Attachment No. 3 - AISA ID Form.pdf

Identification Form

Company name:

Legal status:

Initial Capital:

Type of Operation:

Company Imports:

Company Exports:

Address:

Identification of the President

Name: Father’s name: Surname:

Nationality: Date of Birth: Place of Birth:

ID Card No: Volume: Registration No:

Place Issued: Permanent Address: Phone:

Current Address: Email Address:

Identification of the Vice President

Name: Father’s name: Surname:

Nationality: Date of Birth: Place of Birth:

ID Card No/Passport: Date of Issue: Place of Issue:

Permanent Address: Phone:

Current Address: Email Address:

Photo, President

Photo, Vice

President

We the President and Vice President of the company, jointly agree that the information provided above is true, accurate and complete. If such information is found to be false we assume liability for the revocation of our license.

President’s Signature Vice President’s Signature

Date / / Date / /