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I/we hereby request Y. Potamos FCCA to proceed and register a company in Cyprus in accordance with the information provided herein: 1. Name of company Please indicate a proposed name for the company, or choose a name from our list of pre-approved names. 2. Proposed activities Please provide details of the proposed activities of the company. 3. Share capital The Authorised & issued share capital of the company will be €1.000,00 (1.000 shares €1,00 each). If you need a company with a share capital of more than €1.000 please contact our office. 4. Register office 1B Georgiou Gemistou str. 2047 Strocolos, Nicosia Cyprus We usually use our Office address as the Register address. However if the above is not what you want, please contact our office. 5. Company secretary Usually we use our office company as a secretary. However if the above is not what you want, please contact our office. Details of owner of Company 6. Name & Surname Telephone No. Fax No. Email Passport number Full address Potamos services limited will be appointed as a nominee Director. Potamos services limited will be appointed as a nominee Shareholder. Minimum one (1) shareholder and one (1) Director is required. Please note that One (1) person may be both Director & shareholder. The Director or Shareholder could also be a company.   7. Passport or identification card Copy of passport, legalised by apostille or certified as ''true copy'' by a well known bank. Clients from EU can choose to send a copy of identity card legalised by apostille or certified as ''true copy'' by a well known bank. 8. A bank account will be opened in Cyprus? Yes   No  If yes please complete sections 9 - 19 9. Utility bill A copy of recent utility bill (electricity, or telephone bill or water bill, etc) of the residential address of Directors/owners. 10. Yearly Estimated Turnover   Please estimate the yearly activities of company in € 11. Yearly Estimated Turnover of the Bank Account   Please estimate the yearly activities of company in € 12. Expected origin of funds to be credited (names & countries) 13. Please destination of outgoing payments (names & countries) 14. Names of the main Customers and Suppliers 15. Bank staff will contact you at. Address Telephone Fax Email 16. You need a debit Card (visa)? Yes   No 17. You need e banking? Yes   No 18. For e banking You need to do? Only Enquiries    Both Enquiries and  Transactions 19. For future bank accounts you wish the same as your answer in 18 above? Yes   No Notes i Please Read the Registration procedure carefully before completing the above questionnaire. ii Please note that we will sent you via email a bank document, to complete other Personal information. iii Also please note that all the above information will be treated strictly confidential and only for the formation of the new company and or opening of a bank account. iv Please complete carefully all the above and send to my Office either via fax 00 357 22327700 or via email to yp.potamos@gmail.com

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