Virtual Office Application Form

GENERAL INFORMATION:

Company name

Country and place of registration

Registration number and date of registration

Place of business (physical address if different from the above)

Legal form

Registering authority

Registered office address (legal address)

Taxpayer Identification Number and country of registration

Share capital information

MANAGING BODIES / DIRECTORS

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

Please state the following information for two directors of the comapny: Name; Date and place of birth; Place of residence; Nationality. If there are more than two company directors we will request this information after this application is submitted.

Website, contact telephone and fax numbers, e-mail, contact person (full name, position held by the employee/representative in charge of the transaction on behalf of the customer; contact telephone numbers, fax, e-mail)

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%

Company name / natural person 's full name and other data / Participation Interest (%)

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:

We have beneficial owner(s)

We have no beneficial owner(s) as defined in Article 3(6) of the Directive

We are state owned by:

Name and percentage

* 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).

Shareholder (directly or indirectly) holding a share of more than 25 %

Holder (direct or indirect) of more than 25 % of the voting rights

Other kind of control (direct or indirect) over the management of the company

In case of a foundation or trust: beneficiary receiving more than 25 % of the benefits

In case of a foundation or trust: person in whose interest the foundation or trust was established

In case of a foundation or trust: person exercising control of 25 % or more of the assets of the foundation or trust

Please provide Surname; First name; Address; Date/Place of birth; Citizenship of beneficial owner:

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).

Shareholder (directly or indirectly) holding a share of more than 25 %

Holder (direct or indirect) of more than 25 % of the voting rights

Other kind of control (direct or indirect) over the management of the company

In case of a foundation or trust: beneficiary receiving more than 25 % of the benefits

In case of a foundation or trust: person in whose interest the foundation or trust was established

In case of a foundation or trust: person exercising control of 25 % or more of the assets of the foundation or trust

Please provide Surname; First name; Address; Date/Place of birth; Citizenship of beneficial owner:

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

Name of Beneficial Owner or director:

A. Is the individual a current or former senior official in a foreign government?

Yes

B. Is the individual a current or former senior official of a major foreign political party?

Yes

C. Is the individual a current or former senior executive of a foreign government owned commercial enterprise?

Yes

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).

Yes

Name of Beneficial Owner or director:

A. Is the individual a current or former senior official in a foreign government?

Yes

B. Is the individual a current or former senior official of a major foreign political party?

Yes

C. Is the individual a current or former senior executive of a foreign government owned commercial enterprise?

Yes

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).

Yes

ECONOMIC BACKGROUND AND BUSINESS ACTIVITY

Please provide brief business description (principal activity/services/products)

In which countries do you conduct business?

Source of funds from which the Company intends to make contractual payments to us (e.g., business activity, holding and etc.).

Countries of business activities

Does the company conduct business in any of the territories listed as High-Risk and Other Monitored Jurisdictions by The Financial Action Task Force? Check list on www.fatf-gafi.org?

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.

Signature

Name/Title

Date

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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*

IDENTIFICATION OF BENEFICIAL OWNER

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.

Get in touch by completing the
enquiry form

CONTACT

OPENING HOURS

RESOURCES

We confirm that our organisation complies with The Governance Code for the Community, Voluntary and Charitable Sector in Ireland

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*

IDENTIFICATION OF BENEFICIAL OWNER

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.

CONTACT

OPENING HOURS

RESOURCES

MANAGING BODIES / DIRECTORS

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

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.