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Company information

Date of incorporation
Leave blank if you don't have a website
Operating business address
Cliquez ou déplacez un fichier dans cette zone pour le téléverser.
You can upload 1 document max.
Cliquez ou déplacez un fichier dans cette zone pour le téléverser.
Please upload an utility bill (Water, Power, Gas, Trash, Internet or Phone) or bank account statement.
You can upload 1 document max.
Cliquez ou déplacez un fichier dans cette zone pour le téléverser.
If you have a shareholder register, please upload it
You can upload 1 document max.

Planned business activity

Please briefly list products and service Company offers

Representative of the Company

Full name
Date of birth
Residential address

Head of the Company

Only applicable if Representative is not Head of the Company
The Representative is also the Head of the Company
Full name
Date of birth
Residential address

Head of the Company (additional)

Leave blank if not applicable
Full name
Date of birth
Residential address

Head of the Company (additional)

Leave blank if not applicable
Full name
Date of birth
Residential address

Ultimate Beneficial Owner

Please provide detailed information about natural person(s) who controls the Company by directly or indirectly holding or controlling 25% or more shares or voting rights, or the natural person(s) who otherwise exercises control over the Company.
The Representative is also the Ultimate Beneficial Owner of the Company
Full name
Date of birth
Residential address

Ultimate Beneficial Owner (additional)

Please provide detailed information about natural person(s) who controls the Company by directly or indirectly holding or controlling 25% or more shares or voting rights, or the natural person(s) who otherwise exercises control over the Company.
Leave blank if not applicable
Full name
Date of birth
Residential address

Ultimate Beneficial Owner (additional)

Please provide detailed information about natural person(s) who controls the Company by directly or indirectly holding or controlling 25% or more shares or voting rights, or the natural person(s) who otherwise exercises control over the Company.
Leave blank if not applicable
Full name
Date of birth
Residential address

Ultimate Beneficial Owner (additional)

Please provide detailed information about natural person(s) who controls the Company by directly or indirectly holding or controlling 25% or more shares or voting rights, or the natural person(s) who otherwise exercises control over the Company.
Leave blank if not applicable
Full name
Date of birth
Residential address
Confirmation
Date