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Personal Information

Name of each Beneficial Owner, Director, Officer (separate form for each person) :
Telephone :	Fax :
Permanent Address :
Email :	Nationality :
Date of Birth:	Place of Birth :
Occupation :	Name of Employer :
Nature of Employment if Self-Employed :

Fees

IBC or LLC :	Email us for prices
Hybrid :	$ 1,100 - Minimum annual fees of $750 more info
Local Bank Account :	$ 250 including auditor's letter
Credit Card / Debit Card :	$ 350 (Additional cards $150 each)
Insurance Company: Class 1 - 3 :	$ 10,000*
Insurance Company: Class 4 - 5 :	$ 8,000*
Fund Manager or Insurance Manager :	$ 5,000
Mutual Fund :	$ 8,000*
Bank License :	$20,000*
Corporate Kit :	$ 250 includes seal
Mailbox Service :	$ 250
Answering Service :	$ 150 more info
Managing Director of an IBC :	To be negotiated

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

Total number of Shares :
(e.g. 1000)

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 :

Address:

Passport Number :

Telephone Number :

Telephone Number:

No. of Shares :

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