Non-Profit Organization Intake Form — Eduardo B. Aguilar & Associates

I / We (Instructing Party)

instruct Eduardo B. Aguilar & Associates as follows:

A

Proposed Name of the Non-Profit Organization

Proposed Name *

Alternative Names (in order of preference)

(I) First Alternative

(II) Second Alternative

B

Nature & Purpose of the Non-Profit

Describe the intended/proposed nature of the non-profit in 3 points.

(I) Main Purpose *

(II) Main Purpose

(III) Main Purpose

(IV) Registered Address in Belize *

Address where the company will be doing business in Belize. A Utility Bill or Land Title is required as proof.

(V) Accounting Records Address

Is the physical address where accounting records will be kept the same as the registered address above?

Yes — same as registered addressNo — different address

(VI) Person Responsible for Maintaining Accounting Records

Name

Contact Number

Email Address

C

Directors

A minimum of one director is required. We do not provide nominee Director services.

Director 1

Director Name

Telephone

Address

Email Address

Passport Attached?

YesNo

Director 2

Director Name

Telephone

Address

Email Address

Passport Attached?

YesNo

*** If more directors, please list on a separate sheet and email to [email protected]

C(II)

Positions in the Non-Profit

Possible roles — can select multiple roles per member.

*** If more members, please list on a separate sheet and email to [email protected]

D

Criminal or Fraudulent Offences

Have any of the directors, members or beneficial owners been charged or convicted of any criminal or fraudulent offences?

YesNo

E

Company Seal

Do you require a Company Seal to be provided?

Yes(BZ $150.00)No

F

Bank Account

Do you require a bank account?

Yes

If yes, we will send you a list of the banks in Belize we recommend.

No

BZ $500.00 for assistance.

DD

Due Diligence Requirements

Provide a copy of each director, beneficial owner, member and all persons requesting the registration of the company:

(I)

Certified copy of Passport with picture and signature data pages.

(II)

In the alternative, a Certified copy of any government/official issued form of identification with picture and signature.

(III)

In the alternative, if a Company will hold any of the above positions, then a copy of the corporate documents, a Certificate of Good Standing and Certificate of Incumbency detailing the directors/officers and shareholders/members of the company.

Please email due diligence documents to [email protected] after submitting this form.

★

Declaration & Signatures

I/We declare and confirm the above information is true and correct and that the company will not be used for money laundering, terrorist activities, or any other illegal activities, or in a manner likely to damage the good name of Eduardo B. Aguilar & Associates or the jurisdiction of incorporation. I/We acknowledge the requirements of your AML/CFT Compliance Policy and agree to comply therewith. I/We will take independent legal advice before proceeding and I am/we are aware, and intend, to honor my/our legal responsibilities in my/our jurisdiction.

I/We confirm and agree that should any changes occur in the information contained herein I/We will inform Eduardo B. Aguilar & Associates forthwith.

Date

Dated thisday of20

Signature of Owner (1) *

Sign in the box below using your mouse or finger.

Signature of Owner (2) — if applicable

Sign in the box below using your mouse or finger.