ON COMPANY’S LETTERHEAD

Beneficial Ownership (BO) Declaration

To: Epimoney Pvt Ltd Date:12-06-2024

Application ID:PNF-UTABU-000-MAY24-00079

Name of the Entity: ADS LABTECH

Type of the Entity:Pvt Ltd Co. ☐Partnership Firm☐

LLP☐Listed Entity on Stock Exchange☐Others ☐

Address of the Entity:39/2/10A site-4 Industrial area Ghaziabad EAST DELHI Hasanpur Bhowapur Uttar Pradesh 201010

In case the Applicant is listed on any stock exchange or is a subsidiary of an entity which is listed on a stock exchange in
India or is an entity resident in jurisdictions notified by the Central Government and listed on stock exchanges in such
jurisdictions please fill only the below section and sign in Section II.

I/We,theundersigned,here by declare that our company/holding company is listed on

Name of the Holding Company, M/s

In case of Any Entity other than a Listed Company, please provide details under Section – I (i) and Section – I (ii),as applicable
andSection–IItobe tickedandfilled in.

Section–I(i)
(a) I / We, the undersigned, hereby declare that following persons own Controlling Ownership Interest of morethan 10% in
case of Company, 10 % or more in case of Trust, more than 15% in case of Partnership Firm
andUnincorporatedAssociationor Bodyof Individuals. (Refer Notes- A)

Sr. No. Name of Beneficial Address of BO Details of PAN/ Nationalit %

Owner(Shareholders Registrati y
BO(Shareholde Type KYCDoc. & ofShareholdi
/Partners/Trusteese rs/Partner s/ (Refer KYCIdentifi onNo. ng
tc.) Trusteesetc.) Note- er(ReferNo /Profits/Inte
C) teE) rest
/
Ownershipi
n
theEntity
1 VIRENDERKUMAR 146/1, Global City, ADMPT1268 40%
TIWARI Meerut Cant, L
Meerut Meerut
Uttar Pradesh
250001
2 PUNAM SINGH Flat no 704 Tower - LNTPS8161B 60%
O Amrapali zodiac
sector 0 120
Gautambuddhanag
ar Uttar pradesh
Sec 16 Noida
Uttar Pradesh
201301

Pleaseuseadditionalsheetincaseofmoreinformationtodisclose.

(b) I / We further declare that following persons are the only senior management persons in the Company.
 Sr. No. Name of the Senior Management Person Designation

The Company undertakes that the facts stated above are true and correct.

The Company also undertakes and agrees that it will promptly notify EPIMONEY PRIVATE LIMITEDof any changes in the
aforementioned details.

Section–I(ii)
Applicableonlyifthereis/arenon-individualshareholder(s)/
partners,[Link]–
I(i).Followingperson(s),havecontrollingownershipinterestin BeneficialOwner ofthe Entityas declared inSection–I(i) above.

Sr. Name of Address of BO Details of PAN/ Nationalit %

No. BeneficialOwner BO(Sharehold Type KYCDoc. & Registrati y ofShareholdi
(Shareholders ers/Partners/ (Refer KYCIdentifi onNo. ng
/Partners/Trustee Trusteesetc.) Note- er(ReferNo /Profits/Inte
setc.) C) teE) rest
/
Ownershipi
n
theEntity
1
2
3

OR

Section –II

escribed threshold as declared in [Link](s)holdingthepositionofDirectors/SeniorManage

he captioned company in excess of thethresholdlimit prescribedbelowinNote-A.

AuthorisedSignatory(ies)(i) Signature_

AuthorisedSignatory(ies)(ii) Signature_

AuthorisedSignatory(ies)(ii) Signature_

(RefernoteDforSignaturerequirement)

Signed and Delivered for and on

behalf of ___________________ (Entity Name)

______________________________
 (Authorised Signatory)

Notes

A. AsperthePreventionofMoneylaundering(MaintenanceofRecords)Rules,2005,
Thebeneficialownerforthe purposeofsub-rule(1)shallbe determinedasunder–

(a) Where the customer is a Company, the beneficial owner is the natural person(s), who, whether acting alone ortogether,
or through one or more juridical person, has/ have a controlling ownership interest or who
exercisescontrolthroughothermeans. Explanation-Forthepurposeofthis sub-clause-

i. “Controllingownershipinterest”meansownershipof/entitlementtomorethan10%ofthesharesor
capitalorprofitsofthe company;
ii. “Control”shallincludetherighttoappointmajorityofthedirectorsortocontrolthemanagementorpolicydecisions including by
virtue of their shareholding or management rights or shareholders' agreements orvotingagreements;

