CYPRUS COMPANY FORMATION

QUESTIONNAIRE – Please Print, Complete and Fax to +357 25819960

*Please note that all information and any documentation forwarded to us will be treated as strictly confidential and no information will be divulged to any 3rd parties unless your express prior consent is obtained or unless ordered to do so by rule of law.

Main contact person details:

Name:……………………………………………………………………………………………
Address: ………………………………………………………………………………………….
Telephone: ………………………………… Fax: ……………………………………………
Mobile Telephone No: ……………………………………………………………………………
E-mail: ……………………………………………………………………………………………

(A) Proposed Company Name (please provide 3 choices in order of preference. First name check is free and we will do our best to have your 1st choice approved, subsequent name checks will be charged at cost). All names must end with LTD or LIMITED for limited liability companies:

1………………………………………………
2………………………………………………
3………………………………………………

(B) Type of business activities of the proposed company. Please provide us with a brief description of the intended business activities of the Company:

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

(C) Proposed share capital:
Authorised:……………………………………Class:…………………… Currency:…………………
Issued:………………………………………… Class: ………………….. Currency: …………………

* Please note that unless otherwise indicated on this form, the Company will be formed with an authorised and issued share capital of 1000 shares of EURO1 each. Shares of different class and/or currency denominations are acceptable

(D) Proposed shareholders:

Please indicate whether you would like us to provide you with Nominee Shareholder(s)

Yes …………. No……………

* In case you choose to use Nominee Shareholder(s), a written Declaration of Trust will be provided as proof of beneficial ownership.

If no Nominee Shareholder(s) will be required, then please fill below the details of the proposed shareholders:

For natural persons:

. Full Name: …………………………………………………………………………………..
Address: ……………………………………………………………………………………..
Nationality: ………………………………………………………………………………….
Occupation: …………………………………………………………………………………
Passport Number: ……………………………………………………………………………
Number of shares: ……………………………………………………………………………

For legal entities

. Name of company: ………………………………………………………………………..
Registration Number: ………………………………………………………………………
Registered Address: …………………………………………………………………………
Number of shares: ………………………………………………………………………….

* A minimum of 1 (one) shareholder is required and can either be a natural person or a legal entity.

(E) Proposed Directors:

Please indicate whether you would like us to provide you with Nominee Director(s)

Yes …………. No……………

If no Nominee Director(s) will be required, then please fill below the details of the proposed Directors:

For natural persons:

. Full Name: …………………………………………………………………………………..
Address: ……………………………………………………………………………………..
Nationality: ………………………………………………………………………………….
Occupation: …………………………………………………………………………………
Passport Number: ……………………………………………………………………………
Number of shares: ……………………………………………………………………………

For legal entities

. Name of company: ………………………………………………………………………..
Registration Number: ………………………………………………………………………
Registered Address: …………………………………………………………………………
Number of shares: ………………………………………………………………………….
In cases where we will be acting as Nominee Director(s) we will do so in a non-executive capacity. If we will be requested to carry our any executive and/or management duties, then additional charges will apply, based on time spent, complexity etc. Please contact us with any specific queries you might have.

(F) Proposed Company Secretary:

Please indicate whether you would like us to provide you with Nominee Company Secretary:

Yes …………. No……………

(F) Registered Office:

Please indicate whether you would like us to provide you with Registered Office Facilities:

Yes …………. No……………

(H) Other:

Please indicate whether you would like us to apply for and obtain a T.I.C. (Tax Identification Code) for your Company:

Yes …………. No……………

Please indicate whether you would like us to apply for and obtain a V.A.T. (Value Added Tax) number for your Company:

Yes …………. No……………

Please provide any additional information which you feel is necessary: ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

To meet Due Diligence and KYC requirements, we will need you to forward to us the following:

For each beneficial owner:

Copy of international passport
Recent utility bill (not older than 6 months) as proof of residential address (except mobile telephone bills) OR alternative copy of internal passport (for CIS countries) or any other document evidencing residential address.
Bank OR professional reference letters

In cases where a legal entity will be involved:

Full corporate structure (Memorandum & Articles of Association including the pages where the subscriber is indicated, Certificate of Incorporation, documentation stating the director, secretary, registered office etc.). Sufficient supporting documentation, leading back to natural persons will be required in order to verify the identity of the beneficial owner(s).
For each beneficial owner of the legal entity, the documentation listed above for natural persons will be required.

Thank you for letting us being of service to you!