| Client Information: |
| First Name: |
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Surname: |
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| Address: |
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| Telephone: |
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Fax: |
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| Email Address: |
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URL: |
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| Due Diligence (Know
Your Client): You will need to fulfil our due diligence
requirements, and attach the requested documents to this form, when you
email us the application form. The know your client details should
be completed for EACH of the principal persons: beneficial owner,
shareholder, director(s), attorney-in-fact (where a power of attorney is
requested). |
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| Instructions: You are
authorised to accept instructions from the following persons:
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| Name: |
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Signature: |
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| Address: |
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| Name: |
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Signature: |
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| Address: |
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| Company Name: (please indicate
here what suffix should be used: Inc., Ltd., Limited, Corp.,
Corporation, etc.) |
| Option 1: |
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| Option 2: |
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| Option 3: |
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| For example: |
Koru Corporate Services, or Koru International Services,
or Koru Holdings International |
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| Capital: |
þ |
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| ¨ |
Please incorporate the company with a
standard capital of US$100,000.00 divided into 100,000 share of US$1.00 |
| ¨ |
Please incorporate the company with the
following authorised capital: |
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| Shelf Company:
þ |
| ¨ |
I do not wish to form a tailor-made company,
please provide me with a list of the shelf companies which you have
currently available. |
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| Objective or Business purposes of the
Company: |
| The company is needed to undertake the
following business activities: |
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| Company Director(s):
þ
Nevis Companies require a minimum of 3 directors, unless
there are less than 3 shareholders. If you only have one
shareholder, you are only required to have one director. If you
have 2 shareholders, you are required to have at least 2 directors.
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| ¨ |
I would like for Koru Corporate Services,
Inc. to provide me with a Nominee Director for the Company. Please
send me a Nominee Director Agreement for Koru Nominees, Inc. |
| ¨ |
Please have the following Person(s)
appointed as the Director(s) of the Company: |
| Director: Name: |
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Passport #: |
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| Address: |
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| Director Name: |
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Passport #: |
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| Address: |
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| Director Name: |
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Passport #: |
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| Address: |
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| Company Officer(s):
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| Please note:
All Nevis Companies require a Company
Secretary who may be a natural or legal person, and resident anywhere in
the world. The Company should also have a President or CEO or
Managing Director.
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| Secretary Name: |
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Passport #: |
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| Address: |
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| President Name: |
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Passport #: |
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| Address: |
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| Treasurer Name: |
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Passport #: |
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| Address: |
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| Please Note: a Nevis company
should have a Treasurer. One person may hold more than one office. .
With exception of the Secretary, all officers should be natural persons. |
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| Preparation of Share Certificates:
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Cert. No. |
Name |
No. of Shares |
Passport # |
Address |
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001 |
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002 |
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003 |
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004 |
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005 |
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| Please note: |
It is imperative that the
company have at least one shareholder. |
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| Power of Attorney:
þ
This ONLY applies where the company has Nominee Directors. If you
have supplied the directors, then the director you have appointed will
need to sign the power of attorney. |
| ¨ |
Please issue a General Power of Attorney. |
¨ |
Please issue a Special Power of Attorney |
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Purpose: |
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Details of the Agent to be appointed:
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| Name: |
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Passport #: |
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| Address: |
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Nationality: |
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Authentication of the Power of Attorney: |
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Notarised only |
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Notarised and Apostilled |
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| How Payment will be made:
þ |
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Wire
Transfer |
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Credit
Card |
| Please note that we need to
receive your payment before we can dispatch the company documents to
you. |
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| Dispatch of Documents:
þ |
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Please courier the documents to the address
listed in Client Information |
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Please courier the documents to the
following address: |
| Street: |
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City: |
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| Country: |
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Zip Code: |
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| ¨ |
Please hold the original documents in safe
custody for me at your office. |
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| Due Diligence (Know
Your Client): þ I
have attached for each of the Principal Persons the following Due
Diligence documents, duly authenticated as per the
instructions.
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| ¨ |
Passport copy |
| ¨ |
2nd identification document |
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Proof of Residence |
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Banking Reference
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| Certification: |
| I hereby certify to Koru Corporate Services,
Inc. that the information provided in this application is true and
correct and that I, nor any director, shareholder, or other principal
person relating to the company herein requested, am not in any way
related to any former or current regime which is considered to be
criminal and subject to international sanctions, or organisations which
are generally known to be involved in international terrorism or
organised crime.
I hereby authorise Koru Corporate Services, Inc. to provide any and
all due diligence information and documents provided by me to the
Registered Agent, when so required, or government agencies as required
by the local applicable law.
I further certify that the business purposes indicated in this form
are in no way misleading, and that I am responsible for any
tax-reporting which may be required by my country of origin or
residence. |
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| Signed: |
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Date: |
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| Name: |
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