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Charity Form 3

form 3

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katongoshadrick22
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21 views4 pages

Charity Form 3

form 3

Uploaded by

katongoshadrick22
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Form III

(Regulations 3(1) and 9)(To be completed in duplicate)

(Act No. 16 of 2011)


The Registration of Business Names Regulations, 2011

Shaded fields for Certificate No.


Please complete in block letters official use only Reference No.
Date and Time

Approved Name of Business:


P-CATHY TREASURE GENERAL DEALERS 

INDIVIDUAL/ FIRM
1. (a) Present Name(s) CHARITY
(b) Surname(s) of Applicant(s)
CHINEMU
(c) Former Name(s)

(d) Age ofapplicant(s)


37 YEARS

2. (a) Nationality of applicant(s)


ZAMBIAN
(b) Identity card - 234279/71/1
- National Registration Card
No.(s)
- Passport No.(s)

3. (a) Notification address SHOP NO.12/3 CHELSTONE CHRISMALL

Telephone/Cell No(s). 0970738933


Fax No.
Email address(es) [email protected]
(b) Residential address(es) Plot No.04/44
,CHELSTONE
EXTENSION, LUSAKA

IF APPLICANT IS A CORPORATE BODY


4. (a) Company name and No.

(b) Business address


(c) Notification/Postal address
(d) Email address

GENERAL INFORMATION
5. Type of business or undertaking 4630. Wholesale of food, beverages and tobacco
to be conducted
4719. Other retail sale in non-specialized stores
4690. Non-specialized wholesale trade
4100. Construction of buildings
6209. Other information technology and computer service activities
4922. Other passenger land transport
4220. Construction of utility projects
6499. Other financial service activities, except insurance and pension funding activities, n.e.c.
9609. Other personal service activities n.e.c.

5510. Short term accommodation activities


5610. Restaurants and mobile food service activities
5621. Event catering
5630. Beverage serving activities

6.

7. Proposed date of commencement of 24/10/2024


business (dd/mm/yy)
8. Financial year end (dd/mm/yy) 23/10/2025
9. Have you previously held a
certificate of registration which was
suspended or cancelled by the
Registrar
If yes, specify details:………………………………………………………………………………………………………………
Reason for cancellation:……………………………………………………………………………………………………………

of cancellation:………………………………………………………………………………………………………………
10. Do you have a valid registration in
respect of any other business name?

If yes, specify details:………………………………………………………………………………………………………………


Other existing business name ................................................................................................................................................... Date
of registration:……………………………………………………………………………………………………………….
11. Business names previously held by Certificate No. Location
the applicant under the Registration of
Business Names Act or similar
legislation outside
Zambia
12. Do you have anyinterest by way of partnership/directorship/shareholding in any business or occupation other than
the one in respect of which the application relates?
If yes, specify details:………………………………………………………………………………………………………………
Other existing business name:……………………………………………………………………………………………………
Date of registration:…………………………………………………………………………………………………………………
13. STATUTORY DECLARATION
I CATHERINE KAYAWE do solemnly declare as follows:
ducts
(a) that the information provided in this Form is correct and true; and
(b) that my certificate of registration has never been suspended or cancelled;

And I make this solemn declaration conscientiously believing the same to be true to the best of my/our
knowledge and belief.

24/10/2024
Applicant‘s signature(s) Date

FOR OFFICIAL USE ONLY

Received by: ………………………………………………………………... …………………………..…


Officer Date

Receipt No.: …………………………………………………………………


Date Received: ………………………………………………………………
Amount Received: ………………………………………………………….
Serial No. of application: …………………………………………………..

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