v15 For internal use only Client name KAM or Internal contact Referred by: Pricing specification: Invoicing specification LLC QUESTIONNAIRE Please note that only a fully completed, duly signed, English language questionnaire accompanied by all required documents will be accepted Please complete the form electronically or in block letters in blue ink if printed and completed by hand For our LLC registration and other fees please consult our web site wwwlatcsvgcom 1 Please select the type of LLC: Single LLC Series LLC 2 In case you wish to establish a series LLC, please specify which type of the series this application is for Main (initial) LLC Series (sub) LLC In case of choosing Series (sub) LLC, please specify which Main LLC it should be linked to 3 The chosen legal name of the company The name must include the suffix "Limited Liability Company" or the abbreviation LLC The name should not contain the words "bank"," insurance", "mutual fund" or any other words which may suggest association with the banking or insurance industries or mutual funds Please provide three preferable names, in the order of your preference 1 2 3 4 Do you wish to apply for a Corporate Manager service 1? (Please note that this service has extra set up and annual fees and a Power of Attorney is mandatory for the person who will act/carry on business in the name of the company) 1 When the Manager is provided by the Registered Agent as part of the service 1
v15 If YES, please indicate whether you wish to appoint a company or an individual as we recommend a Company as this has an indefinite legal existence Company Individual If NO, please provide the name(s) of the Manager(s) of your proposed LLC 2: It is not compulsory to appoint any Manager for an LLC If there is no Manager appointed, the Members run the LLC Name: Address: Profession: Name: Address: Profession: 5 Do you wish to apply for Corporate Member service 3? (Please note that this service has extra set up and annual fees and a Power of Attorney is mandatory for the person who will act/carry on business on behalf of the company) If YES, please provide the amount of capital contribution and percentage of interest by Corporate Member (we recommend a Company as this has an indefinite legal existence): Company Individual Total capital in USD or EUR 4 (please also indicate which currency you apply) Amount of capital contribution Percentage of interest (In the currency of the total capital) (calculated from the above amount making 100%) 2 individual who is less than 18 years of age, or of unsound mind (and has been declared so by a tribunal), or is an undischarged bankrupt, is qualified to be a Manager of the company Each Manager must consent in writing to be a Manager of the company 3 4 When the LLC Member is provided by the Registered Agent as part of the service This makes the 100% of interest, out of which you are asked to calculate proportion 2
v15 If NO, please provide the name(s), capital contributions and interest percentage of the Member(s) Name Amount of capital contribution Percentage of interest (preferably in USD or EUR) (calculated from the above amount making 100%) 6 Name (s) of the Ultimate Beneficial Owner(s) if not the same as Member(s) 7 Does the LLC propose to have a specific date of dissolution 5? If YES, please give the chosen date 8 Mailing address where the company documents should be sent to: Name of responsible individual and company (if applicable): Address Phone number Email 9 If you wish to apply for additional services 6 (eg Power of Attorney, Apostille, Certificate of Good Standing, etc), please specify here: 10 Please select the currency of the invoice for the chosen services: USD EUR I authorize Loyal Bank to directly debit the following account with the invoiced amount (only available for customers holding an account with Loyal Bank) 5 6 The date when a purposely registered LLC finishes its activity and wants to be terminated Any additional service has a specific fee, for details please consult our website 3
v15 Account name Account number Account holder s signature 11 Do you wish to open a bank account with Loyal Bank Limited for this LLC? If YES, please make sure that you submit all the documents listed under points 12 and 13, and choose one debit card type from the following list 7: Cirrus/Maestro debit card MasterCard debit card Platinum MasterCard If NO, please make sure that you submit all the documents listed under point 12 Opening of any bank account requires that you kindly submit your business plan for your company for our review 12 Please submit the following supporting documents, together with this form: tarised/certified copies of passport or other acceptable ID (the page with photo and signature) for all Members, Managers (if they are not provided by the Registered Agent), as well as the Beneficial Owners A notarised/certified copy of driver s license is also required for US and Canadian citizens 8 Original or notarised/certified copies of a Utility Bill or Bank Statement 9 as proof of address for all Members, Managers (if they are not provided by the Registered Agent), as well as the Beneficial Owners 10 Original bank references for all Members, Managers (if they are not provided by the Registered Agent), as well as the Beneficial Owners 11 If the Beneficial Owner is a corporate entity, a Certificate of Incorporation and Articles and Memorandum of Association must be submitted Copy of the Share Certificate showing ownership in case of registered shares (of Beneficial Owner Company) is also requested Consent letters 12 from each Corporate Manager (unless you have requested Corporate Director Service) 7 Stakeholder s Details Form for each Owner 13 The card type chosen affects the price of your LLC, so in order to be able to send you the invoice, this information is needed here All other, account related information should be given on the appropriate form(s) 8 9 All ID s should be valid for at least a further 6 months from submission Bank statement as proof of address, and the bank reference letter should be from different banks 10 11 12 Any such document should be on the given person s name and private address, and should not be older than 6 months The bank reference can be replaced by the last three months bank statements for the name of the given person Form can be downloadable from http://wwwwlatcsvgcom/en/products/limitedliabilitycompanyllc/howtoapply 4
v15 The main series LLC agreement and sub series LLC agreement, as appropriate 13 Should you wish to open a bank account as well, please also submit (additionally to the above) Duly completed and signed application form for corporate account Click here Minutes of meeting of Members/Managers as authorisation for the account opening and conferring authority on the person who will operate the account Specimen signature form Click here 14 Declaration required by Law: I/We declare and confirm that the above information is true and correct in every respect and that the company to be incorporated will not be used for criminal or illegal activities, terrorist activities, gambling or gaming, adult entertainment or any other illegal activity or in a manner likely to damage the reputation of Loyal Agency and Trust Corp or of the state of St Vincent and the Grenadines I am/we are aware that I/we should take independent legal or taxation advice before proceeding to have any international structure registered under my / our ownership and I am /We are aware of, and intend to honour my / our legal and taxation responsibilities in my / our jurisdiction or place of residence in full I/We confirm and agree that should any changes whatever occurs in the information contained in this document I/We will immediately inform Loyal Agency and Trust Corp and also provide documentary proof of such changes if requested to do so by Loyal Agency and Trust Corp Date Signature Name in block letters 13 Form can be downloadable from http://wwwwlatcsvgcom/en/products/limitedliabilitycompanyllc/howtoapply 5