NAME OF COMPANY:    


TYPE OF BUSINESS:   


ALTERNATIVE NAMES

a:



b:


REGISTERED OFFICE

KPMG Peat Marwick
P.O. Box 3109
High & Market Streets
St. John's
Antigua, West Indies

AUTHORIZED SHARE CAPITAL
(Standard authorized share capital
is 10,000 Ordinary Shares of US$1 each):


RESTRICTIONS ON SHARE TRANSFER, IF ANY:


MINIMUM NUMBER OF DIRECTORS:
(one or more allowed)
 

NUMBER OF SHARES:  


PAR VALUE:


LIST OF DIRECTORS 

1) Full Name of Director:


Residential Address:
 

Telephone Number:   


Fax Number:    
 

Occupation:    
 

2) Full Name of Director:


Residential Address:


Telephone Number:   


Fax Number:    
 

Occupation:    


LIST OF SHAREHOLDERS

1) Shareholder's Name:


Residential Address:


Telephone Number:   
 

Fax Number:    


Percentage Shareholding:


2) Shareholder's Name:


Residential Address:


Telephone Number:   


Fax Number:    


Percentage Shareholding:



OFFICERS OF THE COMPANY

1) Name:


Residential Address:


Telephone Number:   


Fax Number:    


Position: 


2) Name:


Residential Address:


Telephone Number:   


Fax Number:    


Position: 


CORPORATE  SECRETARY:

KPMG Peat Marwick
P.O. Box 3109
High & Market Streets
St. John's
Antigua, West Indies


AUDITORS: 


END OF FINANCIAL YEAR:   


BANKERS:  


SOLICITORS/ATTORNEYS:    


MAILING ADDRESS:    


REFERENCE:


PLEASE CHECK THE APPROPRIATE BOX TO INDICATE SIGNATOR IS:

Director            
Shareholder         
Other (e.g. Agent)  




SIGNATURE: ____________________________________



PRINTED NAME:  


DATE: