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 and 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) 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 there 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 XXXXXXXXXXXXXXXXXXXis 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 and 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 and not liable for any information or statement herein provided by the undersigned.
Ultimate beneficial owner form.
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