REQUEST FORM TO SET UP OPERATIONS

IN AN EXPORT PROCESSING ZONE

Regulations for Decree on Export Processing Zones

(Decree 31-92, Article 19)

1. GENERAL CHARACTERISTICS OF THE BUSINESS:

A.General Information

Name of the Company: ______RUC No. : ______

Telephone(s):______Fax: ______e-mail: ______

Address: ______P.O. Box: ______

Local Representative (Legal Agent):______

Nationality: ______Passport Number: ______

Name of the Export Processing Zone Park Operator: ______

Name of the Export Processing Zone (Geographical Location if a Stand Alone Export Processing Zone:

______

______

B.General information on the Corporation

Authorized Share Capital, Underwritten and Paid-in (Córdobas C$): ______

Partners and Nationality:

SHAREHOLDERS
FIRST AND LAST NAMES /

NATIONALITY

/ PASSPORT No. / No. OF SHARES / % OF HOLDINGS
TOTAL

Business Activity (what the company will do):

______

______

______

______

  1. INVESTMENT
  1. Pre-Operative Investment (*)

1. By Category of Expenditures

CATEGORY / AMOUNT
IN US$
Legal fees
Studies
Land
Infrastructure
Machinery & Equipment
Vehicles
Office equipment and furnishings
Other

TOTAL

2. Source of Resources
FOREIGN / NATIONAL / TOTAL
Net equity (US$)
Loans (US$)
TOTAL (US$)

(*) Pre-Operative Investment:

Refers to investments made before beginning productive operations. Example: land, construction of buildings, machinery and equipment, vehicles, legal fees, studies, consultants, designs, financing expenses, office equipment.

  1. Investment Plan (First three years of productive operations)

By Expense Category / Year 1 / Year 2 / Year 3 / TOTAL
US$
Legal fees
Studies
Lands
Infrastructure
Machinery and Equipment
Furniture and Furnishings
Vehicles
Others (Specify)
Working Capital
TOTAL US$=
Source of Resources
FOREIGN / NATIONAL / TOTAL
Net equity (US$)
Loans (US$)
TOTAL (US$)
  1. Stages of Project Development:

Pre-Operative Stage (Date)From: ______Until: ______

Beginning of Productive Operations (Date):From: ______

Full Capacity Stage (Date): From: ______

3.EMPLOYMENT AND USE OF LABOR:

  1. Work Day

Number of shifts to be worked each day: ______

Number of hours per shift: ______

Number of working days per week: ______

  1. Attach a Company flowchart.

Cable – TV (Yes, No): ______

  1. ENVIRONMENTAL ASPECTS:

Attach copy of Form Requesting Environmental Permit presented to the Ministry of Natural Resources and the Environment - MARENA

I attest to the truth of the information provided in this request:

______

REGISTERED SIGNATURE OF DATE

LEGAL REPRESENTATIVE

CERTIFICATION BY NOTARY:

  1. PERSONNEL NECESSARY FOR THE BUSINESS’S OPERATIONS
  1. At the beginning of Operations (First Six Months):

Description of Positions
Administration and Plant /

No. Employees per Position

/ Salary Range CS$
(Minimum – Maximum)
National / Foreign

TOTAL CS$ =

Total Monthly Payroll at the Beginning of Operations: ______(Córdobas)

  1. Personnel necessary for Full Operations:

Description of Positions
Administration and Plant /

No. Employees per Position

/ Salary Range CS$
(Minimum – Maximum)
National / Foreign

TOTAL CS$ =

Total Monthly Payroll at Full Operations: ______(Córdobas)

  1. PHYSICAL INSTALLATIONS:

INITIAL STAGE

/ FULL DEVELOPMENT STAGE
AREA m2 / % OF TOTAL AREA / AREA m2 / % OF TOTAL AREA
Administration
Production (plant)
Warehouses
Loading Docks
Bathrooms
Parking
Green areas
Guard area
* Others:

TOTAL

* Specify

  1. Describe in detail the different stages of the industrial process(es) that will be carried out, and attach a map of the plant showing the flow of production operations and lay-out (distribution within the Plant of machinery and equipment, including bank of transformers, machine room, water well, heating elements, fuel tanks, connection to primary line of electrical distribution, etc.
  1. BASIC UTILITIES
  1. Electrical Energy required for Business Operation:

Beginning Full Capacity

Capacity of Transformers Bank (KVA) ______

Phases (Single-phase, Three-phase)______

Voltage Required in Voltage ______

Box (volts)

Maximum Demand (kW)______

Capacity of emergency generator ______

  1. Requirements for Water Supply:

BeginningFull Capacity

Potable

Average daily consumption (Liter/Second)______

Flow required (Liter/Second)______

Industrial

Average daily consumption (Liter/Second)______

Flow required (Liter/Second)______

Characteristics of wastewater: ______

______

  1. Requirements for Communications Services.

BeginningFull Capacity

No. of Telephone Lines Needed______

Internet Subscription (Yes, No)______

REQUEST FORM TO SET UP OPERATIONS IN AN EXPORT PROCESSING ZONE January 2003 Page 1 / 8