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Overseas
Incorporation Services, Inc. |
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Your Offshore Services Provider since 1999 |
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| 1. En
que país desea registrar la sociedad:
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which country would you like to incorporate the company) |
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| 2. Por
favor proveea tres (3) nombres para su sociedad en orden prioritario (Please
provide three |
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in order of priority for your company): |
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| 3.
Por favor indique los nombres de los directores y sus direcciones, se
requieren un mínimo de |
| tres
(3) personas. (Please indicate the name and addresses of the directors,
a minimum of |
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(3) persons are required): |
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| Nombre
(Name) |
Domicilio
(Address) |
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| 4. Desea
que OIS provea los directores. (Would you like OIS to provide nominee
directors) |
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SI (YES) |
NO |
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| 5. Detalle
de los accionistas (Details of the shareholders) |
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| A.
Las siguientes personas deben registrarse como accionistas (The following
persons must be |
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as shareholders) |
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| B. Por
favor proveer accionista (s) (Please provide shareholders): |
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SI (YES) |
NO |
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| 6. El
capital social autorizado será (Our standard authorized social capital
will be) |
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| a. Cantidad
de acciones a emitir (Amount of shares to be issued): |
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| b. Número
de certificados de acciones a emitir (Number of share certificates to
be issued) |
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| c. Tipo
de acciones a emitirse (Type of shares to be issued): |
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Al portador
(To the bearer) |
SI (YES) |
NO |
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Nominativas
(Registered) |
SI (YES) |
NO |
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d.
Si son acciones registradas o si no todas las acciones son por el mismo
monto, favor llenar
abajo (If registered or if not all shares are for the same ammount,
please complete the
following): |
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No.
Certificado |
Nombre del Accionista |
Dirección (Address) |
No. de Acciones |
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(Certificate
No.) |
(Name of the Shareholder) |
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(No. of Shares) |
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7.
A quien usted desea que OIS contacte en referencia a la sociedad? (Who
do you want OIS to contact
regarding the affairs of the company?) |
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| Nombre
(Name)
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| Dirección
(Address)
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OIS
debe comunicarse con dicha persona usando los siguientes métodos (OIS
is requested to communicate
using the following methods): |
| Correo
(Mail):
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| Teléfono
(Telephone):
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| Fax:
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| E-mail:
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| 8. Tipo
de Poder (es), si es necesario (Type of Power (s) of Attorney, if needed): |
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| Especial
(Special)
General
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| En el
nombre de las siguientes personas (In the name of the following persons): |
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| Nombre
(Name)
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| Domicilio
permanente (Permanent address):
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| Código
Postal (Postal Code):
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| Nombre
(Name)
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| Domicilio
permanente (Permanent address):
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| Código
Postal (Postal Code):
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| Nombre
(Name)
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| Domicilio
permanente (Permanent address):
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| Código
Postal (Postal Code):
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| Para
un Poder General, estas son las instrucciones (For a General Power of
Attorney, these
are the instructions): |
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| 9.
Instrucciones especiales sobre documentos registrados (Special instructions
regarding |
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| incorporation
documents): |
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| Notarización
(Notarization):
SI (Yes)
NO |
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| Notarización
y legalización por el Consulado (Notarization and legalization by the
consulate of): |
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| Apostilla
(Apostille):
SI (Yes)
NO |
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| 10.
Información requerida para clientes individuales (Information required
for individual clients): |
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| Nombre
del Propietario |
No. de Pasaporte |
Nacionalidad |
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| (Name of
Beneficial Owner(s) ) |
(No. of Passport) |
(Nationality) |
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| 11.
Información requerida para clientes institucionales (Information required
for institutional clients): |
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| Nombre
de la Compañía |
Persona encargada |
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the company) |
(Officer in Charge) |
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| 12.
Mi dirección de correo electrónico es (My E mail address is):
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| 13.
Método de Pago Inicial. Por favor note que el precio por la incorporación
debe pagarse antes de
la incorporación de la sociedad (Method of Initial Payment. Please note
that incorporation price
must be paid prior to incorporation): |
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| A.
