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PREMIA TNC (MIDDLE EAST) – Company Registration Application Form

(DU) Company Registration Application Form

Company Registration Application Form
Individual Shareholder OR Director OR Secretary OR General Manager OR Ultimate Beneficial Owner’s Information
Corporate Shareholder’s Information

Company Registration Application Form

- Limited Company -

(Dubai - UAE)

Please complete and return this form to PREMIA TNC (MIDDLE EAST) prior to the company‘s incorporation proceed ***

1. Name of the contact person

2. Correspondence Address

3. Date

Please provide at least 3 proposed company names for checking:

4. Company Name

Proposed Name

5. Nature of Business

5.1 Please specify

6. Please provide a brief description the of Company’s business activities, including but not limited to the product/ service the company is or will be providing

Share Capital

7. Dubai Free Zone Company

AED

divided into

shares at

AED each

**Share Capital must in AED

Individual Shareholder/ Director/ Secretary/ General Manager/ Ultimate Beneficial Owner’s Information

1. Individual Shareholder/ Director/ Secretary/ General Manager/ Ultimate Beneficial Owner’s Information

2. Family Name

3. Given Name

4. Residential Address

5. Passport No.

6. No. of shares held

7. Issuing Country

8. Occupation

9. Email address

10. Mobile

11. Date of Birth (DD/MM/YYYY)

12. Father’s Full Name

13. Mother’s Full Name

14. Have you visited/ resided in UAE within the last 5 years?

15. Source of Funds

15.1 Others (please specify)

16. Are you, or any party connected to you, a politically exposed person?

We/I , the above named hereby confirm that the above information is/are true and accurate, and you are authorized to supply any or all of such information for due diligence purposes to the Regulators if so requested by them. We/I also undertake to notify you of any future changes to the above information.

We/ I agree to provide the certified identification documents* in original by CPA/ Lawyer/ Notary Public.

17. Signatures

Select Files

Corporate Shareholder’s Information (including the intermediary corporate layers)

1. Corporate Shareholder’s Information (including the intermediary corporate layers)

2. Company Name

3 .Registered Address

4. Company No.

5. Business Registration No.

6. Name of Representative

7. Email address

8. No. of shares held

9. Source of Funds

We, the above named hereby confirm that the above information is true and accurate, and you are authorized to supply any or all of such information for due diligence purposes to the Regulators if so requested by them. We also undertake to notify you of any future changes to the above information.

We/ I agree to provide the certified identification documents* and corporate documents** in original by CPA/ Lawyer/ Notary Public.

10. Name of Signer

11. Job title of Signer

12. Signatures

Select Files

1. Financial Year End

2. Visa Application

3. No. of Visas needed

4. Bank Account Opening

5. Bank Name

6. Account Type

7. Authorized Signature(s)

8. Signing Arrangement

We/ I, the undersigned certify that all information are true

9. Name of Signer

10. Email

11. Mobile

12. Date

Signature

Select Files

#FATF GUIDANCE – Politically Exposed Persons (Recommendations 12 and 22)

A politically exposed person (PEP) is defined by the Financial Action Task Force (FATF) as an individual who is or has been entrusted with a prominent public function. The potential risks associated with PEPs justify the application of additional anti-money laundering / counter-terrorist financing (AML/CFT) preventive measures with respect to business relationships with PEPs.

* Identification documents:
- Valid Passport Copy
- Valid of Residential address proof issued not more than 3 months

** Corporate documents:
- Certificate of Incorporation (equivalent to)
- Business Registration Certificate (equivalent to)
- Certificate of Incumbency Certificate of Good Standing
- Memorandum and Articles of Association
- Organizational chart (including intermediary corporate layers until UBO)

The Authority may request the attestation by UAE Embassy and MOFA for the above documents.

The information collected will be treated as strictly confidential and will be used for the establishment of the above company only.