Data of the company

1. Public Data

Full name:

Short name:

Seat:

Postal address:

Central telephone number:

Central fax number:

Central e-mail address:

Home page:

Name and title of head of the company:

Direct phone number of head of the company:

Direct fax number of head of the company:

E-mail address of head of the company:

Name and title of the contact person:

Direct phone number of the contact person:

Direct fax number of the contact person:

E-mail address of the contact person:

2. Company Data

Registered capital at acquiring for membership:

The Board of the company, executive officers, senior managers and the professionals in charge of investment services at acquiring for membership:

3. Owners of the company

                                Owners                                              Share of the Registered Capital

                       (name, address/seat)                                  EURO                                      %

1.

2.

3.

4.

5.

6.

Introduction of the company (organization chart):

Date

                                                                                  ………………………………………..

                                                                                              official corporate signature