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ULTIMATE BENEFICIARY OWNER FORM

Ultimate beneficial owner form necessary when transferring a company

Ultimate beneficial owner form.

ULTIMATE BENEFICIARY OWNER FORM
For the drafting and signing of any document and/or notarial deed executed by our office.
We will need a copy of a valid identification (required by standards and regulations of FIU).
Also, (our legal identification obligation by law) from the legal representative of a company/entity.
Including the following information from all persons being an ultimate beneficiary owner (UBO).
That of any (affiliated) corporate entity involved in any notarial transaction at our office.
For each individual person being an UBO of the same entity, a separate form needs to be filled out.
You will also have to indicate below if you are a political exposed person.
(PEP) in or elsewhere, outside of Sint Maarten.
The undersigned, being the legal representative of:

1. Name entity: (e.g. Limited, Corporation, Association etc.)

______________________________________________________
______________________________________________________
Incorporated according to the laws of: ____________________________
Established on (date of incorporation):_____(dd)_____(mm)__________(yr)

2. Are there any bearer shares of the aforementioned legal entity in circulation?

G no
G yes

3. Is the UBO a political exposed person (PEP)?

G no
G yes

4. If applicable how many PEPs are present within the UBOs of the entity?

_______________
If you have answered question 3 with yes, kindly answer the following questions for each PEP:
PEP name: ______________________________________________________
________________________________________________________________
Public office description and role: _____________________________________ ________________________________________________________________
Date when office was assumed: _____(dd)_____(mm)__________(yr)
Date when office was left: _____(dd)_____(mm)__________(yr)
_______________________________________________________________
Notarispraktijk XXXXXXXXXXXXXXXXXXX is registered.
Under XXXXXXXXXXX at the Chamber of Commerce and Industry on Sint Maarten.
XXXXXXXXXXXXXXXXX is the trade name of Notarispraktijk XXXXXXX., established on Sint Maarten.
All services performed by Notary Office XXXXXX are subject to its General Terms and Conditions.
Which include a limitation of liability.
Copies thereof are available upon request.
Payments to notary Mingo via the escrow accounts of notary: XXXXXX

5. The legal representative of the aforementioned entity hereby declares that the following;

Private individual is a UBO’s (for at least 25%) and have at least 25% voting rights within the entity:
Information UBO (for at least 25% or more):
Name (last): ______________________________________________________
Name (all first names): ______________________________________________
Address: _________________________________________________________
________________________________________________________________
Position: _________________________________________________________
Amount of shares (in %):_____________________________________________

6. Is the aforementioned UBO the decision maker of the entity:

G no
G yes
If another individual person is the decision maker
(for 25% or more please indicate so by filling in the following information):
Name (last): _________________________________________________
Name (all first names): __________________________________________
Address: ____________________________________________________
________ __________________________________________________
Position: ________________________________________________________
Amount of shares (in %):_____________________________________________.
Upon signing of this form, the undersigned, herewith declares to have provided the correct information.
Also, statement on the UBO, to civil law notary XXXXXX
Name of the undersigned: ___________________________________________
Address of the undersigned: __________________________________________ _______________________________________________________________
Signed on this day: ___________________________________(date)
in/on _________________________________________________(place and country)
______________________________________ (signature) LEGALIZED BY:
Civil law notary XXXXXXX is not responsible, to be indemnified from any harm.
Also, not liable for any information or statement herein provided by the undersigned.

Ultimate beneficial owner form.

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