1. NAME OF PROPOSED COMPANY (Please provide at least three alternatives)

______

______

______

Or

CHOOSE FROM LIST OF SHELF COMPANIES

______

2. PROPOSED COMPANY ACTIVITIES

(Please include countries where business activity will take place)

______

______

______

3. SHARE CAPITAL:

All BVI companies are incorporated with an Authorized Share Capital of 50000 shares with a nominal value of US$1,00 per share and an Issued Share Capital of 100 shares with a nominal value of US$1,00 per share.

Please state the Authorized Share Capital required:______

Please state the Issued Share Capital required:______

4. REGISTERED OFFICE

Our firm will provide this service.

5. DIRECTORS

Please indicate if you require this service:

YESNO

If NO, please provide the following information:

Name:______

Permanent Residential Address: Postal Address

(if different from permanent address):

______

______

______

Nationality: ______

Occupation: ______

6. NOMINEE SHAREHOLDERS

Please indicate if you require nominee shareholders.

YESNO

If you choose NO please proceed and complete section 8.

7. REGISTERED SHAREHOLDER(S)

Name:______

Number of Shares:______

Permanent Residential Address:Postal Address (if different from above):

______

______

______

Nationality: ______

Occupation: ______

Business activities over the last three years:

______

______

______

REQUIRED IDENTIFICATION DOCUMENTS

Passport number:______

Date of Issue:______

Date of Expiry:______

Country of Issue:______

OR (delete where appropriate)

Drivers License number:______

Date of Issue:______

Date of Expiry:______

State/Country of Issue:______

CONTACT INFORMATION

Home:______

Office:______

Mobile: ______

Fax: ______

Email:______

If insufficient space, please attached additional pages.

BENEFICIAL OWNER 1

Name/Surname:______

ID Card: ______

Passport No.: ______

Home Address: ______

Number of Shares: ______

BENEFICIAL OWNER 2

Name/Surname:______

ID Card: ______

Passport No.: ______

Home Address: ______

Number of Shares: ______

IMPORTANT NOTE: For each Registered Shareholder(s) or Ultimate Beneficial Owner(s), Director appointed by you please, provide the following three documents duly notarized:

  1. Passport copy
  2. Bank reference letter
  3. Utility bill that verifies home address
  4. Due Diligence Declaration

In case the Registered Shareholder or Ultimate Beneficial Owner and/or Director are a corporate entity, please provide us with the following information:

  1. Full set of company certificates
  2. Memorandum and Articles of Association
  3. Register of Members
  4. Register of Directors
  5. Declaration(s) of Trust (In case of nominees)
  6. Share certificates
  7. Passport copy of beneficial owner(s)
  8. Bank reference letter
  9. Utility bill that verifies home address

If the Registered Shareholder or Ultimate Beneficial Owner is a trust, body, corporate or other group of people, please communicate with us for information necessary to be submitted for satisfaction of our Know Your Client procedures.

8. BANK ACCOUNT OPENING

Our firm can open bank account with any of the banks operating in Cyprus (Bank of Cyprus, Hellenic Bank, Alpha Bank, Marfin Popular Bank, etc) or any other Bank of your choice.

Name of Bank:______

Account currency:______

Account signatories:______

(It is advisable to have one of our firm’s

Directors and/or Secretary as one of the Signatories)

Source of Funds:______

Expected Volume:______

(Please specify currency)

9. POWER OF ATTORNEY

Our firm will prepare and issue a General Power of Attorney to be included with the company certificates and resolutions to dispatch.

Please provide us with the following information for the appointed person if different from the beneficiary.

Name:______

Permanent Residential Address:Postal Address (if different from above):

______

______

______

Nationality: ______

Occupation: ______

CONTACT INFORMATION

Home:______

Office:______

Mobile: ______

Fax: ______

Email:______

REQUIRED IDENTIFICATION DOCUMENTS

  • Copy of passport

10. CLIENT INSTRUCTIONS

Please complete any further information and/or instructions you feel are important and that our firm should be aware of.

______

______

______

Declarations

I declare that none of my assets, net worth or income now or in the future arises from drug trafficking, money laundering or nay other activity that is illegal in the Republic of Cyprus or in the European Union or any other jurisdiction.

I further declare that I am currently solvent.

I further declare that I have obtained or will obtain competent independent tax and legal advice from my home jurisdiction to determine whether any taxes are due from my offshore holdings, and that I will be fully responsible for any tax obligations in my home jurisdiction now and in the future.

I further declare that all of the above information and statements are true and correct as of the date of this document.

Date: ______

Beneficial Owner

For any further assistance you can contact us at the following contact information:

DEMETRIOS A. DEMETRIADES LLC
3 Thasos Street,

P.O.Box 22360
Nicosia - Cyprus
Tel.: ++357 22 769000
Fax: ++357 22 769004
E-mail: