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    Name of each Director(s)
    Permanent Address

    Requested Name of Entity

    Total Number of Shares: (circle one)

    Par value (circle one)


    Two (2) Pieces of Current valid Passport, National ID Card or Driver’s License (certified or notarized copy)
    (i.e. Utility Bill, Property Tax Bill)
    A current professional reference letter from a banker, lawyer or accountant in your home jurisdiction.
    (Clearly indicate, type of business, where will the Company operate of offer its services and if additional licensing is required now or in the future)
    Does the Company own or operate any websites now or in the future? If so, what are or will be the website addresses?
    What is the current or expected volume of business (i.e., transaction type and number of transactions)?
    What is the current or expected value of business (i.e., annual turnover in US Dollars or Euros)?
    Source Of Wealth

    Salary – please provide a Bi-Weekly or Monthly Pay Stub
    Savings – please provide a Bank Statement issued to your name
    Please provide frequency of payment?
    What type of Investments do you own? Please provide a Statement or Relevant Document
    Name and Address of Lender?
    Amount of Funds Owed?
    Loan Document
    Date Sold? DD/MM/YYYY
    after payout of mortgage, legal fees, real estate commission
    Sale Document
    Amount of settlment
    Are the funds in your name? Yes / No
    State Name and Address of Lawyer
    Amount of Inheritance
    From whom is in the inheritance?
    Are the funds in your name? Yes / No
    Date of inheritance?

    Please provide details.
    Any Other Document That Would Clarify things

    I / We affirm that any changes in the status of the company will be notified to the incorporator.

    I / We will obtain the necessary license in other jurisdictions if required based on where we intend to offer our products or services.

    I / We affirm that the BC or LLC will not be used for any illegal acts and that the Registered Agent will be indemnified if this is breached.

    I / We authorize verification of all information on this form