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 14/02/2025 14:57
Approved Name of Business: Musoma cash solution
INDIVIDUAL/ FIRM
1. (a) Present Name(s)
Cloudies
(b) Surname(s) of Applicant(s)
Musoma
(c) Former Name(s)
(d) Age of applicant(s)
30
2. (a) Nationality of applicant(s) ZAMBIAN
(b) Identity card - 186771/91/1
- National Registration
Card No.(s)
- Passport No.(s)
3. (a) Notification address Plot No 88, North Park, TAZARA Area , Kapiri Mposhi,
Central Province, Zambia
Telephone/Cell No(s). +260777774349
Fax No.
Email address (es) [email protected]
(b) Residential address (es) Plot No 88, North Park, TAZARA Area , Kapiri Mposhi,
Central Province, 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 undertaking 6499. Other financial service activities, except insurance and pension
to be conducted funding activities, n.e.c.
6. Location of proposed business Plot No 88, North Park, Is premises owner occupier or rented premises?
TAZARA Area , Kapiri (state name of the owner, if rented) OWNED
Mposhi, Central
Province, Zambia
7. Proposed date of commencement 14/02/2025
of business (dd/mm/yy)
8. Financial year end (dd/mm/yy)
14/02/2026
9. Have you previously held a NO
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 NO
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 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 CLOUDIES MUSOMA 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.
…………………………………………………. 14th February 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: …………………………………………………..
