Foreign Register Limited

Company Application Form

Application for a Foreign International Business Company (IBC)

I/We, the undersigned request Foreign Register Limited to proceed on my/our behalf with the formation/purchase of an International Business Company.

1. Correspondence Address.

With whom should Foreign Register Limited correspond concerning the new company?

Name:

Address:

Telephone:

Cell Phone:

Facsimile:

Email Address:

2. Invoicing Address, If Different From Correspondence Address.

Address:

3. Company Name.

Do you want:
(a) A ready made company from our stock Yes No

(b) A new company formed with your own choice of nameYes No

In either case, please list the proposed names in order or preference:

(i)

(ii)

(iii)

4. Jurisdiction.

Country of registration of the above-named Company:

5. Proposed Business Activities.

Please give a full description of the Company's proposed activities/product involved:

Source Of Funds For The Business Activity. Please Explain The Origin Of Funds.

6(a) Beneficial Owner(s).

MUST BE COMPLETED FOR EACH BENEFICIAL OWNER

BENEFICIARY 1.

Name:
Address:
Date & Place of Birth:
Occupation:
Country of Permanent Residence
Nationality:
Domicile:
Passport No.:
Ownership %:

BENEFICIARY 2.

Name:

Address:

Date & Place of Birth:

Occupation:

Country of Permanent Residence

Nationality:

Domicile:

Passport No.:

Ownership %:

PAPERS REQUIRED FOR EACH BENEFICIAL OWNER

6(b) Copy Of Passport.

A copy of the photo page and signature page of the Passport is required for each beneficial owner.

6(c) Bank Or Professional Reference From Your Accountant Or Lawyer.

Bank and/or a professional reference for each beneficiary listed in 6(a) above (in a form similar to Attachment - A).

6(d) Affidavit of Good Standing.

An Affidavit of Good Standing must be provided for each beneficiary listed in 6(a) above (in the form identical to Attachment - B).

6(e) Executed Money Laundering Control Memorandum.

See examples of 6(c), 6(d) and 6(e) at the end of this Form.

7. Director(s).

Foreign Register Limited will be the first Director. Alternatively, where you would like to name some other Director, please provide the following information:

DIRECTOR 1.

Name:
Address:
Date & Place of Birth:
Occupation:
Country of Permanent Residence
Nationality:
Domicile:
Passport No.:

DIRECTOR 2.

Name:

Address:

Date & Place of Birth:

Occupation:

Country of Permanent Residence

Nationality:

Domicile:

Passport No.:

8. Shareholder(s).

(a) Are Nominee Shareholders required.Yes No

(b) Complete this section if you are providing your own Shareholder(s).

SHAREHOLDER 1.

Name:

Address:

No. of Shares:

Occupation:

Certificate To Be Registered To:

SHAREHOLDER 2.

Name:
Address:
No. of Shares:
Occupation:
Certificate To Be Registered To:

Conditions Of Business

This contract is for one year and is renewable on an annual basis. You may, at any time, cancel the service by giving us notice in writing before the renewal date.

I/We confirm that the above conditions have been read and understood.

Signature:			Date:
Signed by or on behalf of:

Please send completed application form along with your passport copy and professional reference to:

Foreign Register Limited

1st Floor, Kings Court, Bay Street

P.O. Box N-3944

Nassau, Bahamas

Email: [email protected]

Payment may be made by:

1. Check;

2. Credit card (MasterCard, Visa); or

3. Direct bank transfer (please request information).

__________________________________________________

Attachment A

To Whom It May Concern:

Please be advised that Mr./Mrs./Ms. , residing at has been a customer of _ (name of bank or professional organization) for many years. He/she is a customer in good standing, both personally and professionally.

If we can be of further assistance in this matter, please do not hesitate to contact us.

Very truly yours,

Name of bank or professional organization

By:_________________________

__________________________________________________

Attachment B

AFFIDAVIT OF GOOD STANDING

[Date]

Foreign Register Limited

1st Floor, Kings Court, Bay Street

P.O. Box N-3944

Nassau, Bahamas

The undersigned, ________________________________________, of _____________________________________, who being first duly sworn upon oath, deposes and states as follows:

1. I have read and understand the Money Laundering Control Memorandum on the attached hereto and confirm and represent that none of the assets which I, or any corporation in which I am either the beneficial owner or hold a controlling interest, have been derived from any of the activities specified in such Memorandum.

2. That I have no pending or threatened claims;

3. That I am not presently under any investigation of any nature, and that I am not involved in any administrative proceedings;

4. That following any subsequent transfers to the Trust, I intend to remain solvent, and able to pay any reasonably anticipated debts as they become due;

5. None of the assets which I may transfer were derived from or relate to any of the activities specified in the Drug Trafficking Offences Act, 1992.

Signature

Name

Date

SWORN AND DECLARED before me at this ___ of _______, 200__.

Notary Public

MONEY LAUNDERING CONTROL MEMORANDUM

The specified activities consist of drug-trafficking offences, and financial misconduct. Drug-trafficking offences include the manufacture, importation, sale, or distribution of controlled substances; the commission of acts constituting criminal enterprise; and transportation of drug paraphernalia.

Financial misconduct includes the concealment of assets from a receiver, custodian, trustee, marshal, or other officer of the court, from creditors in a bankruptcy proceeding; the making of fraudulent conveyance in contemplation of a bankruptcy proceeding or with the intent to defeat any bankruptcy law; the giving of false oaths or claims in relation to a bankruptcy proceeding; bribery; the giving of commissions or gifts for the procurement of loans; theft, embezzlement, or misapplication of bank funds or funds of other lending, credit or insurance institutions; the making of fraudulent bank or credit institution entries or loan or credit applications; and mail, wire, or bank fraud or bank or postal robbery or theft.

Other specified activities include counterfeiting, espionage, kidnapping or hostage taking, smuggling, removing goods from the custody of Customs officials, illegally exporting arms.

Signature

Name

Date