LegalizeS.I. No. 161/1991 - Companies (Forms) Order, 1991
This is the act as published. Later amendments are not folded into the text below: each one is a separate act in this repository and an entry in this law's history.
3 amending acts · 2014-12-23, Companies Act 2014
| Annual Return | Companies Acts 1963 to 1990 | Companies Acts 1963 to 1990 | Registration fee stamp to be affixed above | Registration fee stamp to be affixed above | |
| Section 125 or 126, Companies Act, 1963 | B1S | B1S | |||
| This return is to be used when the certification overleaf can be complied with in full and when there are no more than nine shareholders. In other cases the full return should be used. | Company number ||||| | Company number ||||| | |||
| Please complete using black block capitals or typewriting | Company name in full | ||||
| Limited | Limited | ||||
| Note one The return should be 14 days after the A.G.M. of the company | Return made up to note one | day of | day of | 19 | 19 |
| Note one The return should be 14 days after the A.G.M. of the company | Financial year note two | from | from | 19 | 19 |
| Address of registered office | |||||
| Note two Give the dates of the commencement and completion of the financial year of the accounts presented to the A.G.M. | |||||
| Note two Give the dates of the commencement and completion of the financial year of the accounts presented to the A.G.M. | |||||
| Secretary | |||||
| Surname note three | Forename note three | Forename note three | |||
| Note three Insert full name (initials will not suffice) and usual residential address. Where all the partners in a firm are joint secretaries the name and principal office of the firm may be stated. | Former surname note four | Former forename note four | Former forename note four | ||
| Note three Insert full name (initials will not suffice) and usual residential address. Where all the partners in a firm are joint secretaries the name and principal office of the firm may be stated. | Home address note three | Share Class note eight | Share Class note eight | Number of shares | Number of shares |
| Note three Insert full name (initials will not suffice) and usual residential address. Where all the partners in a firm are joint secretaries the name and principal office of the firm may be stated. | | | | | |||
| Note three Insert full name (initials will not suffice) and usual residential address. Where all the partners in a firm are joint secretaries the name and principal office of the firm may be stated. | | | | | |||
| Note three Insert full name (initials will not suffice) and usual residential address. Where all the partners in a firm are joint secretaries the name and principal office of the firm may be stated. | | | | | |||
| Capital | Nominal | Nominal | Issued—Amounts | Issued—Amounts | |
| Note four Former forename or surname does not include the following: | Paid up shares issued for cash £ | Paid up shares issued for cash £ | |||
| Nominal share capital | Nominal share capital | Considered paid on other shares £ | Considered paid on other shares £ | ||
| In the case of a person usually known by a title different from his surname, the name by which he was known previous to the adoption of or succession to the title. | £ | £ | Total £ | Total £ | |
| In the case of a person usually known by a title different from his surname, the name by which he was known previous to the adoption of or succession to the title. | Issued—Numbers of Shares | Issued—Numbers of Shares | |||
| In the case of a person usually known by a title different from his surname, the name by which he was known previous to the adoption of or succession to the title. | Value per | Value per | Consideration—note five | Consideration—note five | |
| In the case of a person usually known by a title different from his surname, the name by which he was known previous to the adoption of or succession to the title. | Class | Number | share | All Cash | Total Number |
| |£ | | | ||||
| In the case of any person, a former forename or surname where that forename or surname was changed or disused before the person bearing the name attained the age of 18 years or has been changed or disused or for a period of not less than 20 years: | |£ | | | |||
| In the case of any person, a former forename or surname where that forename or surname was changed or disused before the person bearing the name attained the age of 18 years or has been changed or disused or for a period of not less than 20 years: | |£ | | | |||
| In the case of any person, a former forename or surname where that forename or surname was changed or disused before the person bearing the name attained the age of 18 years or has been changed or disused or for a period of not less than 20 years: | |£ | | | |||
| In the case of any person, a former forename or surname where that forename or surname was changed or disused before the person bearing the name attained the age of 18 years or has been changed or disused or for a period of not less than 20 years: | Totals | ||||
| Indebtedness | Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908. | Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908. | Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908. | Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908. | |