(b) Where the customer is a Partnership firm, the beneficial owner is the natural person(s), who, whether
actingaloneortogether,orthroughoneormorejuridicalperson,has/haveownershipof/entitlementtomorethan15%of
capitalorprofitsofthe partnership;

(c) Where the customer is an Unincorporated Association or Body of Individuals, the beneficial owner is thenatural
person(s), who, whether acting alone or together, or through one or more juridical person, has/ haveownership of /r
entitlement to more than 15% of the property or capital or profits of such association or body ofindividuals;

(d) Where no natural person is identified under (a) or (b) or (c) above, the beneficial owner is the relevant
naturalpersonwhoholds thepositionofseniormanagingofficial;

(e) WherethecustomerisaTrust,theidentificationofbeneficialowner(s)shallincludeidentificationoftheauthorof the trust, the

trustee, the beneficiaries with 10 % or more interest in the trust and any other natural
personexercisingultimateeffectivecontroloverthetrustthrougha chainof controlorownership; and

(f) Where the customer or the owner of the controlling interest is a Company listed on a stock exchange in
India,orisasubsidiaryofsuchacompany,orisanentityresidentinjurisdictionsnotifiedbytheCentralGovernmentandlisted on stock
exchanges in such jurisdictions, it is NOT necessary to identify and verify the identity of anyshareholderor beneficialownerof
suchcompanies.

B. BeneficialOwnershipIdentificationisNOTrequired,infollowingcases:
Individual accounts, Sole Proprietorship accounts, HUF, Government Departments, Public Sector Undertaking,Local
Government Bodies (Municipal Corporation, Gram Panchayats etc.), Company listed on a recognized stockexchange. An
entity resident in jurisdictions notified by the Central Government and listed on stock exchanges
insuchjurisdictionsMajorityownedsubsidiaryof aCompanylistedonarecognizedstockexchange.

C. BeneficialOwnershipDeclarationtoprovidedetailsoffollowing

PartnershipFirm/LLP:Naturalpersons/Partners Club:Members/AuthorizedSignatories/Beneficiary
Trust:Trustees/Settlor/Protector/Beneficiary AssociationofPersons:Members/[Link]/
Beneficiary
Foundation:FounderManagers/Directors/ [Link].:Shareholder/
Beneficiary Directors/OtherBeneficiaries
Society:Members/AuthorizedSignatories/ IncaseofForeignEntity:Shareholder/Director/Other
Beneficiary Beneficiaries

D. SignatureonDeclarationform
 Sr. TypeofEntity Signatory(ies)forSigningBODeclaration
No.
i PartnershipFirm/LLP/Trust/Foundation/ AuthorizedSignatoriesshouldsignaspertheModeof
Society/ Club Operations
ii Association AllAuthorizedSignatoriesshouldsign
iii Unlisted Public Limited Companies and AnytwoDirectorsorCompanySecretaryor
PrivateLimitedCompanies AuthorizedSignatoriesasper theBoardResolution
iv ForeignEntity AllAuthorizedSignatoriesshouldsign

E. KYC Documents of Beneficial Owners (KYC of Directors/ Senior Management in case BO is not identified) should
besubmittedasper theOVDunder PMLA andRBIGuidelines,asamendedfrom timetotime.
(1) OnerecentPhotograph
(2) PANor Form60 ifPANis notallotted
(3) * CertifiedCopyofoneoftheOfficiallyValidDocuments(OVDs)listedbelow:

[Link]. OfficiallyValidDocuments(OVDs)
1 Passport
2 DrivingLicense
3 Voter'sIdentityCardissuedbyElectionCommissionofIndia
4 Proof of possession of Aadhaar Number (i.e., Aadhaar letter, Aadhaar Letter downloaded fromUIDAI
website (e-Aadhaar), Aadhaar Card, Aadhaar Secure QR Code, Aadhaar Paperless OfflineKYC(anXML
document generatedbytheUIDAI)**
5 JobCardissuedbyNREGAduly signedbyanofficeroftheStateGovernment
6 LetterissuedbytheNationalPopulationRegistercontainingdetailsofName,Addressofthe
customerwithphotographof thecardholder.
*ObtainingaCertifiedCopybyReportingEntity(thisincludesourCompany)meanscomparingthecopyof Officially Valid
Document (OVD) so produced by the client (i.e., customer) with its Original andrecordingthesameonthecopyby
theauthorizedofficerof theReportingEntity”.
CopiesoftheKYCDocumentsshouldbeSelf-attestedbythecustomers.
**Ensuretoredact/maskonlythefirsteightdigitsoftheAadhaarNo.(oncopyofAadhaar
Letter/AadhaarCardobtained), anditisnotlegible.