Transferencia Bancaria. Favor enviar número de Fax. (Bank Transfer. Please
send Fax number): |
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SI (YES) |
NO |
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| B.
Cheque personal o de gerencia confeccionado para ser pagado a través de
una Banco en E.U. en
Dólares (A bank or personal cheque made payable through a US bank in US
dollars) |
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SI (YES) |
NO |
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| Entendemos
que el trabajo en la incorporación de esta compañía no comenzará hasta
tanto el cheque
no haya sido cobrado efectivamente (We understand that work on this company
will not commence
until this check is cleared) |
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SI (YES) |
NO |
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| 14.
Términos y Condiciones / Declaración (Terms and Conditions / Declaration) |
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| Yo/Nosotros,
la (s) persona (s) cuya dirección (es) aparece (n) abajo, por este medio
declaro (amos)
y por mi (nuestras) firma (s) confirmo (amos): (I/we,
the person (s) whose address is/are the one that appears on the bottom,
by means of this document
I/we declare and with my own signature confirm): |
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| A. |
Que
toda la información que he (mos) proveído en este formulario es cierta
y correcta
(That all the information I have provided in this form is true and correct); |
| B. |
Que
la compañía no será utilizada para lavar dinero, actividades terroristas,recibir
dinero producto del narcotráfico, traficar armas, municiones o cualquier clase
de armas o para ningún propósito ilegal de acuerdo a la ley del país
deincorporación
o administración (That the company will not be used for moneylaundering,
terrorist activities, receiveng procedes of drug traffiking, trading
in arms,
munitions or other weapons or for any purpose which is ilegal under
thelaw
of the place of incorporation and/or management) |
| C. |
Que
en cualquier momento en adelante y de manera irrevocable e incondicionalmente
declaro (amos) que OIS no tiene nada que ver con la operación,
manejo y administración de la compañía y lo indemnizaré (emos), así
como a cualquiera de sus afiliados, corresponsales, socios, empleados, por
cualquier demanda, daños, gastos, recargos o responsabilidad que sobrevengan
en su contra por razón de incumplimiento de cualquiera de las declaraciones
aquí señaladas (That I/we will at all times irrevocably and unconditionaly
hold harmless and indemnify OIS and any parent, subsidiary or afíliate
thereof and their directors, partners, officers and employees against
all proceedings,
suits, damages, fines, expenses, penalties and liabilities arising or
brought against any of them by reason of any breach of the above declarations
or the provision of the Company and/or the Services to me/us or my/our
use thereof); |
| D. |
Que
yo/nosotros hemos obtenido consejo legal o de impuestos antes de solicitar
los servicios de OIS (That I/we have secured legal or taxation advice before
contacting OIS) |
| E. |
Incluyo
(imos) una copia de mi (nuestro) pasaporte (s), recibo (s) de agua,
luz o
teléfono y carta (s) de referencia de un banco, abogado o contador (I/we include
a copy of my (our) passport (s), utility bill (s) and reference letter
(s) from
a bank, lawyer or CPA). |
| F. |
Me (nos)
obligo (amos) a pagar los honorarios anuales acordados y que constan
en las comunicaciones, ya sean por e-mail o fax (I/we obligate to pay the
annual fees agreed and that can be verified in e-mails or faxes) |
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Nombre
y Firma ___________________________________________ |
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(Name
and Signature) |
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Nombre
y Firma ___________________________________________ |
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(Name
and Signature) |
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Nombre
y Firma ___________________________________________ |
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(Name
and Signature) |
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Testigo___________________________________________________ |
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(Witnessed
by) |
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Firma
del Testigo __________________________________________ |
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(Signature) |
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Dirección
del Testigo ________________________________________ |
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(Address) |
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Fecha
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(Date) |
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Después
que este formulario ha sido completado y firmado, favor enviarlo por
courier o Fax a (After
this incorporation form has been completed and signed, please send it
by courier or fax to): |
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Overseas
Incorporation Services, Inc.,50th Street, Global Plaza, 19th Floor, Suite 19, Panama City, Republic of Panama, Telephone:
(507) 263-1042 Fax 507 263-5752 |
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