Contacto | Perez Reboles Law

Form for contracting services*

1. Customer Information (To be completed by individuals or company representatives).

Yes

• Note: Please provide supporting documentation for all information provided. (Copy of Passport (s), Identification (s), Assembly that grants power of signature, as well as any other document that proves your identity and quality).

2. Customer information (To be completed by companies):

Note: please provide supporting documentation for all the information provided (copy of incorporation documents Tax Id number or R.N.C., Copy of Mercantile Registry. Proof of Ownership by the Final Beneficiaries, copy of the identification document of the final beneficiaries , as well as any other that supports the information contained in this document.

3. Contact information:

4. Source of funds

5.Description of activities carried out by the client:

6. Scope(s) of services required:

• Note: This form must be completed and/or updated by all new and existing clients in accordance with Law No. 155-17, Against Money Laundering and Terrorism Financing, promulgated on June 1, 2017 in the Dominican Republic.

By the Client

I, the applicant, understand that if I have made any false or misleading statement in the information provided in this document, the application may be voided. However, the work already carried out and the documents (publications and services of all kinds) supplied by _________________________________) and in force at the time the work was carried out or the goods delivered, and all expenses and disbursements made in the name of the applicant shall be reimbursed by the applicant. If the address of the offices __________________________________)) is used, I exempt it from any liability consecrating it only as a place of documentary reception and not assumed as a place of operations of the acquired company. I/We warrant and warrant that the information I/We have provided today in support of this application is true and accurate and that I/We have not omitted any material fact, for which I/We release the Company from all legal, civil and criminal liability. signature __________________________________) as well as their representatives or employees for the efforts in information handled and carried out in this application ................................................................................................. ………………………………………………..Name: _______________. Position: _________

Signature

Thanks for submitting!

Form for contracting services*

Main office

Office in the National District

International mail address

Copyright © 2023 by Pérez & Robles, Technical Office of Intellectual and Industrial Property