Professional Documents
Culture Documents
Beneficial Ownership Form
Beneficial Ownership Form
What this form is for What this form is NOT for For further information
You may use this form to You cannot use this fom1 Please: refer to our
give notice of person with to give notice of change of guidance: at
significant control (PSC)- details of PSC- Natural www.nuprc.gov.ng
Natural Person. PSC- Person or Legal Entity
legal Entity and details of
the interest(s) held (used
by both entities and
natural persons)
Input month as
abbreviated text e.g
30-Jan-2020
Title
First Name This should be the
current legal name of the
PSC
Surname The family names of the
PSC
Other Name(s) The given names of the
PSC used to distinguish
the individual within the
family.
1
Former name(s) The patronymic name of
the PSC (where used).
City
Nationality/nationalities The nationalities held by
the PSC
Country of residence
Identification number
Identification type Means of identification
e.g. international
passport. National ID
card. Driver’s License.
Permanent Voter’s Card
Gender
Email
Phone number
Address service Building The service address of the
name/number PSC
Street
City
State
Country
2
PSC is resident for tax
purposes
Date of Birth _ _-_ _ _-_ _ _ _ Input month as
abbreviated text e.g
day-month-year 30-Jan-2020
Name of entity
Legal form Choose from:
• Private registered
company
3
• Public registered
company
• Limited liability
partnership
• Other legal entity
(e.g government
department)
• Trust
• Legal arrangement
Country of Registration The country in which this
legal enti1y is registered. if
any.
Legal entities that have a
unique registration must
provide a jurisdiction.
register and identifier.
Register The register in which this
legal entity is registered.
Registration Number The Registration number' for
this legal entity.
E.g., a company number
provided by a central
business register.
Governing law The governing law to which
this legal entity is subject.
Address - registered Building The registered address of the
name/number legal entity
Street
City
State
Country
Interests held
Yes/No
4
Docs the PSC directly Percentage held If ·Yes·. state the
or indirectly hold at directly percentage held directly
Percentage held and indirectly.
least 5% of the shares
or interest in a company indirectly
or limited liability
partnership?
Name of legal Name(s), Share (%) Where some part of the
Owner(s) of shares or jurisdiction(s), interest is held indirectly.
and company the name of the legal owner
interest in the Register
number(s) of through which this interest
and the percentage of legal owner(s) is held should be provided.
the PSC's overall where the PSC holds the
interest held through interest through a
them. combination of legal
owners in the Register. all
relevant legal owners
should be listed.
Where the legal owner is a
natural person. the name
should be as it appears on
the Register. Where the
legal owner is an entity. the
company number and
jurisdiction should also be
provided.
5
be provided.
Where the PSC holds the
interest through a
combination of legal owner
in the Register. all relevant
legal owner.; should
be listed.
Where the legal owner is a
natural person, the name
should be as it appears on
the
Register. Where the legal
owner is an entity, the
company number and
jurisdiction should also be
provided
Significant influence or control whether or not the PSC is a legal entity, but
would itself satisfy any of the first four conditions if it were an individual.
6
control over the
activities of a trust or
furn. whether or not it
is a legal entity, but
would itself satisfy any
of the first four
conditions if it were an
individual?
Term Definition
"person with significant control" means any person:
Name
Address Street
City/Area/District
City/Town/Village
Local Government
Postal code
State
Country
Phone Number
7
Email Accreditation
Number
(where
applicable:)
Signature Date
NOTE:
Petroleum Industry Act, 2021. Section 230.
Subject to the provision of Section 230 (a), (b),( c) and e) any person who fails or
refuses to furnish, return or supply information to the Commission or Authority
or any other lawful authority at the time and in the manner prescribed, furnishes
a false or incomplete return, supplies false or incomplete information, or conceals,
fails or refuses, without reasonable cause, to supply information required by the
Commission or Authority or any duly empowered lawful authority at the time and
in the manner prescribed or when required to do so, commits an offence and is
liable:
a) on conviction by a court of competent jurisdiction is liable to a term of
imprisonment and
b) be liable to a fine as prescribed by the Regulations where such offence is
repetitive or continues after having been so informed in writing by the
Commission.
Nothing in this section shall affect the provision of any enactment imposing
penalties in respect of perjury in force in Nigeria