Formulario Para la Constitución de un Empresa

FAX ALONG WITH SUPPORTING DOCUMENTS TO +1 767 449 9257 WHEN COMPLETED AND SIGNED

You will be contacted via e-mail to finalize the process.

  1. Fill in all sections of this form
  2. Print the application
  3. Sign where indicated by “x”
  4. Enclose the required supporting documents
  5. Fax all pages to +1 767 449 9257, or scan and send to info@griffonbank.com
  6. Send everything to one of the following addresses:
Via regular mail:
P.O. BOX 1324, Roseau
Commonwealth of Dominica, W.I. 		Via courier mail:
Financial Center, Roseau
Commonwealth of Dominica, W.I.

Required Supporting Documents

  • A certified copy of passport (for account holder and any authorized person - certifier's contact information must be on the documentation they signed)
  • An original reference letter from a banker (for account holder and any authorized person - referee's contact information must be on the letter signed)
  • An original utility bill or other document, which proves current address (for account holder and any authorized person)
International Business Company
Note: A company name must end with the word(s) Limited, Corporation, Societe Anonyme or abbreviation thereof. Using Finance, Trust, Bank, Insurance, Royal or Imperial is not allowed.
 
Proposed Name Option #1:
Proposed Name Option #2:
Activities/Purpose of Company:
Authorized Capital (usually USD1,000.00):
Number of Authorized Shares (usually 100):
How is the Capital of the IBC to be divided? According to following %
Other: Please list
Owner / Shareholder
Full Name:
Date & Place of Birth:
Passport number:
Phone number
Fax number:
Current Residential Address:
Occupation / Job Title:
Present Employer:
% of Registered Shares:
E-mail address:
Are you a named party in any litigation or are there any outstanding judgments filed against you or your assets? Yes
  or
No
x _________________________
(Specimen signature)
Other Owner / Shareholder (if any)
Full Name:
Date & Place of Birth:
Passport number:
Phone number
Fax number:
Current Residential Address:
Occupation / Job Title:
Present Employer:
% of Registered Shares:
E-mail address:
Are you a named party in any litigation or are there any outstanding judgments filed against you or your assets? Yes
  or
No
x _________________________
(Specimen signature)
Directors
Full Name (Director 1):
Date & Place of Birth:
Passport number:
Phone number
Fax number:
Current Residential Address:
Occupation / Job Title:
Present Employer:
% of Registered Shares:
E-mail address:
Are you a named party in any litigation or are there any outstanding judgments filed against you or your assets? Yes
  or
No
x _________________________
(Specimen signature)
Full Name (Director 2):
Date & Place of Birth:
Passport number:
Phone number
Fax number:
Current Residential Address:
Occupation / Job Title:
Present Employer:
% of Registered Shares:
E-mail address:
Are you a named party in any litigation or are there any outstanding judgments filed against you or your assets? Yes
  or
No
x _________________________
(Specimen signature)
I/we certify the information given herein is true and correct; the persons mentioned do exist and are persons with integrity and respectability; and that all funds sent are clean and of legal origin and are owned or lawfully managed by the persons signing below.

I/We authorize the registered agent to conduct the proper verification of the above information, if necessary.

I/We agree to hold the registered agent, its Directors, Officers, employees, affiliates and representatives free from all liability incurred when acting on facsimile (fax) or Email instructions provided by me/us. The undersigned shall at all times be liable for the payment upon demand of any debit balance or other obligation owing in any account(s) of the undersigned. Any false statement with regard to any funds or any false statement made in this application shall allow the registered agent to close the account and strike the name from the register.

I/We shall at all times hereafter indemnify and keep indemnified the registered agent, its Directors, Officer, employees, affiliates and representatives against all cost, charges, expenses which may now or hereafter become liable to pay or sustain in connection with any matter which may arise as a result of any false statement with regard to any such funds or any false statement made in this application or in relation to any unlawful transaction of any trust, bank, account or international business corporation named in this application and also against all sums of money whether for damages, costs, attorney fees, charges, expenses and to implement such measures incidental thereto.

I/We confirm the I/We am/are making this declaration for my/our protection as well as the registered agent, its Directors, Officers, employees, affiliates and representatives and hereby give consent to the registered agent to disclose this transaction to law enforcement authorities subject to the confidentiality laws of the Commonwealth of Dominica.

I/We hereby certify that I/We have not received legal or tax advice associated with my/our decision to form this structure and I/We have been encouraged to consult my/our attorney and tax advisor for such advice on my/our personal situation.

I/We understand that funds repatriated to my/our home country may be subject to taxes. This service can be provided through independent representatives, the registered agent, its Directors, Officers, employees, affiliates and representatives cannot be held responsible for any claims or representations outside of what appears in the Application.

I/ We agree that Griffon Bank can automatically debit the company’s annual renewal and agency fees from the company’s account at Griffon Bank at the due date (every 12 months after the date of incorporation).
 
Place:
Date:   
 
Name:
x _________________________
(Signature)
Name:
x _________________________
(Signature)
Name:
x _________________________
(Signature)
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