Incorporation Form for Private Interest Foundation

1. CORPORATE NAME
     Please indicate the requested name(s) with at least two additional alternate choices: (The name      should include the term Foundation or Fundación)

1)
2)
3)

2. CORPORATE OBJECTIVE(S)
     If you wish to incorporate the foundation with a more specific objective, please describe below

3. CORPORATE DIRECTORS AND OFFICERS
     If you wish to propose a specific Foundation Council member, please provide the necessary      corresponding information. A minimum of three councilors. Nominee councilors can be provided by     Rubio, Alvarez, Solis & Abrego.
Name
Nationality
Address
Position

4. POWER OF ATTORNEY
    Please indicate the type of power(s) of attorney (if needed):

Special General

    Issued in favor of:

Name
ID # and Type
Address
    Please indicate any specific instructions for special power(s) of attorney:

5. SPECIAL PROCESSING INSTRUCTIONS
Please indicate if any special processing of the incorporation documents will be required:

Notarization
Notorization and legalization by the consulate of
Apostille
    Please indicate for which documents the above-noted processes are necessary:

6. AUTHORIZED PERSONS
    Please provide the names of all persons authorized to access corporate information:

Name

Company

Address
Tel
Fax
E-mail

7. MAILING INSTRUCTIONS
    For corporate documents:

Name

Company

Address
Tel
Fax
E-mail

    For invoices:

Name

Company

Address
Tel
Fax
E-mail

8. REQUIRED DOCUMENTATION
    For individual clients, the following information is required.

Name
Address
# de Passport

    (Please include a copy of the passport.)

    For institutional clients the following information is required.

Name of the Company
Officer in Charge
    For both individual and institutional clients, please provide your e-mail address:
   

9. REFERENCES

1) Bank

2) Commercial:

3) Personal:

10. TERMS AND CONDITIONS
I hereby declare that all the information I have provided in this form is true and correct and that the company I wish to incorporate will not be used for drug trafficking, terrorism or money laundering. I affirm that I have received legal advice from lawyers in the place of operation of this company, or in the case of institutional clients, that a recommendation to obtain legal advice was suggested to the clients.

Signature: Date:
Name: Email:
Rubio, Alvarez, Solis & Abrego
Attorneys at Law, Av. Federico Boyd Edificio Universal Panama
tel. +507 269-0777 telfax. +507 223-5686