Application to Incorporate A Belize LLC - Glenn D. Godfrey & Co. LLP

I/We *

First

Last

I/We (copy)

First

Last

Of:

hereby instruct Glenn D. Godfrey & Company LLP to form a BELIZE LLC on my/our behalf as follows:

1. Proposed Name:

Company names may be in any language as long as Roman letters are used. The test of theArticles of Organization will be in English. Each company name shall contain the words“Limited Liability Company” or the abbreviation “LLC” or “L.L.C.”.

Choices for company name:

One name per line.

2. Proposed Management:

The Articles of Organization must specify how the limited liability company is to bemanaged:

Management of the limited liability company is vested in a manager or managers;
Management of the limited liability company is reserved to the members.

3. A limited liability company formed under this Act continues perpetually, unless otherwiseprovided in its articles of organisation, or unless the limited liability company is dissolved andterminated in accordance with the provisions of this Act.

The latest date on which the LLC is to dissolve (if applicable):

4.

Certificate of Good Standing:

Yes
No

Individual Nominee Member:

Yes
No

Corporate Nominee Member:

Yes
No

Use of P.O. Box Number:

Yes
No

5. Provide a detailed description of the activities of the proposed Company:

6. In what countries will the Company be operating?

7. Provide the full address of where the Company’s accounting records will be kept:

Address Line 1

Address Line 2

City

State

Zip Code

8. Source of funding for shares and assets held by the Company.

9. Do you require Operational Agreement?

Yes
No

9a. *If yes, do you require the Operation Agreement to be filed as an exhibit to the Articles of Association?

Yes
No

10. Company Seal to be provided by:

Glenn D. Godfrey & Company LLP to supply Corporate Seall
Yourselves (Imprint must be sent to Registered Agent)

11. Do you require a bank account?

Yes
No

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

12. Do you require notarization and/or apostille?

Yes
No

12a. If yes, please specify which docs.

13. Mailing address (all documents will be sent to this address unless advised otherwise):

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

14. Instructions submitted by:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone:

Fax:

Email: *

*I/We declare and confirm the above information is true and correct and that the company tobe incorporated will not be used for money laundering, terrorist activities or any otherillegal activity or in a manner likely to damage the good name of Glenn D. Godfrey &Company LLP or the jurisdiction of incorporation. I/We will take independent legal advicebefore proceeding and I am/We are aware, and intend, to honour my/our legalresponsibilities in my/our jurisdiction.

I/We confirm and agree that should any changes occur in the information contained herein I/We will inform Glenn D. Godfrey & Company LLP:

Signature of Beneficial Owner

Date