Electricity, gas supply, heat supply, air conditioning
Services and consultancy (Please describe)
Construction
Wholesale and retail; automotive and motorcycle repair
Transportation and storage
Lodging and catering services
Information and communications services
Financial and insurance activities (with license only)
Real estate transactions
Professional, scientific and technical services
Administration and services
State governance and defense; mandatory social insurance (Subject to compliance dept approval)
Education
Health and social care
Art, entertainment and leisure
FULL DESCRIPTION OF BUSINESS ACTIVITIES
Full description of the business, activities and operations
I confirm that the aforementioned business activities do not require a licence or special permit at the place of business.
The aforementioned business activities require a licence or special permit at the place of business and I attach a copy of the licence and/or special permit.
BUSINESS ACTIVITIES
Duration of business activities (years)
Up to 1 1-3 3-5 5-7 More than 7
Number of employees of the company:
Up to 10 10 - 50 50 - 250 More than 250
Key financial indicators. Annual sales volume of the company (USD /EUR. Please circle appropriate currency):
Up to 2 2 - 10 10 - 50 More than 50
Total assets on the company’s balance sheet (USD /EUR mio. Please circle appropriate currency):
Up to 2 2 - 10 10 - 43 More than 43
AUTHORISED SIGNATORY DETAILS
First name*
Last name*
Passport/ID no*
Nationality
Telephone no*
Fax no*
Designated email address*
Address*
City/State*
Zip code*
Country*
DIRECTORS OF THE COMPANY
First name*
Last name*
Passport/ID no*
Nationality
Telephone no*
E-mail*
Address*
ULTIMATE BENEFICIARY DETAILS
Share(%)*
First name*
Last name*
Passport/ID no*
Nationality
Telephone no*
E-mail*
Address*
SOURCE OF INITIAL FUNDING
Value of Initial Funding*
Currency of Initial Funding*
Originating Bank Name*
Originating Bank Address*
Account Name*
Account Number*
Signatory*
Describe precisely how these funds were generated*