| In the case of married woman, the name or surname by which she was known previous to her marriage. | Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908. | Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908. | Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908. | Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908. | £ |
| Note five Give the numbers of shares issues subject to payment wholly in cash under "All Cash" and shares issued for any other consideration under "Other" | Presenter's Name | Address | Address | Address | Address |
| Note five Give the numbers of shares issues subject to payment wholly in cash under "All Cash" and shares issued for any other consideration under "Other" | |||||
| Note five Give the numbers of shares issues subject to payment wholly in cash under "All Cash" and shares issued for any other consideration under "Other" | |||||
| Note five Give the numbers of shares issues subject to payment wholly in cash under "All Cash" and shares issued for any other consideration under "Other" | |||||
| Telephone Number | Reference | Reference | Reference | Reference | |
| Directors (including shadow directors) and their ??????? | Directors (including shadow directors) and their ??????? | Directors (including shadow directors) and their ??????? | Directors (including shadow directors) and their ??????? | Directors (including shadow directors) and their ??????? | |
| Note Six Company name and number of bodies corporate, whether incorporated in the State or elsewhere, except for | Surname note three | Forename note three | Forename note three | Forename note three | Forename note three |
| Note Six Company name and number of bodies corporate, whether incorporated in the State or elsewhere, except for | Former surname note four | Former forename note four | Former forename note four | Former forename note four | Former forename note four |
| Note Six Company name and number of bodies corporate, whether incorporated in the State or elsewhere, except for | Business occupation | Date of birth | Day | Month | Year |
| Home address note three | Nationality | Nationality | Nationality | Nationality | |
| Bodies of which the person has not been a director at any time during the past ten years | Share class note eight | Share class note eight | Number of shares | Number of shares | |
| Bodies of which the person has not been a director at any time during the past ten years | | | | | |||
| | | | | ||||
| Bodies of which the company is or was at the relevant time) a wholly owned subsidiary | Other directorships note six | Registered at note seven | Registered at note seven | Company | Company |
| Bodies of which the company is or was at the relevant time) a wholly owned subsidiary | number | number | |||
| | | | | ||||
| Bodies which are (or were at the relevant time) wholly owned subsidiaries of the company | | | | | |||
| Bodies which are (or were at the relevant time) wholly owned subsidiaries of the company | | | | | |||
| Bodies which are (or were at the relevant time) wholly owned subsidiaries of the company | |||||
| Former surname note four | Former forename note four | Former forename note four | Former forename note four | Former forename note four | |
| Note Eight When full particulars of past and present members have been given in a return for any of the 5 years preceding this return, only particulars relating to new members, persons who have ceased to be members and ???? transferred since that ??? ???? furnished. If full particulars are now given, specify under "Date of full listing" the date of the relevant annual return was made up to. | Business Occupation | Date of birth | Day | Month | Year |
| Note Eight When full particulars of past and present members have been given in a return for any of the 5 years preceding this return, only particulars relating to new members, persons who have ceased to be members and ???? transferred since that ??? ???? furnished. If full particulars are now given, specify under "Date of full listing" the date of the relevant annual return was made up to. | Home address note three | Nationality | Nationality | Nationality | Nationality |
| Note Eight When full particulars of past and present members have been given in a return for any of the 5 years preceding this return, only particulars relating to new members, persons who have ceased to be members and ???? transferred since that ??? ???? furnished. If full particulars are now given, specify under "Date of full listing" the date of the relevant annual return was made up to. | Share class note eight | Share class note eight | Number of shares | Number of shares | |
| Note Eight When full particulars of past and present members have been given in a return for any of the 5 years preceding this return, only particulars relating to new members, persons who have ceased to be members and ???? transferred since that ??? ???? furnished. If full particulars are now given, specify under "Date of full listing" the date of the relevant annual return was made up to. | | | | | |||
| Note Eight When full particulars of past and present members have been given in a return for any of the 5 years preceding this return, only particulars relating to new members, persons who have ceased to be members and ???? transferred since that ??? ???? furnished. If full particulars are now given, specify under "Date of full listing" the date of the relevant annual return was made up to. | | | | | |||
| Note Eight When full particulars of past and present members have been given in a return for any of the 5 years preceding this return, only particulars relating to new members, persons who have ceased to be members and ???? transferred since that ??? ???? furnished. If full particulars are now given, specify under "Date of full listing" the date of the relevant annual return was made up to. | Other directorships note six | Registered at note seven | Registered at note seven | Company number | Company number |
| Note Eight When full particulars of past and present members have been given in a return for any of the 5 years preceding this return, only particulars relating to new members, persons who have ceased to be members and ???? transferred since that ??? ???? furnished. If full particulars are now given, specify under "Date of full listing" the date of the relevant annual return was made up to. | | | | | |||
| Note Eight When full particulars of past and present members have been given in a return for any of the 5 years preceding this return, only particulars relating to new members, persons who have ceased to be members and ???? transferred since that ??? ???? furnished. If full particulars are now given, specify under "Date of full listing" the date of the relevant annual return was made up to. | | | | | |||
| Note Eight When full particulars of past and present members have been given in a return for any of the 5 years preceding this return, only particulars relating to new members, persons who have ceased to be members and ???? transferred since that ??? ???? furnished. If full particulars are now given, specify under "Date of full listing" the date of the relevant annual return was made up to. | | | | | |||
| Surname note three | Forename note three | Forename note three | Forename note three | Forename note three | |
| Former surname note four | Former forename note four | Former forename note four | Former forename note four | Former forename note four | |
| Business Occupation | Date of birth | Day | Month | Year | |
| Home address note three | Nationality | Nationality | Nationality | Nationality | |
| Share class note eight | Share class note eight | Number of shares | Number of shares | ||
| | | | | ||||
| | | | | ||||
| Other directorships note six | Registered at note seven | Registered at note seven | Company number | Company number | |
| | | | | ||||
| | | | | ||||
| | | | | ||||
| Other shareholders note eight | Other shareholders note eight | Other shareholders note eight | Other shareholders note eight | Other shareholders note eight | |
| Documents Annexed | |||||
| Mark "X" in the box relative to each annexed document | Name and address | Share class | Share class | Number of shares | Number of shares |
| Balance Sheet S. 128, Companies Act, 1963 (CA - '63); S. 7 and S. 18, Companies (Amendment) Act, 1986 CAA - '86) | |||||
| Balance Sheet S. 128, Companies Act, 1963 (CA - '63); S. 7 and S. 18, Companies (Amendment) Act, 1986 CAA - '86) | |||||
| Balance Sheet S. 128, Companies Act, 1963 (CA - '63); S. 7 and S. 18, Companies (Amendment) Act, 1986 CAA - '86) | |||||
| Profit and Loss A/C S. 7 and S. 18, CAA - '86 | Date of full listing note eight | Day | Day | Month | Year |
| Directors Report S. 128, CA - '63; S. 7 and S. 18, CAA - '86 | Certification | Certification | Certification | Certification | Certification |
| We the undersigned hereby certify that | We the undersigned hereby certify that | We the undersigned hereby certify that | We the undersigned hereby certify that | We the undersigned hereby certify that | |
| Auditors Report S. 128, CA - '63; S. 7 and S. 18, CAA - '86 | 1. this form contains the particulars in respect of the above named company as at the date up to which the return is made; | 1. this form contains the particulars in respect of the above named company as at the date up to which the return is made; | 1. this form contains the particulars in respect of the above named company as at the date up to which the return is made; | 1. this form contains the particulars in respect of the above named company as at the date up to which the return is made; | 1. this form contains the particulars in respect of the above named company as at the date up to which the return is made; |
| Auditors Report S. 128, CA - '63; S. 7 and S. 18, CAA - '86 | 2. all share capital of the company was fully paid up on that date; | 2. all share capital of the company was fully paid up on that date; | 2. all share capital of the company was fully paid up on that date; | 2. all share capital of the company was fully paid up on that date; | 2. all share capital of the company was fully paid up on that date; |
| 3. no shares were transferred since the date of the last return (or the date of incorporated if this is the first return); | 3. no shares were transferred since the date of the last return (or the date of incorporated if this is the first return); | 3. no shares were transferred since the date of the last return (or the date of incorporated if this is the first return); | 3. no shares were transferred since the date of the last return (or the date of incorporated if this is the first return); | 3. no shares were transferred since the date of the last return (or the date of incorporated if this is the first return); | |
| Guarantee S. 17, CAA - '86 | 4. no shares were issued at a discount; | 4. no shares were issued at a discount; | 4. no shares were issued at a discount; | 4. no shares were issued at a discount; | 4. no shares were issued at a discount; |
| 5. no premium was paid on any share; | 5. no premium was paid on any share; | 5. no premium was paid on any share; | 5. no premium was paid on any share; | 5. no premium was paid on any share; | |
| Declaration S. 17, CAA - '86 | 6. no shares were forfeited; | 6. no shares were forfeited; | 6. no shares were forfeited; | 6. no shares were forfeited; | 6. no shares were forfeited; |
| 7. no commission was paid in respect of any shares or debentures; | 7. no commission was paid in respect of any shares or debentures; | 7. no commission was paid in respect of any shares or debentures; | 7. no commission was paid in respect of any shares or debentures; | 7. no commission was paid in respect of any shares or debentures; | |
| Notification to shareholders of Guarantee S. 17, CAA - '86 | 8. the registers of members/debentures holders/directors' service contracts and/or memoranda are kept at the registered office; | 8. the registers of members/debentures holders/directors' service contracts and/or memoranda are kept at the registered office; | 8. the registers of members/debentures holders/directors' service contracts and/or memoranda are kept at the registered office; | 8. the registers of members/debentures holders/directors' service contracts and/or memoranda are kept at the registered office; | 8. the registers of members/debentures holders/directors' service contracts and/or memoranda are kept at the registered office; |
| 9. the company has not since the date of the last annual return (or the date of incorporation if this is the first return) issued any invitation to the public to subscribe for any shares or debentures in the company. | 9. the company has not since the date of the last annual return (or the date of incorporation if this is the first return) issued any invitation to the public to subscribe for any shares or debentures in the company. | 9. the company has not since the date of the last annual return (or the date of incorporation if this is the first return) issued any invitation to the public to subscribe for any shares or debentures in the company. | 9. the company has not since the date of the last annual return (or the date of incorporation if this is the first return) issued any invitation to the public to subscribe for any shares or debentures in the company. | 9. the company has not since the date of the last annual return (or the date of incorporation if this is the first return) issued any invitation to the public to subscribe for any shares or debentures in the company. | |
| Note stating company has availed of exemptions in S. 17, CAA - '86 | Signed | Signed | Signed | Signed | Signed |
| --- | --- | --- | --- | ||
| Annual Return | Companies Acts 1963 to 1990 | Registration fee stamp to be affixed above | |||
| Section 125 or 126, Companies Act, 1963 | B1 | ||||
| Company number | |||||
| ||||| | |||||
| Please complete using black block capitals or typewriting | Company name in full | Company name in full | Company name in full | ||
| Limited | |||||
| Return made up to note one | day of | 19 | |||
| Financial year note two | from | to | |||
| Note one The date should be 14 days after the A.G.M. of the company. | Address of registered office | ||||
| Note one The date should be 14 days after the A.G.M. of the company. | |||||
| Note one The date should be 14 days after the A.G.M. of the company. | |||||
| Note two Give the dates of the commencement and completion of the financial year of the accounts presented to the A.G.M. | Other Addresses | Places where the register of members, register of debenture holders and directors' service contracts/memoranda are kept, if other than the registered office | Places where the register of members, register of debenture holders and directors' service contracts/memoranda are kept, if other than the registered office | ||
| Address | Address | Description of address | |||
| Note three Insert full name (initials will not suffice) and usual residential address. Where all the partners in a firm are joint secretaries the name and principal office of the firm may be stated | | | ||||
| Note three Insert full name (initials will not suffice) and usual residential address. Where all the partners in a firm are joint secretaries the name and principal office of the firm may be stated | | | ||||
| Note three Insert full name (initials will not suffice) and usual residential address. Where all the partners in a firm are joint secretaries the name and principal office of the firm may be stated | | | ||||
| Note three Insert full name (initials will not suffice) and usual residential address. Where all the partners in a firm are joint secretaries the name and principal office of the firm may be stated | | | ||||
| Note three Insert full name (initials will not suffice) and usual residential address. Where all the partners in a firm are joint secretaries the name and principal office of the firm may be stated | | | ||||
| | | |||||
| Note four Former forename or surname does not include the following: | | | ||||
| Note four Former forename or surname does not include the following: | Secretary | Secretary | Secretary | ||
| In the case of a person usually known by a title different from his surname, the name by which he was known previous to the adoption of or succession to the title; | Surname note three | Surname note three | Forename note three | ||
| In the case of a person usually known by a title different from his surname, the name by which he was known previous to the adoption of or succession to the title; | Former surname(s) note four | Former surname(s) note four | Former forename note four | ||
| In the case of a person usually known by a title different from his surname, the name by which he was known previous to the adoption of or succession to the title; | Home address note three | Home address note three | Home address note three | ||
| In the case of a person usually known by a title different from his surname, the name by which he was known previous to the adoption of or succession to the title; | |||||
| In the case of a person usually known by a title different from his surname, the name by which he was known previous to the adoption of or succession to the title; | |||||
| In the case of any person, a former forename or surname where that forename or surname was changed or disused before the person bearing the name attained the age of 18 years or has been changed or disused for a period of not less than 20 years; | Indebtedness | Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908. | Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908. | ||
| In the case of any person, a former forename or surname where that forename or surname was changed or disused before the person bearing the name attained the age of 18 years or has been changed or disused for a period of not less than 20 years; | Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908. | Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908. | |||
| In the case of any person, a former forename or surname where that forename or surname was changed or disused before the person bearing the name attained the age of 18 years or has been changed or disused for a period of not less than 20 years; | £ | Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908. | Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908. | ||
| In the case of any person, a former forename or surname where that forename or surname was changed or disused before the person bearing the name attained the age of 18 years or has been changed or disused for a period of not less than 20 years; | Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908. | Total amount of indebtedness of the company in respect of all mortgages and charges which are required to be registered with the Registrar of Companies under the Companies Acts or which would have been required to be registered if created after 1st July, 1908. | |||
| In the case of any person, a former forename or surname where that forename or surname was changed or disused before the person bearing the name attained the age of 18 years or has been changed or disused for a period of not less than 20 years; | |||||
| --- | --- | --- | --- | --- | --- |
| In the case of a married woman, the name or surname by which she was known previous to her marriage. | Presenter's Name | Presenter's Name | Address | Address | Address |
| In the case of a married woman, the name or surname by which she was known previous to her marriage. | |||||
| Telephone Number | Telephone Number | Telephone Number | Reference | Reference | |
| Note five | |||||
| Where appropriate references to shares will be taken as references to stock and references to numbers of shares as references to amount of stock | Capital — Nominal note five | Capital — Nominal note five | Capital — Nominal note five | Nominal Share Capital £ | Nominal Share Capital £ |
| Where appropriate references to shares will be taken as references to stock and references to numbers of shares as references to amount of stock | |||||
| Where appropriate references to shares will be taken as references to stock and references to numbers of shares as references to amount of stock | |||||
| Class | Class | Class | Number | Number | Value Per share |
| | £ | | £ | ||||
| | £ | | £ | ||||
| | £ | | £ | ||||
| | £ | | £ | ||||
| | £ | | £ | ||||
| | £ | | £ | ||||
| Capital — Issued | Capital — Issued | Capital — Issued | Issued Amounts | Issued Amounts | |
| Note six | Total Issued Capital £_____ | Total Issued Capital £_____ | Total Issued Capital £_____ | Paid up on shares issued for cash | Paid up on shares issued for cash |
| Give the total number of shares held by each member | Considered paid on other shares | Considered paid on other shares | |||
| Total calls unpaid | Total calls unpaid | £ | |||
| Shares issued | Shares issued | Shares issued | |||
| Consideration — all cash | Consideration — all cash | Consideration — all cash | |||
| Note seven applicable to private companies only. | |||||
| Particulars of shares ???? since the date of the last return or, in the case of a first return, the date of incorporation, by persons who are still members and persons who have ceased to be members. Give the date of registration of each transfer and the number transferred on each date. | Class | Number | Number | Amount called up per share | Amount paid per share |
| Particulars of shares ???? since the date of the last return or, in the case of a first return, the date of incorporation, by persons who are still members and persons who have ceased to be members. Give the date of registration of each transfer and the number transferred on each date. | |£ | |£ | |£ | |£ | |
| Particulars of shares ???? since the date of the last return or, in the case of a first return, the date of incorporation, by persons who are still members and persons who have ceased to be members. Give the date of registration of each transfer and the number transferred on each date. | |£ | |£ | |£ | |£ | |
| Particulars of shares ???? since the date of the last return or, in the case of a first return, the date of incorporation, by persons who are still members and persons who have ceased to be members. Give the date of registration of each transfer and the number transferred on each date. | | | | | |£ | |£ | |
| Particulars of shares ???? since the date of the last return or, in the case of a first return, the date of incorporation, by persons who are still members and persons who have ceased to be members. Give the date of registration of each transfer and the number transferred on each date. | | | | | |£ | |£ | |
| | | | | |£ | |£ | |£ | |
| | | | | |£ | |£ | ||
| Note eight | | | | | |£ | |£ | |
| Name should be given in alphabetical order or an indix should be annexed. | | | | | |£ | |£ | |
| Totals | | (A) | | (A) | |£ | ||
| --- | --- | --- | --- | --- | |
| Consideration — not all cash | Consideration — not all cash | Consideration — not all cash | Consideration — not all cash | Consideration — not all cash | |
| Class | Number | Amount called up per share | Amount considered paid per share | Total amount paid | |
| | | |£ | |£ | |£ | ||
| | | |£ | |£ | |£ | ||
| | | |£ | |£ | |£ | ||
| | | |£ | |£ | |£ | ||
| | | |£ | |£ | |£ | ||
| | | |£ | |£ | |£ | ||
| | | |£ | |£ | |£ | ||
| | | |£ | |£ | |£ | ||
| Totals | | (B) | |£ | |||
| Total number of shares issued (A) and (B) | This total must agree with the total number of shares held by existing members as stated in the "List of past and Present Members" section of the return | This total must agree with the total number of shares held by existing members as stated in the "List of past and Present Members" section of the return | This total must agree with the total number of shares held by existing members as stated in the "List of past and Present Members" section of the return | ||
| Other Share/Debenture Details | Details of shares forfeited, shares/debentures issued at a discount, or on which a commission was paid including share class, number of shares and amounts in each case | Details of shares forfeited, shares/debentures issued at a discount, or on which a commission was paid including share class, number of shares and amounts in each case | Details of shares forfeited, shares/debentures issued at a discount, or on which a commission was paid including share class, number of shares and amounts in each case | Details of shares forfeited, shares/debentures issued at a discount, or on which a commission was paid including share class, number of shares and amounts in each case | |
| --- | --- | --- | --- | --- | --- |
| List of persons holding shares on the 14^th day after the annual general meeting for19____, 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, the date of the incorporation of the company | List of persons holding shares on the 14^th day after the annual general meeting for19____, 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, the date of the incorporation of the company | List of persons holding shares on the 14^th day after the annual general meeting for19____, 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, the date of the incorporation of the company | List of persons holding shares on the 14^th day after the annual general meeting for19____, 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, the date of the incorporation of the company | List of persons holding shares on the 14^th day after the annual general meeting for19____, 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, the date of the incorporation of the company | |
| Share Class | Numbers Held note six | Numbers Transferred and Date note seven | Numbers Transferred and Date note seven | Particulars of Transferee | |
