Application For Incorporation As A Private Company Limited By Shares Page 4

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We, the several persons whose names and addresses are subscribed, wish to be formed into a PRIVATE COMPANY LIMITED BY
SHARES in pursuance of this application, and we respectively agree to take the number of shares in the capital of the company set
opposite our respective names.
Nationality and
No. and class of
Forenames
NRC
Residential address
Postal address
shares to be taken
Signature of subscriber
and surname
Number or
passport number
Ordinary
Preferential
NOTE: An Application shall be accompanied with:-
(a) The proposed articles where the standard articles are not adopted
(b) A declaration of compliance with the Act
Dated the …………………………………… day of……………………………… 20…………..
Witness to the above signatures:
……………
…….…………
………………….
…………………….
Name
Address
Occupation
Signature
Name and address of individual lodging the application:
…………………………………………………………………………………………………………………..

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