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BNForm III

The document is an application form for the registration of a business name, POWERLAND ELECTRONICS, submitted by applicant VIVEN MWANGULUKULU. It includes personal details, business information, and a statutory declaration affirming the accuracy of the provided information. The proposed commencement date for the business is January 22, 2025, with a financial year end on January 22, 2026.

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36 views3 pages

BNForm III

The document is an application form for the registration of a business name, POWERLAND ELECTRONICS, submitted by applicant VIVEN MWANGULUKULU. It includes personal details, business information, and a statutory declaration affirming the accuracy of the provided information. The proposed commencement date for the business is January 22, 2025, with a financial year end on January 22, 2026.

Uploaded by

zmnathan058
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, 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 official use only Reference No.
letters Date and
Time

Approved Name of Business: POWERLAND ELECTRONICS


Ö

INDIVIDUAL/ FIRM
1. (a) Present Name(s) VIVEN

(b) Surname(s) of
Applicant(s) MWANGULUKULU
(c) Former Name(s)

(d) Age of applicant(s) 48 YEARS

2. (a) Nationality of
applicant(s) ZAMBIAN
(b) Identity card - NRC
- National Registration 601562/11/1
Card No.(s)
- Passport No.(s)

3. (a) Notification address PLOT NO. 16402/1080 ESTHER LUNGU ROAD KAMWALA
SOUTH LUSAKA ZAMBIA

Telephone/Cell No(s). 0977793361


Fax No.
Email address(es) [email protected]
(b) Residential address(es) PLOT NO. 16402/1080 ESTHER LUNGU ROAD KAMWALA
SOUTH LUSAKA ZAMBIA

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 9609.OTHER PERSONAL SERVICE ACTIVITIES n.e.c
undertaking to be conducted
6. Location of proposed Plot No. 16402/1080 Is premises owner occupier or rented
business premises? (state name of the owner, if
ESTHER LUNGU ROAD rented)
OWNER
KAMWALA SOUTH LUSAKA
ZAMBIA

7. Proposed date of z
commencement of business 22/01/2025
(dd/mm/yy)
8. Financial year end
(dd/mm/yy) 22/01/2026
9. Have you previously held a
certificate of registration NO
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 NO
any other business name?
If yes, specify details:
………………………………………………………………………………………………………………
Other existing business name:
……………………………………………………………………………………………………
Date of registration:
……………………………………………………………………………………………………………….
11. Business names previously Certificate No. Location
held by the applicant under NO
the Registration of Business
Names Act or similar
legislation outside Zambia
12. Do you have any interest 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/We VIVEN MWANGULUKULU do solemnly declare as follows:
(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 /we make this solemn declaration conscientiously believing the same to be
true to the best of my/our knowledge and belief.

………………………………………………….
22/01/2025
Applicant‘s signature(s) Date

FOR OFFICIAL USE ONLY

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


…………………………..…
Officer Date
Receipt No.: …………………………………………………………………
OFFICAL
Date Received: ……………………………………………………………… STAMP
Amount Received: ………………………………………………………….
Serial No. of application: …………………………………………………..

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