The Applicants

First Name of Applicant 1:

Surname of Applicant 1:

Postal Address of Applicant 1:

First Name of Applicant 2:

Surname of Applicant 2:

Postal Address of Applicant 2:

First Name of Applicant 3:

Surname of Applicant 3:

Postal Address of Applicant 3:

The Company

Name of Proposed Company:

Company name, second choice:

Address of Registered Office:

Address for service:

Postal address to which Communications from Registrar may be sent:

The Directors

1st Director’s First Name:

1st Director’s Surname:

1st Director’s Postal Address:

2nd Director’s First Name:

2nd Director’s Surname:

2nd Director’s Postal Address:

Secretary’s First Name:

Secretary’s Surname:


Secretary’s Postal Address:

The Shares

1st Shareholder’s First Name

1st Shareholder’s Surname:

1st Shareholder’s Postal Address:

2nd Shareholder’s First Name

2nd Shareholder’s Surname:

2nd Shareholder’s Postal Address:

Number of shares:

Class of shares:

Value per share: USD$

The Business

Nature of the Business:

Authorized capital of the proposed company: USD$

Email address of Applicant: