TURKS & CAICOS ISLANDS FINANCIAL SERVICES COMMISSION

TURKS AND CAICOS ISLANDS REGISTRATION OF BUSINESS NAMES

NEW APPLICANT: RENEWAL: AMENDMENT: Registration No:

Period (Year/s) of renewal: / / /

I/We (Full names of person/s or firm applying)

_ Hereby apply for Registration under Section5 of the Registration of Business Names Ordinance and furnish the following statement of particulars.

1. Business Name:

2. General Nature of Business: _

3. Principal place of Business (Full address)

_

4. Particulars of individual or partners of the firm applying:

Full name/s:

Names of any former business/s:

Nationality:

Nationality of origin (P.O.B):

Usual Residence (address):

5. Date of commencement of Business

6. Any other Business Name(s) under which the Business is carried on:

7. If the business has more than one location please provide details of each branch location

If the Firm includes one or more Corporation(s)

Name of Corporation

Registered Office Registered No. Country of Incorporation

CERTIFICATE COLLECTION AUTHORIZATION

I hereby authorize:

to collect the certificate on my behalf upon submission of identification.

Dated this _________ day of __________________________20 .

Name:

Contact Information

Name/s: _______________________________________________________________________.

Signature/s: __________________________________________________________________.

__________________________________________

Telephone No.

___________________________________________

E-mail:

PLEASE NOTE:

___________________________________________

• This application must be signed by the Individual or all Partners of the Firm

applying for registration. In the case of a Corporation a Director or Secretary

may and should state the capacity in which he or she does so.

• The Registrar may request the applicant/s to provide any other relevant

document in respect of this application.

• All Applicant/s must sign and must produce a valid government issued ID

before submitting this application for processing.

• All applicant/s must renew registration certificates on the anniversary of

the registration date. PRCOCESSING OFFICER

(OFFICIAL USE ONLY)

Initial:

Charges:

Date: