Registration Form s24

(Labuan Company No. LL07577 l Trust License No. LT0046)

REGISTRATION FORM LABUAN COMPANY (LABUAN COMPANIES ACT, 1990)

This information is confidential and will be used for our internal purpose only. The information may first be furnished by facsimile. The original copy duly completed and signed must be sent by courier together with the other documents to the following address:-

Labuan Borneo Trustees Limited Unit 3A-25, U0350, 3rd Floor, Labuan Times Square, Jalan Merdeka, 87007 Labuan F.T, Malaysia. Tel No: +60 87 417577 I Fax No: +60 87 423577

Email: [email protected]

IMPORTANT: We reserve the right to accept or reject any application submitted without assigning any reason thereof. Applicant will be notified accordingly.

Details of authorized person/ultimate beneficial owner who completed the form: a. Name : b Company : . c. Correspondence Address :

d Residential Address : .

e. Telephone No (Office) :

(H/P) : f. Fax No : g. Email address :

Labuan Borneo Trustees Limited (Co No: LL 07577) (License No: LT0046) is authorised and regulated by the Labuan Financial Services Authority and is a member of the Association of Labuan Trust Companies. 1 (Labuan Company No. LL07577 l Trust License No. LT0046)

SECTION A – PROPOSED NAME

Please provide three (3) alternative names in order of preference. (Please note that the proposed name must end with Ltd, Corp, Inc., Limited, Corporation, Incorporated. You may also use (L) as part of the Labuan Company's name. Additionally, you may also use "Bhd." or "Berhad" but it must be with (L) as part of the Labuan Company's name.) a. b . c.

SECTION B – TYPE OF COMPANY

Please indicate the type of Labuan Company a. A Company limited by shares b A Company limited by guarantee . c. An unlimited Company

SECTION C – PURPOSE

Please indicate the purpose or principal activity of the proposed Labuan Company

SECTION D – SOURCE OF FUND

Please indicate the source of fund of the proposed Labuan Company

SECTION E – ISSUED CAPITAL & PAID UP CAPITAL

1 Currency : . (other than Malaysian Ringgit) 2 Issued Capital : ______(Amount of______Share(s)(No of Shares) . (minimum of one share ) is required) 3 Paid up Capital : ______(Amount of______Share(s)(No of Shares)

Labuan Borneo Trustees Limited (Co No: LL 07577) (License No: LT0046) is authorised and regulated by the Labuan Financial Services Authority and is a member of the Association of Labuan Trust Companies. 2 (Labuan Company No. LL07577 l Trust License No. LT0046)

. (minimum of one share ) is required)

Note: The incorporation fee payable to the Labuan Financial Services Authority are as follows:- i. Paid up capital not exceeding the equivalent of RM50,000 RM1,000 ii. Paid up capital between the equivalent of RM50,000 and RM 999,999 RM2,000 iii. Paid up capital of or exceeding the equivalent of RM1,000,000 RM5,000

SECTION F – MEMBER(S)

(NOTE: At least one member is required. Corporate member may be appointed. )

1 Do you need Labuan Borneo Trustees Limited or its subsidiary to : Yes . act as the first subscriber for the purpose of incorporation? (Recommended if you need the company urgently) No

If NO, please provide us with the following details of subscriber(s)/member(s).

1. Name : Occupation : Nationality : Passport/Company No. : Date of birth / incorporation : Place of birth / incorporation : Registered Address : Correspondence Address : Residential Address : Telephone No (Office) : (H/P) : Fax No : Email address : No. of share(s) :

2. Name : Occupation : Nationality : Passport / Company No. : Date of birth / incorporation : Place of birth / incorporation : Registered Address : Correspondence Address : Residential Address : Telephone No (Office) : (H/P) : Fax No : Email address :

Labuan Borneo Trustees Limited (Co No: LL 07577) (License No: LT0046) is authorised and regulated by the Labuan Financial Services Authority and is a member of the Association of Labuan Trust Companies. 3 (Labuan Company No. LL07577 l Trust License No. LT0046)

No. of share(s) :

3. Name : Occupation : Nationality : Passport / Company No. : Date of birth / incorporation : Place of birth / incorporation : Registered Address : Correspondence Address : Residential Address : Telephone No (Office) : (H/P) : Fax No : Email address : No. of share(s) :

4. Name : Occupation : Nationality : Passport / Company No. : Date of birth / incorporation : Place of birth / incorporation : Registered Address : Correspondence Address : Residential Address : Telephone No (Office) : (H/P) : Fax No : Email address : No. of share(s) :

5. Name : Occupation : Nationality : Passport / Company No. : Date of birth / incorporation : Place of birth / incorporation : Registered Address : Correspondence Address : Residential Address : Telephone No (Office) : (H/P) : Fax No : Email address : No. of share(s) :

Labuan Borneo Trustees Limited (Co No: LL 07577) (License No: LT0046) is authorised and regulated by the Labuan Financial Services Authority and is a member of the Association of Labuan Trust Companies. 4 (Labuan Company No. LL07577 l Trust License No. LT0046)

SECTION G – DIRECTOR(S)

(NOTE: At least one Director is required. Corporate Director may be appointed. )

1 Do you need Labuan Borneo Trustees Limited or its Trust Officer : Yes . to act as *Resident Director (* please choose one). No

If NO, please provide us with the following details of director/corporate director:-

1. Name : Occupation : Nationality : Passport / Company No. : Date of birth / incorporation : Place of birth / incorporation : Registered Address : Correspondence Address : Residential Address : Telephone No (Office) : (H/P) : Fax No : Email address :

3. Name : Occupation : Nationality : Passport / Company No. : Date of birth / incorporation : Place of birth / incorporation : Registered Address : Correspondence Address : Residential Address :

Labuan Borneo Trustees Limited (Co No: LL 07577) (License No: LT0046) is authorised and regulated by the Labuan Financial Services Authority and is a member of the Association of Labuan Trust Companies. 5 (Labuan Company No. LL07577 l Trust License No. LT0046)

Telephone No (Office) : (H/P) : Fax No : Email address : 4. Name : Occupation : Nationality : Passport / Company No. : Date of birth / incorporation : Place of birth / incorporation : Registered Address : Correspondence Address : Residential Address : Telephone No (Office) : (H/P) : Fax No : Email address :

SECTION H – ADDITIONAL /JOINT SECRETARY (Optional)

Do you wish to appoint additional secretary in addition to the Resident Secretary? If yes, please provide us with the following details of additional secretary:-

Name : Occupation : Nationality : Passport/Company No. : Date of birth / incorporation : Place of birth / incorporation : Registered Address : Correspondence Address : Telephone No (Office) : (H/P) :

Labuan Borneo Trustees Limited (Co No: LL 07577) (License No: LT0046) is authorised and regulated by the Labuan Financial Services Authority and is a member of the Association of Labuan Trust Companies. 6 (Labuan Company No. LL07577 l Trust License No. LT0046)

Fax No : Email address :

(NOTE: It is a mandatory requirement of the Labuan Companies Act 1990 for a Labuan Trust Company to be appointed as the Resident Secretary)

SECTION I – ULTIMATE BENEFICIAL OWNER INFORMATION

Kindly provide us with the following information of ultimate beneficial owner, if different from member(s) of the proposed Labuan Company.

Name : Occupation : Nationality : Passport / National Identity No. : Date of birth : Place of birth : Registered Address : Correspondence Address : Residential Address : Telephone No (Office) : (H/P) : Fax No : Email address :

SECTION J – AUTHORISED PERSON

Please provide us with the following information of the authorised person if you choose to appoint one. This person will be the individual who is authorised to instruct Labuan Borneo Trustees Limited in respect of all the Labuan company matters on behalf of the ultimate beneficial owner.

Name : Occupation : Nationality : Passport / National Identity No. : Registered Address : Date of birth : Place of birth : Correspondence Address : Residential Address : Telephone No (Office) : (H/P) : Fax No : Email address : Specimen signature :

Labuan Borneo Trustees Limited (Co No: LL 07577) (License No: LT0046) is authorised and regulated by the Labuan Financial Services Authority and is a member of the Association of Labuan Trust Companies. 7 (Labuan Company No. LL07577 l Trust License No. LT0046)

SECTION K – OTHER INFORMATION

1 Financial Year End : .

2 Tax status : .

3 Any special Articles required : Yes . No

If YES, please provide us with the information: ______

4 Audit : Yes . No

If YES, please provide us your preferred Approved Auditor : ______

5 Do you need Labuan Borneo Trustees Limited to act as tax agent : Yes . to file the Tax Return of the Labuan Company? No

If NO, please provide us your preferred tax agent :

6 Do you need Labuan Borneo Trustees Limited to assist you with : . the opening of bank account? If yes, please provide us your preferred Banker.

7 Do you need internet banking facility ( if you choose option 6) : Yes . No

8 Do you require work permit? If yes, do you need Labuan Borneo . Trustees Limited to assist you with the application? Yes

Labuan Borneo Trustees Limited (Co No: LL 07577) (License No: LT0046) is authorised and regulated by the Labuan Financial Services Authority and is a member of the Association of Labuan Trust Companies. 8 (Labuan Company No. LL07577 l Trust License No. LT0046)

9 Other services required:- . ______

SECTION L – DUE DILIGENCE DOCUMENTS REQUIRED

In line with international Standards of Anti-Money Laundering and Anti-Terrorism Financing Act 2001, all Trust Company Service Providers are now subject to the said Act. In view of that, we are required to carry Customer Due Diligence on all Ultimate Beneficial Owners, Directors, Shareholders and any Authorised Persons.

The following original documents MUST be provided to us for Customer Due Diligence review and record keeping.

All documents MUST BE CERTIFIED by a member of a professional body i.e. lawyer, auditor, company secretary or commissioner of oath, unless the original is provided.

For Individual

1 Copy of Passport . 2 Copy of National Identity Document . 3 Other beneficial identification documentations . 4 Proof of address i.e utility bill or bank statement (not more than 3 months old) . 5 Reference letter from a Banker or Professional . 6 Personal resume .

For Corporation

1 Memorandum and Articles of Association . 2 Certificate of Incorporation or Certificate of Incumbency . 3 Letter of Information or Letter of Good Standing . 4 Certificate of Change of Name (if any) . 5 Current Register of Members& Directors . 6 Member and Director Resolution authorising the establishment of the Labuan Company .

Labuan Borneo Trustees Limited (Co No: LL 07577) (License No: LT0046) is authorised and regulated by the Labuan Financial Services Authority and is a member of the Association of Labuan Trust Companies. 9 (Labuan Company No. LL07577 l Trust License No. LT0046)

7 The contact details of the Registered Secretary or Registered Agent .

DECLARATION AND INDEMNITY

I/we the * ultimate beneficial owner or the authorised person of the Labuan company does solemnly and sincerely affirm that:-

(a) all information provided in this registration form is correct to the best of my/our knowledge; (b) I/we have read and accept the terms and conditions outlined in this registration form and the Fee Schedule; (c) to indemnify Labuan Borneo Trustees Limited, its subsidiaries and its employees or its agents for all and any loss, damage, claims, charges, fees, taxes, costs and expenses howsoever suffered or incurred from any claims, actions or proceedings initiated or brought by any persons arising from the corporate secretarial services provided to me/us including the provision of resident directors and the opening of bank accounts for and on my/our behalf and for taking and acting on the instructions of my/our authorized person(s) unless the same is caused by gross negligence or willful default.

______Signature Name: Passport or NRIC No.: Ultimate Beneficial Owner or Authorised Person

Date :

Labuan Borneo Trustees Limited (Co No: LL 07577) (License No: LT0046) is authorised and regulated by the Labuan Financial Services Authority and is a member of the Association of Labuan Trust Companies. 10 (Labuan Company No. LL07577 l Trust License No. LT0046)

Witnessed By :

______Signature Name: Passport or NRIC No.: