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Virtual Office Application Form

GENERAL INFORMATION:

MANAGING BODIES / DIRECTORS
 

Names, place of residence and dates/place of birth, nationality, passport numbers of all managing bodies/directors of the company:

Shareholders/members*
 

if corporate entities: status (member, shareholder, etc.), name, address, jurisdiction, date of incorporation, percentage held

if natural persons: status (member, shareholder, etc.), name, nationality, date of birth, identity document details, residence address, participation interest (percentage)

*For publicly traded companies need to provide details for each shareholder/member that hold over 5%

IDENTIFICATION OF BENEFICIAL OWNER
 

Beneficial owners (holding a share of more than 25% of the shares or voting rights or otherwise exercise control over the management of the company)

We are informed about who may be deemed to be beneficial owner(s) as defined in Article 3(6) of the Directive* and hereby declare that:

* Under Article 3(6) of the Directive the “beneficial owner” means any natural person(s) who ultimately owns or controls the customer and/or the natural person(s) on whose behalf a transaction or activity is being conducted and includes at least:

 

(a) in the case of corporate entities:

 

(i) the natural person(s) who ultimately owns or controls a legal entity through direct or indirect ownership of a sufficient percentage of the shares or voting rights or ownership interest in that entity, including through bearer shareholdings, or through control via other means, other than a company listed on a regulated market that is subject to disclosure requirements consistent with Union law or subject to equivalent international standards which ensure adequate transparency of ownership information.

 

A shareholding of 25 % plus one share or an ownership interest of more than 25 % in the customer held by a natural person shall be an indication of direct ownership. A shareholding of 25 % plus one share or an ownership interest of more than 25 % in the customer held by a corporate entity, which is under the control of a natural person(s), or by multiple corporate entities, which are under the control of the same natural person(s), shall be an indication of indirect ownership. This applies without prejudice to the right of Member States to decide that a lower percentage may be an indication of ownership or control. Control through other means may be determined, inter alia, in accordance with the criteria in Article 22(1) to (5) of Directive 2013/34/EU of the European Parliament and of the Council (3);

(ii)    if, after having exhausted all possible means and provided there are no grounds for suspicion, no person under point (i) is identified, or if there is any doubt that the person(s) identified are the beneficial owner(s), the natural person(s) who hold the position of senior managing official(s), the obliged entities shall keep records of the actions taken in order to identify the beneficial ownership under point (i) and this point

Please provide the following information for each beneficial owner, holding directly or indirectly share/voting rights of more than 25 % and/or exercising directly or indirectly control over the management of the company. (In case there are more than two beneficial owners we will request this information after the form is submitted).
Please provide the following information for each beneficial owner, holding directly or indirectly share/voting rights of more than 25 % and/or exercising directly or indirectly control over the management of the company. (In case there are more than two beneficial owners, please let us know and we will request this information after the form is submitted).

POLITICALLY EXPOSED PERSONS (“PEPs”)*

* “Politically exposed person” means an individual who is, or has at any time in the preceding 12 months been, entrusted with a prominent public function, including either of the following individuals (but not including any middle ranking or more junior official):
(a)    a specified official;

(b)    a member of the administrative, management or supervisory body of a state-owned enterprise

A. Is the individual a current or former senior official in a foreign government?
B. Is the individual a current or former senior official of a major foreign political party?
C. Is the individual a current or former senior executive of a foreign government owned commercial enterprise?
D. Is the individual an immediate family member of any of the above-mentioned persons? (Includes: spouse, parent, sibling, child and spouse's parents, siblings, or children).
A. Is the individual a current or former senior official in a foreign government?
B. Is the individual a current or former senior official of a major foreign political party?
C. Is the individual a current or former senior executive of a foreign government owned commercial enterprise?
D. Is the individual an immediate family member of any of the above-mentioned persons? (Includes: spouse, parent, sibling, child and spouse's parents, siblings, or children).

ECONOMIC BACKGROUND AND BUSINESS ACTIVITY

SIGNATURE

​I (we), the undersigned, being duly authorized officer(s) confirm that all information provided herein is true, correct, and complete as of the signature date.

This form may take a few seconds to submit after you click 'Submit Application'

GDPR Consent
This information will be stored in Wix.com, and accessed by Terenure Enterprise Centre staff. Any processing of your data will be low tech: we will occasionally perform searches based on your profile, and contact you about relevant opportunities. We occasionally share member data in aggregate, however we will always reach out for confirmation before using or publishing anything specific. If you have any concerns please contact info@terenure-enterprise.ie

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