1- Legal name :

2- Trade name :

3- Type of business activity:

4- Business address of office in Iraq: City:
Governorate:
Postal code:

Business telephone in Iraq: Business facsimile in Iraq: Business e-mail:

6- Name of authorized representative for filing with the registrar ( must reside in Iraq) \

Local address: City:
Governorate: Postal code: Telephone number:

5- name of chief management official in Iraq (must reside in Iraq ):

Local address: City:
Governorate: Postal code: Telephone number:

7- name of chief executive officer in home country of establishment:
Business address:
Local address:

City:
Province / state : Postal code: Country:
Business telephone: Business facsimile: Business e-mail:

8- Amount of authorized capital (specify currency ):

9- Name and address of owners of 10% or more company equity:

Name address

Under the penalty of law, I hereby declare that all information contained in this form and other submitted materials is correct complete and authentic.

Printed name
(authorized representative for filings )

signature
( authorized representative for filings)

Date ( D / M / Y)

                                                    REGISTRAR USED ONLY BELOW THIS LINE

Checklist for receipt of other required items initials of official

1. Authenticated certificate of registration from home country of origin

2. Copy of the company’s charter or equivalent, authenticated by competent authority in home country of origin

3-Financial statements of company for the last fiscal year