Please provide the following contact information:

Name
Title
Company
Street Address
Address (suite)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
Facsimile
E-mail
URL

Please provide the following information for incorporation:

Name of proposed company:
First choice
Alternative 1
Alternative 2
Limited
-or-
Ltd.

State and provide details of the nature, purpose, objects, fields of operation of the business to be carried on by the company:

Registered office in Bermuda:	Marshall Diel & Myers Sofia House 48 Church Street Hamilton HM 12 Bermuda
	-or-

Date company proposes to commence business:

Amount of share capital:
Minimum	12,000 shares with a par value of $1.00 per share
	-or-
Authorised (Exempt companies)	ASSESSABLE CAPITAL & ANNUAL FEE
	$12,000   =>   US$1,787.50 $12,001 - $120,000   =>   US$3,649.60 $120,001 - $1,200,000   =>   US$5,621.24 $1,200,001 - $12,000,000   =>   US$7,489.98 $12,000,001 - $100,000,000   =>   US$9.363.73 $100,000,001 - $500,000,000   =>   US$16,728.46 $500,000,001+   =>   US$27,880.76
Issued (Local companies)	ISSUED CAPITAL & ANNUAL FEE
	>$50,000   =>   BD$580.00 $50,001 - $250,000   =>   BD$865.00 $250,001 - $500,000   =>   BD$1,445.00 $500,001 - $1,000,000   =>   BD$2,880.00 $1,000,001 - $5,000,000   =>   BD$5,760.00 $5,000,001 - $10,000,000   =>   BD$10,975.00 $10,000,001 +   =>   BD$16,460.00
Par value of shares (NIL par value shares not permitted)
Currency

 

Shareholders

SHAREHOLDER (INDIVIDUAL) :
Name
Address
Date of Birth
Occupation
Nationality

SHAREHOLDER (INDIVIDUAL) :
Name
Address
Date of Birth
Occupation
Nationality

SHAREHOLDER (INDIVIDUAL) :
Name
Address
Date of Birth
Occupation
Nationality

 

SHAREHOLDER (CORPORATE) :
Corporate name
Place of incorporation
Date of incorporation
Number of shares issued / Percentage ownership
Name
Address
Date of birth
Occupation
Nationality
SHAREHOLDER (CORPORATE) :
Corporate name
Place of incorporation
Date of incorporation
Number of shares issued / Percentage ownership
Name
Address
Date of birth
Occupation
Nationality
SHAREHOLDER (CORPORATE) :
Corporate name
Place of incorporation
Date of incorporation
Number of shares issued / Percentage ownership
Name
Address
Date of birth
Occupation
Nationality

Publicly traded company:
Stock Exchange
Stock symbol

Date of most current audited financial statements (document to follow):

 

SHAREHOLDERS (PARTNERSHIP OR TRUST) :
Partnership or Trust name
Place of formation
Date of formation
Number of shares issued / Percentage ownership
Partner / Trustee name
Address
Date of birth
Occupation
Nationality
Trust beneficiary
Name
Address
Date of Birth
Occupation
Nationality
SHAREHOLDERS (PARTNERSHIP OR TRUST) :
Partnership or Trust name
Place of formation
Date of formation
Number of shares issued / Percentage ownership
Partner / Trustee name
Address
Date of birth
Occupation
Nationality
Trust beneficiary
Name
Address
Date of Birth
Occupation
Nationality

 

Bank Information

Bank Reference (document to follow) for each shareholder:
Name of bank
Bank account number
Date bank account activated (not less then 3 years)

 

Bermuda Banking:
	The Bank of Bermuda Limited
	The Bank of N. T.  Butterfield & Son Limited

Account & signing authority:
Name		Joint One only Any two
Name		Joint One only Any two
Name		Joint One only Any two

 

Carrying on business:
Carry on business in Bermuda?	Yes No
If NO, who will manage business in Bermuda?
If YES, will the company employ non-Bermudians?	Yes No
If YES, state capacity
State who will provide expertise

 

Directors and Associates

DIRECTORS (FIRST):
Name
Address in Bermuda
Occupation
Nationality

 

DIRECTORS (SECOND):
Name
Address in Bermuda
Occupation
Nationality

 

ALTERNATE DIRECTORS (FIRST):
Name
Address in Bermuda
Occupation
Nationality

 

ALTERNATE DIRECTORS (SECOND):
Name
Address in Bermuda
Occupation
Nationality

 

OFFICERS :
President or Chair (a Director)
Vice-President or Deputy Chair (a Director)
Secretary
Additional Officers:
Position
Name
Position
Position
Name

 

Fiscal Year End (Month):

 

ACCOUNTANTS :
Name

 

AUDITORS :
Name

 

BYE-LAWS:	Marshall Diel & Myers Bye-Laws
Additional special provisions:	-and-