tax PAN)

8. Voter's identity card number

9. Passport number

10. Driving license number

Line II

11. Permanent residential address

City

State Pin code

*e-mail ID

12. Whether present residential address is same as permanent residential address

Phone Fax

Line I

ISO country code

Country

*Mobile

Name(b)

(a)

Director Name Nationality Date of birth

Income-tax permanent accountnumber (Income-tax PAN)

Driving license number

Voters Identity card number

Permanent residential address

Passport number

Present residential address

Yes No

Yes No

Pre-fill

Verify Income-tax PAN details

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Line II

13. Present residential address

City

Line I

State Pin code

ISO country code

Country

FaxPhone

*

*

It is hereby certified that the attached photograph and attached documents are of the applicant. It is furthercertified that all required attachments and verification by the applicant have been completely attached to thisapplication.

It is further certified that I have verified the above particulars of the applicant from the original documentsof the applicant and found them to be true and correct.

Certification

Attachments List of attachments

1. Proof of change in particulars*

*

3. Optional attachment(s) - if any

To be digitally signed by

This eForm has been taken on record by the Central Government through electronic mode and onthe basis of statement of correctness given by the person filing the form

Chartered accountant or Company secretary or Cost accountant (in whole- time practice)

Whether associate or fellow

Membership number or certificate of practice number

Associate Fellow

Chartered accountant (in whole-time practice) or Cost accountant (in whole-time practice) or

Company secretary (in whole-time practice)

*

*

2. Copy of verification by the director as per Annexure - 2

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Attach

Attach

Attach

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