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General information
Name of the Company
*
Country of incorporation
*
S.R.L
S.A
S.A.S
Foreign
Other
Specifique
Country of incorporation
*
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
País
RNC / ID Number
*
Company Address
*
Address
City
State / Province
Zip / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Main activity
*
Phone number
*
E-mail address
*
Countries where you operate
*
Contact Person:
*
Job title
*
E-mail address
*
Phone number
*
Entity Partners
Lista
*
Name
Address
ID / passport
Nationality
Add
Remove
Governing Board of the entity
Duration of the Board
*
Start date of the board:
*
DD slash MM slash YYYY
Lista
*
Name
Address
ID / passport
Nationality
Job title
Add
Remove
The persons indicated above are the beneficiaries, owners or controllers of the shares/shares issued, that there are no other owners or controllers other than those declared, and that if there are others in the future, HERNANDEZ ESPIRITU CONSULTORES & ASOCIADOS, S.R.L. will be notified within a period of no more than 30 days from the date of modification.
FINAL BENEFICIARY STATEMENT: "The natural person who exercises ultimate effective control over a legal person or holds at least 20% of the capital of the legal person, including the natural person for whose benefit a transaction is carried out".
Lista
*
Name
Id / Passport
Nationality
Add
Remove
Politically Exposed Person (PEP)
Politically exposed persons are those who perform or have performed, during the last 3 years, high public functions, by election or executive appointments, in a foreign country or in national territory, including high officials of international organizations. Likewise, persons who have held positions in which they have had to file a sworn statement of assets are considered PEPs (e.g. Head of Government, Vice President, High Court Judge, Minister, Vice Minister, Mayor, Councilman, Ambassador, Consul, High Ranking Military, etc.).
Are you a politically exposed person?
*
Yes
No
Position held or occupied that makes you a PEP
*
Are you related by blood or affinity to a Politically Exposed Person (e.g. spouse, intimate partner, child, sibling, grandparent, grandchild, in-law, spouse's grandparents, close associate, or representative)?
*
Yes
No
Please specify:
*
Name and position of the family member who is a PEP and position held:
*
Supporting Documentation
Proof of the company's existence (current Commercial Registry Certificate, National Taxpayer Registry Certificate (RNC), incorporation documents including Minutes of Assembly and List of Shareholders, Certificate of Good Standing or Existence, or homologous in the country of incorporation of the company)*.
*
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Max. file size: 20 MB.
The Compliance Officer may request any other necessary documents.
How did you hear about our services?
Sin nombre
Friends, family, or colleague
Social media
Internet search or website
Business association membership
Newspaper or magazine
Other
Especifique
Source of funds statement
I declare under oath that all activities carried out by the company are within the legal framework and that the resources used in this operation are its property and do not derive from any illicit or illegal activity.
Affidavit
I declare under oath that I have read this form and that the information contained herein is true and correct. I confirm that the information provided herein and the supporting documents are accurate and authentic. Likewise, I undertake to keep the documentation updated and to inform about any modification that may occur in relation to what is established in this document. Likewise, I expressly and formally authorize HERNANDEZ ESPIRITU CONSULTORES & ASOCIADOS, S.R.L. to inquire about the financial and patrimonial resources that I have declared, without this entailing any violation of professional secrecy by HERNANDEZ ESPIRITU CONSULTORES & ASOCIADOS, S.R.L. in accordance with the provisions of the legal regulations governing the matter and, consequently, I expressly waive any kind of legal action for claim for damages for the due diligence of verification and verification of the data provided herein, discharging HERNANDEZ ESPIRITU CONSULTORES & ASOCIADOS, S.R.L. from any responsibility derived from erroneous or inaccurate information provided by the undersigned of this document. The Client authorized HERNANDEZ ESPIRITU CONSULTORES & ASOCIADOS, S.R.L. to provide and request to the Credit Information Companies (SIC) according to the provisions of Law 172-13, the available credit information. I attest that I have completed this form in a personal way, in full power of my conditions and without any coercion.
Name
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Job title
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Signature
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Date
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Important: This information will be kept under strict confidentiality and will be provided only at the request of a competent authority in case of investigation, after compliance with legal procedures.
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