Application Questionnaire

DATE OF FORMATION

NAMES OF REGISTERED/DIRECT SHAREHOLDER(S):


NAMES OF ULTIMATE BENEFICIAL OWNER(S) (if different from above):


NAMES OF DIRECTORS (if more than three, please insert accordingly):


*In addition to this form, please submit copies of the following documents:

CERTIFICATE OF INCORPORATION

CERTIFICATE OF INCUMBENCY/GOOD STANDING (where applicable)

REGISTER OF DIRECTORS, ACCOMPANIED BY VALID PASSPORT COPIES

REGISTER OF SHAREHOLDERS AND SUPPORTING CORPORATE DOCUMENTS (where applicable)

RECENT UTILITY BILL OF THE COMPANY'S PHYSICAL ADDRESS (from the last three months)

By signing this form you confirm and declare that:

  • You must have not been engaged in or have benefited from criminal conduct in any part of the world and funds which are subject to the proposed arrangement do not wholly or in part directly or indirectly represent the proceeds of criminal conduct.
  • The information given hereunder and in the documents requested hereby is to the best of your knowledge true and accurate as at the date hereof, and should there be any changes in the information so provided you undertake to promptly advise us of the same in writing.

I am agree with these conditions