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Start Your Own Company
Company Order form
Step
1
of
7
- Contact details
14%
I agree to the
Terms of Business of Crowley Corporate
Company Package
(Required)
Basic
Standard
Premium
Affiliated
Contact Name
(Required)
First
Last
Practice/ Company:
(Required)
"If applicable"
Address:
(Required)
Eircode/Postcode:
(Required)
Contact Number:
(Required)
E-Mail Address:
(Required)
Company Type
LTD
DAC
CLG
ULC
Company Name First Option
Please include up to 3 company name options.
Company Name Second Option
Company Name Third Option
Company Registered Address Including Eircode:
Company Trading Address Including Eircode:
Leave blank If the registered address is the same as the trading address
E-Mail Address:
Principle Activity Of The Company:
What is the proposed activity/purpose of the new company?
Director Name:
(Required)
Please note we will need PPS Numbers of all directors to be disclosed to complete formation as well as registered name with Department of Social Protection
Address:
Eircode/Postcode:
Date Of Birth:
Occupation:
Nationality:
Residency:
Other Directorships:
Yes
No
Details of Directorship
Disqualified or Restricted:
Yes
No
Add Additional Director 2
Yes
No
Director 2 Name:
Address:
Eircode/Postcode:
Date of Birth
MM slash DD slash YYYY
Occupation:
Nationality:
Residency:
Other Directorships
No
Yes
Details of Directorship:
Disqualified or Restricted:
No
Yes
Other directorship
Add Additional Director 3
No
Yes
Directors 3 Name:
Address:
Eircode/Postcode:
Date of Birth
MM slash DD slash YYYY
Occupation:
Nationality:
Residency:
Residency:
Other Directorships:
No
Yes
Details of Directorship:
Disqualified or Restricted:
No
Yes
Other directorship
Add Additional Director 4
No
Yes
Director 4 Name:
Address:
Eircode/Postcode:
Date of Birth:
MM slash DD slash YYYY
Occupation:
Nationality:
Residency:
Other Directorships:
No
Yes
Details of Directorship:
Disqualified or Restricted:
No
Yes
Other directorship
Add Additional Director 5
No
Yes
Director 5 Name:
Address:
Eircode/Postcode:
Date of Birth:
MM slash DD slash YYYY
Occupation:
Nationality:
Residency:
Other Directorships:
No
Yes
Details of Directorship
Disqualified or Restricted:
Yes
No
Other directorship
Company Secretary
(Required)
Individual
Corporate
Name:
Address:
Eircode/Postcode:
Date of Birth:
MM slash DD slash YYYY
Nationality:
Residency:
Company Name:
Company Number:
Registered Address:
Eircode/Postcode:
Name of director signing on behalf of company:
Share Capital/Members
(Required)
Individual Member
Corporate member
Member 1 Name:
Address :
Eircode/Postcode:
Date of Birth:
MM slash DD slash YYYY
Nationality:
Residency:
Number of shares:
Beneficial Owner:
No
Yes
“you are a beneficial owner if you are holding over 25% of the shares”
Company Name:
Company Number:
Registered Address:
Eircode/Postcode:
Name of director signing on behalf of company:
Number of shares:
Member 2 Name:
Individual Member
Corporate member
Name:
Address:
Eircode/Postcode:
Date of Birth:
MM slash DD slash YYYY
Nationality:
Residency:
Number of shares:
Beneficial Owner
Yes
No
you are a beneficial owner if you are holding over 25% of the shares
Company Name:
Company Number:
Registered Address:
Eircode/Postcode:
Name of director signing on behalf of company:
Number of shares:
Member 3 Name:
Individual Member
Corporate member
Name:
Address:
Eircode/Postcode:
Date of Birth:
MM slash DD slash YYYY
Nationality:
Residency:
Number of shares:
Beneficial Owner:
Yes
No
“you are a beneficial owner if you are holding over 25% of the shares”
Company Name 3:
Company Number 3:
Registered Address:
Eircode/Postcode:
Name of director signing on behalf of company:
Number of shares:
Member 4 Name:
Individual Member
Corporate member
Name:
Address:
Eircode/Postcode:
Date of Birth:
MM slash DD slash YYYY
Nationality:
Residency:
Number of shares:
Beneficial Owner:
Yes
No
you are a beneficial owner if you are holding over 25% of the shares
Company Name 4:
Company Number 4:
Registered Address:
Eircode/Postcode:
Name of director signing on behalf of company:
Number of shares:
Beneficial owners Name:
(Required)
Address :
Eircode/Postcode:
Date of Birth:
MM slash DD slash YYYY
Number of shares:
Nature of beneficial ownership:
Politically Exposed Person:
Yes
No
Beneficial Owner 2:
No
Yes
Name:
Address:
Eircode/Postcode:
Date of Birth:
MM slash DD slash YYYY
Number of shares:
Nature of Beneficial Ownership:
Politically Exposed Person:
Yes
No
Beneficial Owner 3:
No
Yes
Name:
Address:
Eircode/Postcode:
Date of Birth:
MM slash DD slash YYYY
Number of shares:
Nature of Beneficial Ownership:
Politically Exposed Person:
Yes
No
Option to tick boxes for
(Required)
The information provided is correct and accurate
Agree to Our Terms of Business AML requirements
Consent for contact from Crowley Corporate Services.
Additional Notes:
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