Personal
Information
(Please complete a new form for each principal) |
|
Name of each Beneficial Owner, Director, Officer (separate
form for each person):
|
Telephone #:
|
Fax
#:
|
Permanent
Address:
|
Email
address:
|
Nationality:
|
Date
of Birth:
|
Place
of Birth:
|
Occupation:
|
Name
of Employer:
|
Nature of Employment if Self-Employed:
|
| |
|
|
| IBC
or LLC: |
|
| Hybrid: |
|
| Local
Bank Account: |
|
| Credit
Card / Debit Card: |
|
| Insurance
Company: Class 1 - 3 |
|
| Insurance
Company: Class 4 - 5 |
$ 8,000* |
| Fund
Manager or Insurance Manager: |
$ 5,000 |
| Mutual
Fund: |
|
| Bank
License: |
|
| Corporate
Kit: |
|
| Mailbox
Service: |
|
| Answering
Service: |
$ 150 more info � |
| Managing
Director of an IBC: |
|
*(Does not include government fees) *(Where due
dilligence is required please add $ 2,200) |
| U.S.
Citizens and residents: I/We will pay taxes in my/our jurisdiction |
Required information of each Beneficial
Owner, Director & Signatory of IBC, Settlor, Protector & Beneficiaries of Trust
1) Current valid passport,
National ID Card or Driver's License (certified copy)
Passport copy should show:
- passport number
- picture
- place of issue
- date of issue
- expiration date
- signature |
|
|
| IBC's |
Name of IBC, LDC or Hybrid:
First
Choice |
Second Choice |
|
Par Value:
(e.g. $1) |
Total Value:
(Par
value x No. of Shares) |
Allocation of Shares:
Name: Number of
Shares: |
| Name:
Number of Shares: |
Bearer Shares: Yes No
Names of beneficial owners must be provided whether registered or bearer shares |
| Provide copies of any Power of Attorney given by Directors |
| Provide a signed directors' statement as to the nature of the business |
Beneficiaries of Bearer Shares:
Beneficiary 1
Name
|
Beneficiary 2
Name
|
|
Address
|
|
Passport
Number
|
|
Telephone
Number
|
No. of Shares:
|
No.
of Shares:
|
| Payment - For
details about Payment, please see Payment options and instructions here. The Payment options will open in a new Browser window. |
