Application Form

 
1.   Country of Incorporation  
      
2.   Please state required name of company (if not shelf company please give three names )

  a) 

  b) 

  c) 

3.   Outline briefly the principal objectives of the proposed company

4.   Particulars of Proposed Directors

A.
Family Name (Mr/Mrs/Ms)
First Name(s)         
Any former name

Nationality     
Date of  Birth  
Passport
Identity Card  No

Business Occupation (please be specific )

Telephone     
Permanent Address :

Telephone     
Facsimile       		B.
Family Name (Mr/Mrs/Ms)

First Name(s)         
Any former name
Nationality    
Date of  Birth 
Passport
Identity Card  No

Business Occupation (please be specific )

Telephone    
Permanent Address :

Telephone.    
Facsimile        

C.  Do you wish CYWORLD  Business Centre to arrange the appointment of  local directors?

        Yes                   No

5.  Details of Company Secretary (Normally Cyworld  Business Centre provides secretarial services). If interested, please check this box  

Family Name (Mr/Mrs/Ms)
Any former name
Nationality
Business Occupation (please be specific )

Qualifications

Telephone     		First Name(s)    
Passport
Identity Card No

Date of  Birth       
Permanent Address :

Facsimile        

6.  Details of Shareholders ( please check one box only)

             Please provide nominee services for the following parties.

             The following parties are to be registered as shareholders.

A.
Family Name (Mr/Mrs/Ms)
First Name(s)     
Any former name
Nationality   
Date of  Birth 
Passport
Identity Card No

Business Occupation (please be specific )

Telephone     
Permanent Address :

Telephone     
Facsimile        
Shares to be held (please state number and/or %)
 B.
Family Name (Mr/Mrs/Ms)
First Name(s)        
Any former name
Nationality    
Date of  Birth   
Passport
Identity Card No

Business Occupation (please be specific )

Telephone    
Permanent Address :

Telephone     
Facsimile        
Shares to be held (please state number and/or %)

C.   In order to speed up the process of incorporation, we recommend that temporary subscribers to the Memorandum and Articles of Association be appointed by us. Please indicate your approval.

        Yes                   No

D.  Do you wish CYWORLD  Business Centre to use their nominee and trustee companies to hold the Shares ?

     Yes                No

E.   Proposed capital structure (minimum issued capital required CYP 1,000). If the company wishes to have its own office premises in Cyprus then the paid up capital must be at least CYP 10,000).

                                                      Number of Shares                Value in CYP

 Authorized Share Capital  

Issued Share Capital           

7.  Details of Contact Person ( the person CYWORLD will contact regarding the affairs of the company)
A.
Family Name (Mr/Mrs/Ms)
First Name(s)        
Address :

Telephone    
Facsimile         		B.
Family Name (Mr/Mrs/Ms)
First Name(s)            
Address :

Telephone   
Facsimile       

  CYWORLD is requested to communicate using the following methods (please check accordingly).

    Mail       Telephone      Facsimile        E-mail

8.  Mail forwarding instructions (normally CYWORLD provides mail forwarding.
       If interested please check this box    

  If you would like us to forward mail, telephone messages and facsimiles to the
contact person stated above please check this box  

  If not, where would you like your mail, telephone messages and facsimiles
to be sent? (fill in the table below)
Family Name (Mr/Mrs/Ms)
Permanent Address :

Telephone      		First name(s)   
Special Instruction

Facsimile       

9.  If you would like CYWORLD to assist in the opening of a corporate bank
account for this company please check this box    

   If you have checked the question above our Banking Services Department
will contact you, to discuss your requirements.

10.  Despatch of company documentation.

       Ordinary Mail     Registered Mail        Courier

   If the address is the same as the Contact Address please check this box  

   If not, please fill the address for despatch in the table below:

Family Name (Mr/Mrs/Ms)
Permanent Address :

Telephone     		First name(s)   
Special Instruction

Facsimile       

11.  Name and address of home banks that may give references for the shareholders
       with respect to their financial standing, respectability, business integrity, credit
       worthiness and responsibility for engagements.

  а) 

  б) 

12.  Method of Initial Payment (Please note that incorporation costs, first year
        annual fees and disbursements must be paid prior to acquiring a company).
A.
A Bank transfer of (amount)
  has been sent on
 
To :
Bank: THE CYPRUS POPULAR BANK LTD
Account Name: CYWORLD  Business Centre
Swift code: LIKICY2N
Account N: 070-21-048483
From :
                      (name of  Company)		 B.
A bank/personal cheque made payable to
CYWORLD is enclosed from :


Quoting Reference:
(i.e. Incorporation fees, auditing fees etc.)
 

Note: We understand that work on this
company will not commence
until this cheque is cleared.

C.  Please debit my Credit Card account with the incorporation costs, annual fees:

          Visa        Mastercard      Diners     Amex

Card Namber
Card Holders Name

Cardholder  Signature        		Expire Date
Address to which statements are sent

Date

     Please send me a copy of the charge.

             Yes              No

13.   Annual Fees.
         Please debit my credit card for the company’s future annual fees and disbursements

          Yes                No

   Signature

     Please send me a copy of the charge.

          Yes           No

    OR

   Please send me an annual invoice for the company’s annual fees and disbursements to:

      The Contact Address stated in paragraph 7     The address shown below

Family Name (Mr/Mrs/Ms)
Permanent Address :

Telephone    		Firs Name(s)   
Special Instructions :

Facsimile       

14. Important Instructions.

CYWORLD will accept instructions concerning the affairs of this company
from any of the person(s) listed and signing below unless we are advised in
writing to the contrary by all the signatories appearing below:

Full Name

Date
Signature 		Full Name

Date
Signature


  15.  Declaration by the Beneficial Owner(s).

    I/We declare and confirm that the above information is true and correct and
the company mentioned above of which, I/We are to be beneficial owner(s) will
not be used for money laundering, receiving the proceeds of drug trafficking,
terrorist activities, trading in arms and weapons, any other illegal activity or in
a manner likely to damage the good name and reputation of Cyworld Business Centre Limited or the jurisdiction of incorporation.

Signed   
Signed   
Witness address
 Witnessed by   
Witness signature      
Witness occupation :

Date


   16.  Processing Procedure

 

   Signature 

  

       Please fax or mail this application form to:

CYWORLD
Business Centre Limited
P.O. Box 26557,
CY-1640 Nicosia
Cyprus

Facsimile: +357-22751522

      We will acknowledge receipt of this application form by facsimile.

   17.   Notes

    This application does not constitute a contract unless accepted by us and
      we reserve the right not to process this application.

     If you have any difficulties in completing this form or wish to discuss your
     offshore requirements in detail please contact Cyworld  Business Centre Ltd.

     Telephones:    +357-22760330            Facsimiles:     +357-22751522

                          +357-99622535 (24 hours)                 

     Please attach photocopies of the passports of all of the beneficial owners,
directors, shareholders and company secretary of the company when you
send/fax us this form. We are unable to process application prior to receiving
passports copies