Company Order Form for UK/NI Company | Company Bureau Formations Ireland

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Please ensure all relevant fields are completed otherwise your order may be delayed. It is your responsibility to ensure all info provided and spelling of names and addresses are 100% correct. All information provided will be kept strictly confidential. Questions marked with asterisk (*) required for Companies House digital signature

PROFESSIONAL ADVISOR (PA) AML STATUS

Are you PA advisor regulated for AML purposes?*

yes

no

will you provide AML documentation when requested?

yes

no

UK/NI Limited Company Formation – €395+VAT

COMPANY JURISDICTION

ADDITIONAL SERVICES REQUIRED

'Open for Business’ package (incorporation + all below services marked *)*

yes

no

*Combined Company Secretarial & Compliance Service (€350+VAT per year)*

yes

no

Registered Office Options*

Select a Registered Office Option

Provision of Online, Transactional Bank Account (€395+VAT)*

yes

no

Any other professional services we can help you with?

CLIENT DETAILS (FOR INVOICING & DELIVERY PURPOSES)

Your Name*

Firstname Lastname

Your Company/Firm Name (If applicable)

Full Address*

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

Phone number*

Email*

COMPANY DETAILS

1st Choice Company Name*

2nd Choice Company Name

Brief Description of Company Objectives*

Registered Office Address (Must be in UK – we can provide this facility if you wish)

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

Place Where Activities will be carried out*

Place of Company Administration*

SHARE CAPITAL

Number of Issued Shares*

(Standard is 100. This will be applied if left blank)

Select Numbers of Directors*

1ST DIRECTOR

Name*

Firstname Lastname

Residential Address*

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

Correspondence Address: (If you don’t want residential address on public record)

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

Occupation*

Date of Birth*

Director’s identity verification code*

Other Directorships*

yes

no

Nationality*

2ND DIRECTOR

Name*

FIrstname Lastname

Residential Address*

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

Correspondence Address: (If you don’t want residential address on public record)

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

Occupation*

Date of Birth*

Director’s identity verification code*

Other Directorships*

yes

no

Nationality*

3RD DIRECTOR

Name*

Firstname Lastname

Residential Address*

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

Correspondence Address: (If you don’t want residential address on public record)

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

Occupation*

Date of Birth*

Director’s identity verification code*

Other Directorships*

yes

no

Nationality*

4TH DIRECTOR

Name*

Firstname Lastname

Residential Address*

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

Correspondence Address: (If you don’t want residential address on public record)*

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

Occupation*

Date of Birth*

Director’s identity verification code*

Other Directorships*

yes

no

Nationality*

Company Secretary

Name

Firstname Lastname

Residential Address

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

Correspondence Address: (If you don’t want residential address on public record)

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

Date of Birth

Directorships

yes

no

Town of Birth

Phone Number (first 3 digits only)

Mothers’ Maiden Name

SHAREHOLDERS / ULTIMATE BENEFICIAL OWNERS

Select Number of Shareholders*

1st Shareholder

Name*

Firstname Lastname

Residential Address*

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

Correspondence Address: (If you don’t want residential address on public record)

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

Number of Shares*

Identity verification code (if the individual is Person of Significant Control)

Town of Birth*

Phone Number (first 3 digits only)*

Mothers’ Maiden Name*

Occupation*

Date of Birth*

Nationality*

2nd Shareholder

Name*

Firstname Lastame

Residential Address*

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

Correspondence Address: (If you don’t want residential address on public record)

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

Number of Shares*

Identity verification code (if the individual is Person of Significant Control)

Town of Birth*

Phone Number (first 3 digits only)*

Mothers’ Maiden Name*

Occupation*

Date of Birth*

Nationality*

3rd Shareholder

Name*

Firstname Lastname

Residential Address*

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

Correspondence Address: (If you don’t want residential address on public record)

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

Number of Shares*

Identity verification code (if the individual is Person of Significant Control)

Town of Birth*

Phone Number (first 3 digits only)*

Mothers’ Maiden Name*

Occupation*

Date of Birth*

Nationality*

4th Shareholder

Name*

Firstname Lastname

Residential Address*

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

Correspondence Address: (If you don’t want residential address on public record)

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

Number of Shares*

Identity verification code (if the individual is Person of Significant Control)

Town of Birth*

Phone Number (first 3 digits only)*

Mothers’ Maiden Name*

Occupation*

Date of Birth*

Nationality*

5th Shareholder

Name*

Firstname Lastname

Residential Address*

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

Correspondence Address: (If you don’t want residential address on public record)

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

Number of Shares*

Identity verification code (if the individual is Person of Significant Control)

Town of Birth*

Phone Number (first 3 digits only)*

Mothers’ Maiden Name*

Occupation*

Date of Birth*

Nationality*

Are the Shareholders detailed above also the only Persons of Significant Control?

yes

no

If no, please give full details of the Person of Significant Control as for the shareholders above.

Company Formation Essentials

Company Types & International Options

Pricing & Professional Support

Compliance Services

Company Changes

Company Documents

Business Services

Financial/Director Services

Marketing/Technology

Company Order Form for UK/NI Company | Cozmotec Test

PROFESSIONAL ADVISOR (PA) AML STATUS

UK/NI Limited Company Formation – €395+VAT

ADDITIONAL SERVICES REQUIRED

CLIENT DETAILS (FOR INVOICING & DELIVERY PURPOSES)

COMPANY DETAILS

SHARE CAPITAL

1ST DIRECTOR

2ND DIRECTOR

3RD DIRECTOR

4TH DIRECTOR

Company Secretary

SHAREHOLDERS / ULTIMATE BENEFICIAL OWNERS

1st Shareholder

2nd Shareholder

3rd Shareholder

4th Shareholder

5th Shareholder

AML/CFT QUESTIONS

PAYMENT AND DELIVERY OPTION

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