FORM 28

REPUBLIC OF TRINIDAD AND TOBAGO

THE COMPANIES ACT, CH. 81:01

[Section 194(1)]

ANNUAL RETURN OF A COMPANY FOR PROFIT INCORPORATED,

CONTINUED OR AMALGAMATED UNDER THE ACT

1. Name of Company 2. Company No.

3. Registered Office of Company

4. (a) Anniversary Date of [ ] Incorporation [ ] Continuance [ ] Amalgamation

4. (b) Share Capital Issued by Company in Purchased/Redeemed by

the last financial period Company in the last
financial period
Class of Number Amount of Number Amount of Number Reduction
Shares issued and stated of shares stated of shares of stated capital
outstanding capital capital

5. AUTHORIZED SHARE CAPITAL, IF ANY

Class of Shares Number of Shares in each Class

1.

2.

3.

4.

6. List of persons holding shares in the company on the day of ,

20 , and of persons who have held shares therein at any time since the date of the last return, or (in the case
of the first return) of the incorporation, continuance or amalgamation of the company, showing their names and
addresses and an account of the shares so held.
 Class of Shares
Address/
Name Occupation/Status and Number Held
Registered Office
at date of Return

ACCOUNTS OF SHARES
Particulars of Shares transferred Particulars of Shares transferred since the
since the date of the last Return or (in date of the last Return or (in the case of the
the case of the first Return) of the first Return) of the incorporation of the
incorporation of the Company, or of its Company, or of its continuance, by persons
continuance, by persons who are still who have ceased to be Shareholders
Shareholders
Class of Shares and Date of
Class of shares and Number at date of Date of Registration
Number at date of Registration Remarks
Return of Transfer
Return of Transfer

Date Signature Title

7. Total amount of the indebtedness of the Company in respect of all mortgages and charges of the kind which are
required to be registered with the Registrar under the Companies Act $

8. The directors of the company as of the date of the Annual Return are:
Name Address Occupation

9. The secretary/assistant secretary(ies) of the company as of the date of the Annual Return is/are:
Address/Registered Office
Name Occupation/Status
Principal Place of Business

10. Particulars of share warrants or bearer share warrants surrendered to the company pursuant to section 33(7) or
cancelled under section 33(10):
Share Warrant/
Serial Number(s) Date of Surrender Date of Cancellation
Bearer Share Warrant

11. Particulars of holders and beneficial owners of shares in the company as of the date of the Annual Return:
Class of shares
Names, Addresses and Occupation/ Names, Addresses and Occupation of
and Number held
Status of Holder(s) of Shares Beneficial Owner(s)
at date of Return
Given Name(s) Nationality/
Address/ Given Number of
& Surnames/ Occupation/ Jurisdiction of Class of
Registered Name(s) Address Occupation Nationality Shares
Company Status Incorporation/ Shares
Office & Surnames held
Name Formation

12. Date Name and Title Signature

 THE COMPANIES ACT, CH. 81:01

ANNUAL RETURN OF A COMPANY FOR PROFIT INCORPORATED,

CONTINUED OR AMALGAMATED UNDER THE ACT

FORM 28

INSTRUCTIONS
Format
Documents required to be sent to the Registrar pursuant to the Act must conform to regulation 3 of the
Regulations under the Act.

Items 1, 2
Set out the full legal name of the company, and except where a number has not been assigned, state the
company number.

Item 3
State full address of registered office of company.

Item 4
State the anniversary of incorporation, continuance or amalgamation under the Act. Tick the
appropriate box. N.B.-this Return is due “not later than the thirty days after each anniversary date of its
continuance, incorporation or amalgamation” under the Act [section 194(1)].
In the case of a company being continued, state “Not Applicable” or “N/A” in Item 4(b)

Item 5
State class(es) of shares by distinctive name or other form of designation and total number of shares in
each class.

Item 6
(i) State same date as at Item 4 above.
(ii) State full name of each shareholder, whether a natural person or a corporation.
(iii) State address (if a natural person) or registered office (if a corporation).
(iv) State occupation/calling (if a natural person) or status (i.e., “corporation”/“limited” or
“unlimited liability company”) (if a corporation).
(v) State class of shares as per 5 above and number held by each existing shareholder at date of
Return.
(vi) State particulars of shares transferred since the date of the last return or since the date of
incorporation, continuance or amalgamation of the company by persons who are still
shareholders or who have ceased to be shareholders, as the case may be.

In either case, state the following:

- the number of shares transferred.
- the relevant class(es) of the shares transferred.
- the date of registration of each transfer of shares.
- Insert the name of the transferee (the person to whom the shares have been transferred) in the
“Remarks” column immediately opposite the particulars of each transfer. N.B.-the particulars
of transfer should be placed opposite the name of the transferor (the person who has transferred
the shares) and not opposite that of the transferee.
Item 8
With respect to each director:
(a) set out first given name, middle name and family name;
(b) state full address; and
(c) specify other occupation clearly. Where possible, specify area of speciality e.g., electrical
engineer. In the case of an individual who has no business occupation, but who holds any other
directorships, particulars of that other directorship or at least one of those other directorships
should be stated. In the case of an individual who has no other business occupation or
directorship of any kind, state “Not applicable” or “N/A”.

Item 9
(a) In the case of an individual, set out first given name, middle name and family name; or
(b) In the case of a firm or corporation, set out the registered name.
(c) In the case of (a), state full address, in the case of (b), state principal place of business or
registered office, as the case may be.
(d) In the case of an individual, specify other business occupation clearly. Where possible, specify
area of speciality e.g., electrical engineer. In the case of an individual who has no business
occupation, but who holds any other secretaryship or secretaryships, particulars of that other
secretaryship or at least one of those other secretaryships should be stated. In the case of an
individual who has no other business occupation or secretaryship of any kind, state “Not
applicable” or “N/A”.
(e) In the case of a firm or corporation set out status e.g., “firm of accountants” or “company
incorporated under the laws of Trinidad and Tobago” (or elsewhere).

Item 10
Set out information as specified (e.g. in the first column state the type of instrument i.e., whether a
share warrant or bearer share warrant) if there are no serial numbers available, please indicate “Not
applicable” or “N/A”.

Item 11
Please set out all details of beneficial ownership information (as indicated) as at the date of the Annual
Return.

NOTE: The Companies Act, Chapter 81:01 (as amended by the Companies Amendment) Act requires
the disclosure of beneficial ownership information, (and any changes) with penalties for non-compliance.

Signature
A director or authorised officer of the company shall sign a return.

Completed documents, in duplicate, and the prescribed fees are to be filed at the office of the Registrar
and one set of the duplicate originals would be returned to the company or its representative with the
endorsement “Registered” and the date of registration.