Form 3
(Regulation
4) (In typescript and completed in
duplicate)
THE PATENTS AND COMPANIES REGISTRATION AGENCY
The Companies Act, 2017
(Act No. 10 of 2017)
The Companies (Prescribed Forms) Regulations, 2018
(Section 12, 13 and 94)
Available at [Link]
APPLICATION FOR INCORPORATION
PART A
COMPANY
DETAILS
Private Company Limited By Shares x Ensure that the
Private Company Limited By Guarantee members of the
Type of Company
1. Select one type of Company by Public Limited Company
company understand
the kind of company
marking with “X”
Unlimited Private Company being incorporated
and
the liability it carries
Local Bank
Foreign Bank
Company Category Insurance Company
2. Select category of Company by Re-Insurance Company
marking with “X” Bureau De Change
Financial Institution
Other (Specify) x
Company Name
3. Ensure that the name is captured CHAMA POWER CONSTRUCTION LIMITED
exactly as approved by Company
Registry and has not expired
4. Principal Business Activity 4100. Construction of buildings Business activity to be
classified in accordance
with the ISIC
Classification. A full list
5. Other Business Activities of the
trade
classification codes is
available on our
website:
[Link]
6. Whether Articles Restrict
Nature of Business NO x YES
Mark with “X” As Appropriate
7. Type of Articles STANDARD NON-STANDARD x
Mark With “X” As Appropriate
Plot/House/
Physical Village 12
8. Address Street 540049
State the Area kambombo
registered office of Town Chama District
the Company Province Muchinga Province
Postal Address Post Box 540049
9. State the Area kambombo
notification Town Chama District
address of the Province Muchinga Province
Company
Phone Number Mobile +260776553079
10. Include the
international Landline
code (e.g. +260
for
Zambia)
11. Email Address Kasandaemmanuel149@[Link]
Nominal Capital or
12. Guaranteed 15,000 Zambian Kwacha
Amount
Nominal Capital or Guaranteed
amount must not be less than the
prescribed minimum
Class of Shares
13. If other indicate the specific class of ORDINARY PREFERENTIAL OTHER
Not applicable to
shares. companies limited by
14. Number of Shares 15,000 guarantee
15. Par Value 1,00 ZMW
Financial Year End
16. The first financial year end must
not be more than 12 months from
11.12.2024
the date of incorporation
Pledged Investment Amount
17. In case of Foreign Investors state
the
amount and period for pledged
investment
PART B
FIRST
DIRECTORS
Note: Minimum of two Directors for private and three for public limited companies. The number of directors resident in Zambia
shall not be less than half the number of directors appointed
PARTICULARS OF DIRECTOR
First Name EMMANUEL MBULO OSWARD YOBE SANDWELL
KASANDA KAFULA NG’UNI
Surname CHANDA GOMA
MALE
MALE MALE MALE MALE
Gender
06/02/1979 14/04/1981 12/12/1980 01/01/1988 01/01/1973
Date of Birth
ZAMBIAN ZAMBIAN ZAMBIAN ZAMBIAN
Nationality ZAMBIAN
Identity Type
For Zambians: NRC
For non-Zambians: NRC NRC NRC NRC NRC
NRC/Passport/
Driver’s
Licence/Resident
Permit
832819/11/1
Identity Number 355862/61/1 333305/61/1 130778/56/1 102207/56/1
18.
Phone Mob +260977761015 +260971487206
+260973943012
Number ile +260968574106 +260950043254
Include the
international Lan
code (e.g. dlin
+260 for e
Zambia)
Chandambulo oskafman@gm Yomejubell130
Email Address Kasandaemman
01@[Link] [Link] 7@[Link]
uel149@gmail.c
om
Plo 12 12 12 12
t/
Ho 12
us
e/
Vil
lag
e
Physical KAMBOMBO KAMBOMBO KAMBOMBO KAMBOMBO KAMBOMBO
Str
Address ee
t
Ar KAMBOMBO KAMBOMBO KAMBOMBO KAMBOMBO KAMBOMBO
ea
To CHAMA CHAMA CHAMA CHAMA CHAMA
w DISTRICT DISTRICT DISTRICT DISTRICT DISTRICT
n
Pr MUCHINGA MUCHINGA MUCHINGA MUCHINGA
ov MUCHINGA PROVINCE PROVINCE PROVINCE PROVINCE
i PROVINCE
nc
e
Co ZAMBIA ZAMBIA ZAMBIA ZAMBIA
un ZAMBIA
try
DECLARATION FOR CONSENT TO ACT AS DIRECTOR:
We, whose name(s) and particulars appear above, consent to act as director(s) for the
above mentioned company:
19. Signature: Date: 11/12/2023
Signature: Date: 11/12/2023
Signature: Date: 11/12/2023
Signature: Date: 11/12/2023
Signature: Date: 11/12/2023
Replicate Part B to add more first directors
PART C
SHAREHOLDER
S
Applicable to Public Company, Private Company Limited by Shares and Unlimited Private Company
PARTICULARS OF SHAREHOLDERS
First Name EMMANUEL MBULO OSWARD YOBE SANDWELL
KASANDA KAFULA NG’UNI
Surname CHANDA GOMA
MALE
MALE MALE MALE MALE
Gender
06/02/1979 14/04/1981 12/12/1980 01/01/1988 01/01/1973
Date of Birth
ZAMBIAN ZAMBIAN ZAMBIAN ZAMBIAN
Nationality ZAMBIAN
Identity Type
For Zambians: NRC NRC
For non-Zambians: NRC NRC NRC NRC
NRC/Passport/ Driver’s
Licence/Resident Permit
832819/11/1
Identity Number 355862/61/1 333305/61/1 130778/56/1 102207/56/1
Name of Body
Corporate
20. Where applicant is a Body
Corporate
Nature of Body
Corporate
Where applicant is a Body
Corporate, indicate
whether applicant is a
Company, Co-operative,
Trust, Society,
Etc.
Registration
Number, Date and
Country of
Incorporation of
Body Corporate
Where applicant is a Body
Corporate
+26097394301 +260977761015 +260971487206
Mobile +260968574106 +26095004325
Phone 2 4
Number
Landline
Chandambul
oskafman@gm Yomejubell130
Email Address Kasandaemman o01@gmail.c
[Link] 7@[Link]
uel149@[Link] om
m
Plot/Hous 12 12 12 12 12
e/ Village
KAMBOMBO KAMBOMBO KAMBOMBO KAMBOMBO KAMBOMBO
Street
Physical KAMBOMBO KAMBOMBO KAMBOMBO KAMBOMBO KAMBOMBO
Area
Address CHAMA CHAMA CHAMA CHAMA CHAMA
Town DISTRICT DISTRICT DISTRICT DISTRICT DISTRICT
MUCHINGA MUCHINGA MUCHINGA MUCHINGA
Province MUCHINGA PROVINCE PROVINCE PROVINCE PROVINCE
PROVINCE
ZAMBIA ZAMBIA ZAMBIA ZAMBIA
Country
ZAMBIA
21. Number of Shares 3000 3000 3000 3000 3000
ORGINARY ORGINARY ORGINARY ORGINARY ORGINARY
Class of Shares
Signature: Date: 11/12/2023
Signature: Date: 11/12/2023
22. Signature: Date: 11/12/2023
Signature: Date: 11/12/2023
Signature: Date: 11/12/2023
Legal owner(s) to sign if not the Beneficial Owner
Replicate Part C to add more Shareholders
PART D
BENEFICIAL
OWNERSHIP
Applicable to Public Company, Private Company Limited by Shares and Unlimited Private Company
PARTICULARS OF BENEFICIAL OWNERSHIP
First Name EMMANUEL MBULO OSWARD YOBE SANDWELL
KASANDA KAFULA NG’UNI
Surname CHANDA GOMA
MALE
MALE MALE MALE MALE
Gender
06/02/1979 14/04/1981 12/12/1980 01/01/1988 01/01/1973
Date of Birth
ZAMBIAN ZAMBIAN ZAMBIAN ZAMBIAN
Nationality ZAMBIAN
Identity Type
For Zambians:
NRC
For non-Zambians: NRC NRC NRC NRC NRC
NRC/Passport/
Driver’s
Licence/Resident
Permit
832819/11/1
Identity 355862/61/1 333305/61/1 130778/56/1 102207/56/1
Number
Occupation
Name of Body
Corporate
Where applicant is
a Body Corporate
23. Nature of Body
Corporate
Where applicant is
a Body Corporate,
indicate whether
applicant is a
Company, Co-
operative, Trust,
Society, Etc.
