(1) Name : Chinese characters :

(2) Town & Place of Birth : Date of Birth :

(3) Nationality/Citizenship a) Current :

b) At Birth :

(4) Travel Document No. : a) Date of Issue :

(Please specify whether Passport/
Certificate of Identity/Document of
Identity/Others) b) Country of Issue :

(5) Identity Card Number : a) Date of Issue :

b) Country of Issue :

(6) Occupation: (7) Email Address:

(8) Handphone No.:

(9) Address In a) Singapore

b) Overseas

c) Others

(10) Countries of Residence (If different from Country of Birth)

Period

(11) Directorships of other companies (if any)

NB: It is compulsory to provide email address and handphone no.

Signature ……………………………………….
_____________________________________
Name of director/subscriber*
* to delete accordingly
** L denotes public company in Singapore or its subsidiaries
Incorporation of proposed company :

Particulars of Corporate Shareholder

(1) Name of Company :

(2) Company Number :

(3) Date of Incorporation : (please complete)

(4) Registered Address :

(5) Country of Incorporation :

(6) Email Address :

(7) Person Appointed and Authorised to subscribe share(s) and to sign/execute all relevant
documents in connection with the incorporation of the above proposed company

Name :
Passport No.:
Address :

Signature :

Name of Authorised Person