Branch Formation Order Form

Branch Formation Order Form | Cozmotec Test

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Please ensure all relevant fields are completed, otherwise your order may be delayed.

It is your responsibility to ensure all information provided, including spelling of names and addresses, is 100% correct. Additional fees may be incurred if details supplied need to be amended subsequently.

PROFESSIONAL ADVISOR (PA) AML STATUS

Are you PA advisor regulated for AML purposes?*

yes

will you provide AML documentation when requested?

yes

SERVICES REQUIRED

(Fees exclude VAT where applicable)

Combined Registered Agent & Local Representative (€595 per year)*

yes

Combined Registered Agent, Local Representative, & Registered Office Service (€795 per year)*

yes

The above two services include a local agent who ensure legal compliance + accept legal service as required by EU Branch legislation

Registered Office Service only (€375 per year)*

yes

Quotation for Accounting and Booking Services (We will contact you to discuss)*

yes

Tax Registration (€295. Includes VAT if applicable)*

yes

Any other professional services we have help you with?

CUSTOMER DETAILS (FOR INVOICING & DELIVERY PURPOSES)

Your Name*

Firstname Lastname

Your Company/Firm Name*

Full Address*

Street Address Address Line 2 City County / State / Region Eircode/Postal/Zip Code Country

Phone number*

Email*

COMPANY DETAILS

Full legal title of Mother Company*

Registered Number of Mother Company*

Business name to be used in Ireland (if different):

Country*

Date of Incorporation*

Brief Description of Business Activities*

VAT number for invoicing (if applicable)

Registered Office Address of Mother Company*

Street Address Address Line 2 City County / State / Region Eircode/Postal/Zip Code Country

Do you require a branch address in Ireland?*

yes

We can provide this service if you order Combined Registered Agent, Local Representative, & Registered Office Service or Registered Office Service above
If not, please give Irish address details

Registered Office Address

Street Address Address Line 2 City County / State / Region Eircode/Postal/Zip Code Country

Select Numbers of Directors*

1ST DIRECTOR OF MOTHER COMPANY

Name*

Firstname Lastname

Residential Address*

Street Address Address Line 2 City County / State / Region Eircode/Postal/Zip Code Country

Occupation*

Date of Birth*

Other Directorships: (If applicable)

Nationality*

Will this director be authorised to represent the branch?*

yes

IF YES, can this person represent the branch alone or jointly?

2ND DIRECTOR OF MOTHER COMPANY

Name*

FIrstname Lastname

Residential Address*

Street Address Address Line 2 City County / State / Region Eircode/Postal/Zip Code Country

Occupation*

Date of Birth*

Other Directorships: (If applicable)

Nationality*

Will this director be authorised to represent the branch?*

yes

IF YES, can this person represent the branch alone or jointly?

3RD DIRECTOR OF MOTHER COMPANY

Name*

Firstname Lastname

Residential Address*

Street Address Address Line 2 City County / State / Region Eircode/Postal/Zip Code Country

Occupation*

Date of Birth*

Other Directorships: (If applicable)

Nationality*

Will this director be authorised to represent the branch?*

yes

IF YES, can this person represent the branch alone or jointly?

4TH DIRECTOR OF MOTHER COMPANY

Name*

Firstname Lastname

Residential Address*

Street Address Address Line 2 City County / State / Region Eircode/Postal/Zip Code Country

Occupation*

Date of Birth*

Other Directorships: (If applicable)

Nationality*

Will this director be authorised to represent the branch?*

yes

IF YES, can this person represent the branch alone or jointly?

LOCAL REPRESENTATIVE*

LOCAL REPRESENTATIVE DETAILS

Name*

Firstname Lastname

Residential Address in Ireland*

Street Address Address Line 2 City County / State / Region Eircode/Postal/Zip Code Country

Occupation*

Date of Birth*

Other Directorships: (If applicable)

Nationality*

Will there be anyone else who will be appointed to represent the branch?*

yes

Name*

Firstname Lastname

Residential Address in Ireland*

Street Address Address Line 2 City County / State / Region Eircode/Postal/Zip Code Country

Occupation*

Date of Birth*

Other Directorships: (If applicable)

Nationality*

COMPANY SECRETARY SECTION

Does the Mother company have Company Secretary?*

yes

Name

First Last

Virtual Office Bronze Package 20% OFF (€50+VAT/month Total: €369.00 includes first 3 months services + 3 months deposit)

20% Off and No set-up fees, for a limited time only! Provision of dedicated business telephone number with call forwarding to any number in the world. Our Bronze package includes: – Call divert to any number in the world. – Provision of a dedicated business telephone number. – Mail forwarding service. Pricing is based on a first 3 months services + 3 months deposit at 50+VAT/month, includes setup and VAT.

Virtual Office Silver Package 20% OFF (€90+VAT/month Total: € 664.20 includes first 3 months services + 3 months deposit)

20% Off and No set-up fees, for a limited time only! Provision of dedicated business telephone number with message taking and mail forwarding. Our Silver package includes: – Full call answering and forwarding of messages by e-mail. -Provision of dedicated business telephone number. – Mail forwarding service. Pricing is based on a first 3 months services + 3 months deposit at ~~€108+VAT~~ 90+VAT/month, includes setup and VAT.

Virtual Office Gold Package 20% OFF (€110+VAT/month Total: € 811.80 includes first 3 months services + 3 months deposit)

20% Off and No set-up fees, for a limited time only! Provision of dedicated business telephone number with message taking and mail forwarding. Our Gold Package includes: – Full call answering and forwarding of messages by e-mail. – Provision of a dedicated business telephone number. – Mail forwarding service. – Mail scanning service. Pricing is based on a first 3 months services + 3 months deposit at ~~€132+VAT~~ 110+VAT/month, includes setup and VAT.

AML QUESTIONS

Source Of Funds*

Rationale for setting up a limited company*

Geographical area/s of trading (suppliers and customers):*

Percentage of the business that is going to be cash based (if applicable):*

The annual turnover anticipated*

number of employees*

Are any of the officers, shareholders or beneficial owners a Politically Exposed Person (PEP)?*

yes

For new customers, please note that customer due diligence (CDD) documentation will be required for at least two Directors (unless there is just one Director) and shareholders/beneficial owners with than 25% of the shares in the company’

Please give details*

Have any of the above persons ever been charged and/or convicted of any criminal offence other than motoring offences or have they been declared bankrupt or have they a bad credit history?*

yes

Please give full details*

PAYMENT AND DELIVERY OPTION

Please choose delivery option (If documents are to be sent)*

Normal post – Registered post within Ireland (Free)

Collection from the Office (Free)

International Express Post (€25)

UK/ International courier – Price on application

** Please note that payment is required before we can incorporate your company.

Special Requests: (If any)

Important Payment Instruction:

Please ensure that the Invoice Number and/or Company Name is listed as a reference to ensure payment is processed correctly.

Payment must be nett of bank charges.