ORDER FORM FOR NOMINEE SERVICES - SINGAPORE OR HONG KONG COMPANY
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- Bryan Booker
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1 Ntice: We are cllecting the infrmatin n this frm fr the purpse f administering yur accunt and prviding the services which yu are requesting. This infrmatin will be retained and used fr thse purpses and may be passed t anther party t achieve these gals. If yu agree, we may elect t use this infrmatin t infrm yu f specific prducts and/r services that we r ur assciates prvide based n the prbable relevance t yur needs if yu check this bx. I agree. (G t t read ur plicy in full.) Cmpletin f this frm is necessary t facilitate Hilda Le Assciates in perfrming the service(s) yu require. Once signed, this frm becmes a legally binding cntract, fr this reasn, Hilda Le Assciates s Terms and Cnditins shuld be reviewed first. Please (ps@hildale.cm) r fax cmpleted frm t (SIN) *Hilda Le Assciates reserves the right nt t nbard ptential clients that d nt prvide us with the dcuments r infrmatin necessary fr cmpliance duties with regards t this rder frm. ORDER FORM FOR NOMINEE SERVICES - SINGAPORE OR HONG KONG COMPANY Part A: Cmpany Infrmatin 1. Name f Cmpany t be represented by ur Nminee (knwn as Represented Cmpany ) 2. Cmpany Number 3. Registered Address 4. Nminee Agreement & Appintment Letter t be signed by: (Please indicate full name and address f the **Nminatr and authrized signr inf will be reflected n these dcuments) Is the Nminatr als the #Cntrller? If NO, please prvide full name, passprt cpy and address f CONTROLLER Page1
2 ** A Nminatr is a persn wh (r ne wh) nminates a Nminee Directr, signs the nminee agreement and gives directins & instructins t the Nminee Directr in the curse f the Cmpany s peratins. # A Cntrller gives directins & instructins t the Nminee Directr and is in cntrl f the Cmpany s peratin. Part B: Nminee Services Required 1. Fr Singapre cmpany* * Crprate Directr nt allwed Fr Hng Kng cmpany* ** At least ne Directr must be a natural persn wh can then appint Crprate Directr 2. Nminee Directr Sle Directr (Singapre Natural Persn) (SGD 3,000 per year + SGD 3,500 refundable security depsit) (USD 2,230 per year + USD 3,500 refundable security depsit) Directr (by Singapre Natural Persn & where Client X is appinted as a freign directr) (SGD 2,000 per year + SGD 2,500 refundable security depsit) (USD 1,490 per year + USD 2,500 refundable security depsit) **Directr (BVI Crprate Bdy) (SGD 600 per year + security depsit nt required) (USD 450 per year + security depsit nt required) **Directr (Hng Kng Crprate Bdy) (SGD 950 per year + SGD 1,000 refundable security depsit)(usd 700 per year + USD 1,000 refundable security depsit) **Directr (Singapre Crprate Bdy) (SGD 950 per year + SGD 1,000 refundable security depsit)(usd 700 per year + USD 1,000 refundable security depsit) T issue Pwer f Attrney t (SGD 175, witnessed by Singapre Ntary Public) (USD 130, witnessed by Singapre Ntary Public) Page2
3 3. Nminee Sharehlder Sharehlder (Singapre Natural Persn, number f shares t be issued (SGD 750 per year + SGD 1,000 refundable security depsit) (USD 575 per year + USD 1,000 refundable security depsit) Sharehlder (BVI Bdy Crprate), number f shares t be issued (SGD 550 per year + security depsit nt required) (USD 450 per year + security depsit nt required) Sharehlder (HKG Bdy Crprate), number f shares t be issued (SGD 700 per year + SGD refundable security depsit) (USD 400 per year + USD refundable security depsit) Declaratin f Trust witnessed by HLA staff (fr Singapre C) (SGD 125 per Sharehlder appintment) (USD 100 per Sharehlder appintment) Declaratin f Trust witnessed by Singapre Ntary Public (fr Singapre C) (SGD 175 per Sharehlder appintment) (USD 130 per Sharehlder appintment) Declaratin f Trust adjucated by HKG stamp ffice (fr Hng Kng C) (SGD 200 per Sharehlder appintment) (USD 150 per Sharehlder appintment) Part C: Nminatr / Beneficial Owner Representative/ Principal Cntact Infrmatin 1. Nminatr / *BO Representative/ *Principal Cntact name as per passprt: (*Please delete if nt applicable) Are yu als the BENEFICIAL OWNER? If yes, skip Beneficial Owner infrmatin sectin n Part D 2. Date & Place f Birth (Please indicate bth city and cuntry) Date (dd/mm/yyyy) City Cuntry 3. Natinality 4. Passprt / ID number 5. Residence Address Page3
4 6. Cuntry f Dmicile (If multiple, please prvide all cuntry names) 7. Cuntry, Name n ID & ID N. fr each cuntry f which yu are a citizen. 8. Telephne ID 9. D yu have an alternate address fr mailing r ther functins? If Yes, please prvide 10. Are yu a Plitically Expsed Persn (PEP) #? If Yes, please prvide details f the psitin held and assciatin # A Plitically Expsed Persn is smene wh, thrugh their prminent psitin r influence, nw, r in the past, is mre susceptible t being invlved in bribery r crruptin. In additin, any clse business assciate r family member f such a persn will als be deemed as being a risk, and therefre culd als be added t the PEP list. Fr mre infrmatin see: D yu have any pending r threatened claims r have yu ever been cnvicted f any crimes / fraud under a curt f law r under any investigatin f any nature r invlved in legal prceedings? If Yes, please prvide details Page4
5 12. Are yu a United States (US) persn*? (as defined fr US tax purpses)? If Yes, Please prvide a) Duly signed Frm Affidavit (T be prvided separately) b) One f the fllwing (Please mark X) ITIN Number Visa number Green Card Number SSN 13. Surce f Wealth (SOW) Infrmatin Please tick all that applies: Surce f Wealth/Incme Business Prceeds Dividend Incme Directr s Fees Emplyment Incme Pensin Scheme Agent s Cmmissin Intellectual Prperty Ryalties Lan Principal/Interest Lease Rents Insurance Savings Others (If any please state) Investment Incme Prperty Security Equity Others (If any please state) Inheritance & Gift Please furnish with supprt dcuments (E.g. Death Certificate) Part D: Ultimate Beneficial Owner Infrmatin (MUST BE A NATURAL PERSON) *This sectin must be cmpleted if yu are neither the Sharehlder nr Directr listed at Part B abve.* 1. Full Name (As per passprt) 2. Date & Place f Birth (Please indicate bth city and cuntry) Date (dd/mm/yyyy) City Cuntry 3. Natinality Page5
6 4. Passprt / ID number 5. Residence Address 6. Cuntry f Dmicile (If multiple, please prvide all cuntry names) 7. Cuntry, Name n ID & ID N. fr each cuntry f which yu are a citizen. 8. Telephne ID 9. D yu have an alternate address fr mailing r ther functins? If Yes, please prvide 10. Are yu a Plitically Expsed Persn (PEP) #? If Yes, please prvide details f the psitin held and assciatin # A Plitically Expsed Persn is smene wh, thrugh their prminent psitin r influence, nw, r in the past, is mre susceptible t being invlved in bribery r crruptin. In additin, any clse business assciate r family member f such a persn will als be deemed as being a risk, and therefre culd als be added t the PEP list. Fr mre infrmatin see: Page6
7 11. D yu have any pending r threatened claims r have yu ever been cnvicted f any crimes / fraud under a curt f law r under any investigatin f any nature r invlved in legal prceedings? If Yes, please prvide details 12. Are yu a United States (US) persn*? (as defined fr US tax purpses)? If Yes, Please prvide c) Duly signed Frm Affidavit (T be prvided separately) d) One f the fllwing (Please mark X) ITIN Number Visa number Green Card Number SSN 13. Surce f Wealth (SOW) Infrmatin Please tick all that applies: Surce f Wealth/ Incme Business Prceeds Dividend Incme Directr s Fees Emplyment Incme Pensin Scheme Agent s Cmmissin Intellectual Prperty Ryalties Lan Principal/Interest Lease Rents Insurance Savings Others (If any please state) Investment Incme Prperty Security Equity Others (If any please state) Inheritance & Gift Please furnish with supprt dcuments (E.g. Death Certificate) Part E: Declaratin 1. I/We (hereinafter the Client) als cnfirm that the Client has been infrmed that the structure/cmpany that the Client is setting up culd be reprtable and taxable in my cuntry f residency/citizenship, and therefre the Client shuld btain apprpriate legal and tax advice in my hme jurisdictin and all ther relevant jurisdictins. The Client hereby declares that the Client will fllw the advice received and cmply with my reprting bligatins if any. Page7
8 2. In the event that Hilda Le Assciates Pte. Ltd.(HLA), as service prvider, is at any time under the legal bligatin t any applicable gvernmental authrity, directly r indirectly t reprt the structure r becmes tax liable tgether with me in relatin t the assets held in the structure, HLA may be bligated t enquire r ensure that the Client has sught r implemented any such tax and/r legal advice and that the Client will reprt all relevant infrmatin t the Tax Authrities. In the event f such reprting, the Client shall hld HLA harmless fr any damages r actins resulting frm such reprting. 3. The Client cnfirm that nne f the assets prpsed t transfer t the Structure/Cmpany has been derived frm r relate t any f the Designated Categries f Offences. 4. The Client and the undersigned, cnfirm that the nminee services requested are nt used fr illegal purpses and hereby cnsent t act as Nminatr/Cntrller and/r Directr and/r Beneficial Owner Representative and/r Principal Cntact f the Cmpany. Where the infrmatin prvided in Sectin A t D is changed frm any time hereafter, The Client and the undersigned agree t infrm Hilda Le Assciates Pte. Ltd. immediately. The Client and the undersigned hereby cnfirm and declare that all details prvided abve are true and crrect t the best f their knwledge. Name Signature Date Place Cntact Number 5. Designed Categries f Offences List f Designated Categries f Offences as per Frty Recmmendatins n Mney Laundering prepared by the Financial Actin Task Frce (FATF). Participatin in an rganized criminal grup and racketeering. Terrrism, including terrrist funding. Human trafficking and migrant smuggling r sexual explitatin, including that f children. Illicit trafficking f narctics and psychtrpic substances, arms r stlen gds. Bribery and crruptin. Fraud, cunterfeiting currency and the cunterfeiting r piracy f prducts. Envirnmental Crime. Murder and Grievus bdily injury. Kidnapping, illegal restraint and hstage-taking. Theft, rbbery r smuggling (including thse related t custm excise duties and taxes) Tax crimes (Related t direct taxes and indirect taxes) Extrtin, frgery r piracy. Insider training an market manipulatin. Page8
9 Please ensure the fllwing dcuments are attached r have already been sent t Hilda Le Assciates: Scanned cpy f identificatin in the frm f a passprt r natinal ID fr each nminatr/cntrller, directr, sharehlder, ultimate beneficial wner OR a cpy f the Certificate f Incrpratin & Incumbency r similar fr Crprate Sharehlders/Nminatr. Scanned cpy f utility bill r credit card/bank statement as prf f current address fr each nminatr/cntrller, directr. sharehlder & ultimate beneficical wner. Scanned cpy f the Cetificate f Incrpratin & C. Prfile (Bizfile r similar shwing registered address, dirctrs & sharehlders inf) f Represented C. Payment fr nminee services and security depsits Thank yu fr chsing Hilda Le Assciates Pte Ltd Page9
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