Registration
Number, Date
and Country of
Incorporation
of Body
Corporate
Where applicant is
a Body Corporate
M
o
b +26096857 +260973943012 +260977761015 +260971487206
+260950043254
i 4106
l
e
L
Phone Number a
n
d
l
i
n
e
Kasandaemm Chandambulo01 oskafman@gm Yomejubell1307
Email Address @[Link] [Link] @[Link]
anuel149@gm
[Link]
Physical/ P 12 12 12 12 12
Registered l
o
Office
Address t
/
H
o
u
s
e
/
V
i
l
l
a
g
e
S
t KAMBOM
KAMBOMBO KAMBOMBO KAMBOMBO KAMBOMBO
r BO
e
e
t
A KAMBOM
r KAMBOMBO KAMBOMBO KAMBOMBO KAMBOMBO
e
BO
a
T CHAMA CHAMA CHAMA CHAMA CHAMA DISTRICT
o DISTRICT DISTRICT DISTRICT
w
DISTRICT
n
P MUCHINGA MUCHINGA MUCHINGA MUCHINGA
r PROVINCE PROVINCE PROVINCE PROVINCE
o MUCHING
v
A
i
n
PROVINCE
c
e
C ZAMBIA ZAMBIA ZAMBIA ZAMBIA
o
u
ZAMBIA
n
t
r
y
DIRECTOR/TRUSTEE OF BODY CORPORATE
No First Identity Physical Address: Date Appointed:
Name: Number:
Surname: Gender:
Email:
Phone
24. Number:
Nationality:
Date of Birth:
Occupation:
1
2
3
4
SHAREHOLDER/SETTLER OF BODY CORPORATE
No First Identity Physical Number Class of Number of Paid
Name: Number Address of Shares: Up Shares:
Surname : Shares:
: Gender:
Email:
25.
Phone
Number:
Nationality:
Date of Birth:
Occupation:
1
2
3
4
BENEFICIAL OWNER/BENEFICIARY OF BODY CORPORATE
No First Identity Physical Address Nature of Interest
Name: Number:
Surname: Gender:
Email:
Phone
26. Number:
Nationality:
Date of Birth:
Occupation:
1
2
3
4
Number of Shares (if any) 3000 3000 3000 3000 3000
Class of Shares (if any) ORDINARY
Nature of Beneficial
Ownership
Briefly explain the nature of LEGAL OWNERS
beneficial ownership (whether
trust, legal arrangement etc.)
27. including how ownership control
or economic
interest is maintained
Date when beneficial
11/12/2023
interest was acquired
If beneficial owner is
politically exposed person
(PEP) as defined in the no
Financial Intelligence Act
No. 46 of 2010, provide
details (e.g. position held)
DECLARATION OF BENEFICIAL OWNERSHIP:
We, whose names and particulars appear above, declare that I am the beneficial owner as indicated above.
28. Signature: Date: 11/12/2023
Signature: Date: 11/12/2023
Signature: Date: 11/12/2023
Signature: Date: 11/12/2023
Signature: Date: 11/12/2023
Replicate Part D if the Beneficial Owners are more than two
PART E
GUARANTOR
S
Applicable to Companies Limited by Guarantee
GUARANTOR
First Name
Surname
Gender
Date of Birth
Nationality
Identity Type
For Zambians: NRC
For non-Zambians: NRC/Passport/
Driver’s Licence/Resident Permit
Identity Number
Name of Body Corporate
Where applicant is a Body Corporate
29. Nature of Body Corporate
Where applicant is a Body
Corporate, indicate whether
applicant is a Company, Co-
operative, Trust, Society, Etc.
Registration Number,
Date and Country of
Incorporation of Body
Corporate
Where applicant is a Body Corporate
Mobile
Phone Number
Landline
Email Address
Plot/House/
Village
Street
Physical Area
Address
Town
Province
Country
30. Guaranteed Amount
GUARANTOR’S DECLARATION:
We, whose name(s) and particulars appear above, hereby undertake to contribute the
guaranteed amount(s) specified:
31.
Signature: Date:
Signature: Date:
Replicate Part E to add more Guarantors
PART F
COMPANY SECRETARY
SECRETARY
First Name EMMANUEL
KASANDA
Surname
MALE
Gender
06/02/1979
Date of Birth
Nationality
ZAMBIAN
Identity Type
For Zambians: NRC NRC
For non-Zambians: NRC/Passport/
Driver’s Licence/Resident Permit
Identity Number 355862/61/1
Name of Body Corporate
Where applicant is a Body Corporate
Nature of Body Corporate
Where applicant is a Body
32.
Corporate, indicate whether
applicant is a Company, Co-
operative, Trust, Society, Etc.
Registration Number,
Date and Country of
Incorporation of Body
Corporate
Where applicant is a Body Corporate
Mobile +260968574106
Phone Number
Landline
Email Address Kasandaemmanuel149@g
[Link]
Plot/House/ 12
Village
KAMBOMBO
Street
Physical KAMBOMBO
Address Area
CHAMA DISTRICT
Town
Province
MUCHINGA PROVINCE
Country
ZAMBIA
DECLATION FOR CONSENT TO ACT AS COMPANY SECRETARY:
I\We, whose name(s) and particulars appear above, consent to act as Company secretary(s)
for this Company:
Signature: Date: 11/12/2023
Replicate Part F to add more Secretaries
PART G
DECLARATION OF COMPLIANCE
I, ………EMMANUEL KASANDA……..…………..do solemnly and sincerely declare that I am: a legal
practitioner engaged in the formation of the Company a first director named in the application for
incorporation or the first secretary named in the application for incorporation (delete whichever is
not
applicable) and that all the requirements of the Companies Act, No 10 of 2017, in respect of
matters
precedent to the incorporation of the Company and incidental thereto, have been complied with. I make
this solemn declaration conscientiously believing the same to be true.
Declared at ………21:16…………. the ……MONDAY…… day of ……………11………………, 20…23……..
Signature: ………………………………….
PART H
PARTICULARS OF PERSON LODGING APPLICATION
33. First Name
EMMANUEL
34. Surname KASANDA
35. Gender MALE
36. Date of Birth 06/02/1979
ZAMBIAN
37. Nationality
Identity Type
For Zambians: NRC
38. NRC
For non-Zambians: NRC/Passport/
Driver’s Licence/Resident Permit
39. Identity Number 355862/61/1
Mobile +260968574106
40. Phone Number
Landline
Kasandaemmanuel149@[Link]
41. Email Address
Plot/House/
Village 12
KAMBOMBO
Street
Physical
42. Address KAMBOMBO
Area
Town
CHAMA DISTRICT
Province
MUCHINGA PROVINCE
ZAMBIAN
Country
43. Signature: Date: 11/12/2023