| Name notes three and eight | | | | | | | | | | |
| Address notes three and eight | | | | | | | | | | |
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| Total number of shares held must agree with the total number of issued shares given in the "Shares Issued" section of the return | Total number of shares held must agree with the total number of issued shares given in the "Shares Issued" section of the return | Total number of shares held must agree with the total number of issued shares given in the "Shares Issued" section of the return | |||
| Total number held note ten | Total number held note ten | ||||
| Earlier full listing | When full particulars of past and present members have been given in a return for any of the 5 years preceding this return, only particulars relating to new members, persons who have ceased to be members and shares transferred since that date need be furnished. If full particulars are not now given, specify the date the relevant annual return was made up to. | When full particulars of past and present members have been given in a return for any of the 5 years preceding this return, only particulars relating to new members, persons who have ceased to be members and shares transferred since that date need be furnished. If full particulars are not now given, specify the date the relevant annual return was made up to. | When full particulars of past and present members have been given in a return for any of the 5 years preceding this return, only particulars relating to new members, persons who have ceased to be members and shares transferred since that date need be furnished. If full particulars are not now given, specify the date the relevant annual return was made up to. | When full particulars of past and present members have been given in a return for any of the 5 years preceding this return, only particulars relating to new members, persons who have ceased to be members and shares transferred since that date need be furnished. If full particulars are not now given, specify the date the relevant annual return was made up to. | When full particulars of past and present members have been given in a return for any of the 5 years preceding this return, only particulars relating to new members, persons who have ceased to be members and shares transferred since that date need be furnished. If full particulars are not now given, specify the date the relevant annual return was made up to. |
| Return made up to note one | day of 19 | day of 19 | day of 19 | ||
| --- | --- | --- | --- | ||
| Note nine Company name and number of other bodies corporate, whether incorporated in the State or elsewhere, except for | Surname note three | Forename note three | Forename note three | ||
| Note nine Company name and number of other bodies corporate, whether incorporated in the State or elsewhere, except for | Former Surname note four | Former Forename note four | Former Forename note four | ||
| Business occupation | Date of birth: | Day Month Year | |||
| Bodies of which the person has not been a director at any time during the past ten years | |||||
| Bodies of which the person has not been a director at any time during the past ten years | Home address note three | Nationality | |||
| Bodies of which the company is or was at the relevant time a wholly owned subsidiary | |||||
| Bodies of which the company is or was at the relevant time a wholly owned subsidiary | |||||
| Other directorships note nine | Registered at note ten | Company number | |||
| | | |||||
| Bodies which are (or were at the relevant time wholly owned subsidiaries of the company | | | | | | | ||
| --- | --- | --- | --- | --- | --- |
| Note ten | Surname note three | Forname note three | Forname note three | Forname note three | Forname note three |
| Place of incorporation if outside the State | Former Surname note four | Former Forename note four | Former Forename note four | Former Forename note four | Former Forename note four |
| Business occupation | Date of birth: | Date of birth: | Day Month Year | Day Month Year | |
| Home address note three | Nationality | Nationality | Nationality | Nationality | |
| Note eleven mark "X" in the relevant box(es) | |||||
| Other directorships note nine | Registered at note ten | Registered at note ten | Company number | Company number | |
| | | | | ||||
| | | | | ||||
| Documents Annexed note eleven | Surname note three | Forename note three | Forename note three | Forename note three | Forename note three |
| Mark "X" in the box relative to each annexed document | Former Surname note four | Former Forename note four | Former Forename note four | Former Forename note four | Former Forename note four |
| Balance Sheet □ S. 128, Companies Act, 1963 (CA — '63): S. 7 and S. 18, Companies (Amendment) Act, 1986 CAA — '86) | Business occupation | Date of birth: | Day Month Year | Day Month Year | Day Month Year |
| Balance Sheet □ S. 128, Companies Act, 1963 (CA — '63): S. 7 and S. 18, Companies (Amendment) Act, 1986 CAA — '86) | Home address note three | Nationality | Nationality | Nationality | Nationality |
| Profit and Loss □ | |||||
| A/C S. 7 and S. 18, CAA — '86 | |||||
| Directors Report □ | |||||
| S. 128, CA — 63: S. 7 and S. 18, CAA — '86 | Other directorships note nine | Registered at note ten | Company number | Company number | Company number |
| | | | | | | |||
| Auditors Report □ | | | | | | | ||
| S. 128, CA — '63; S. 7 and S. 18, CAA — '86 | |||||
| Guarantee □ | |||||
| S. 17, CAA — '86 | |||||
| Declaration.. □ | Surname note three | Forename note three | Forename note three | Forename note three | Forename note three |
| S. 17, CAA — ''86 | |||||
| Notification to shareholders of Guarantee S. 17, CAA — '86 | Former Surname note four | Former Forename note four | Former Forename note four | Former Forename note four | Former Forename note four |
| Business occupation | Date of birth: | Day Month Year | Day Month Year | Day Month Year | |
| Note stating □ company has availed of exemptions in S. 17, CAA — '86 | Home address note three | Nationality | Nationality | Nationality | Nationality |
| Other directorships note nine | Registered at note ten | Registered at note ten | Registered at note ten | Company number | |
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| We hereby certify that this form contains the particulars in respect of the company as at the date up to which the return is made and that note eleven | We hereby certify that this form contains the particulars in respect of the company as at the date up to which the return is made and that note eleven | We hereby certify that this form contains the particulars in respect of the company as at the date up to which the return is made and that note eleven | We hereby certify that this form contains the particulars in respect of the company as at the date up to which the return is made and that note eleven | We hereby certify that this form contains the particulars in respect of the company as at the date up to which the return is made and that note eleven | |
| The Company is not a private company | The Company is not a private company | The Company is not a private company | The Company is not a private company | The Company is not a private company | |
| The Company is a private company and has not since the date of the last annual return (or the date of incorporation if this is the first return) issued any invitation to the public to subscribe for any shares or debentures in the company | The Company is a private company and has not since the date of the last annual return (or the date of incorporation if this is the first return) issued any invitation to the public to subscribe for any shares or debentures in the company | The Company is a private company and has not since the date of the last annual return (or the date of incorporation if this is the first return) issued any invitation to the public to subscribe for any shares or debentures in the company | The Company is a private company and has not since the date of the last annual return (or the date of incorporation if this is the first return) issued any invitation to the public to subscribe for any shares or debentures in the company | The Company is a private company and has not since the date of the last annual return (or the date of incorporation if this is the first return) issued any invitation to the public to subscribe for any shares or debentures in the company | |
| --- | --- | --- | --- | --- | --- |
| The Company is a private company with more than 50 members. The excess of the number of members over 50 consists wholly of persons who, under section 33 (1) (+b) of the Companies Act, 1963 , are not to be included in reckoning the number of 50 | The Company is a private company with more than 50 members. The excess of the number of members over 50 consists wholly of persons who, under section 33 (1) (+b) of the Companies Act, 1963 , are not to be included in reckoning the number of 50 | The Company is a private company with more than 50 members. The excess of the number of members over 50 consists wholly of persons who, under section 33 (1) (+b) of the Companies Act, 1963 , are not to be included in reckoning the number of 50 | The Company is a private company with more than 50 members. The excess of the number of members over 50 consists wholly of persons who, under section 33 (1) (+b) of the Companies Act, 1963 , are not to be included in reckoning the number of 50 | The Company is a private company with more than 50 members. The excess of the number of members over 50 consists wholly of persons who, under section 33 (1) (+b) of the Companies Act, 1963 , are not to be included in reckoning the number of 50 |
Signed
Director Secretary
GIVEN under my Official Seal, this 26th day of June, 1991.
DESMOND O'MALLEY,
Minister for Industry and Commerce.
EXPLANATORY NOTE.
The purpose of this Order is to prescribe forms to be used for the purposes of certain sections of the Companies Acts, 1963 to 1990.
This document does not substitute the official text published in the Irish Statute Book. We accept no responsibility for any inaccuracies arising from the transcription of the original into this format.
This text is published under Irish Statute Book's own terms of reuse, not a Legalize or public-domain licence.
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