Contact Company Directors Shareholders Decralations Order Number COMPANY REGISTRATION PACKAGES * Standard Package - RM3,000 Complete Package - RM3,500 Foreigner Set-up Package - RM4,000 CONTACT PERSON’S DETAILS Name * Contact No. * Email * Remarks PROPOSED COMPANY NAME(S) Please provide at one proposed company name and clarify meaning of the name - state whether is is the name of a director / shareholder; single letters included in the name stand for; consent letter for using a similar name to another company. Proposed Company Name 1 * Clarification for Proposed Name 1 * Proposed Company Name 2 Clarification for Proposed Name 2 Proposed Company Name 3 Clarification for Proposed Name 3 Description of Business Activity * Business Address * Address Where Accounting Records are Kept same as biz add same as business address Email * Office No. Number of Director(s) * 1 2 3 4 5 Are all directors also shareholders ? * Yes for all Yes for some No Number of Individual Shareholder(s) (who is not director) * 0 1 2 3 Have any corporate shareholder(s) ? * Yes No All Shareholders / Directors hereby : * Declare that all information furnished to YAU & CO. are complete, true and correct and will immediately inform YAU & CO. of any changes to the same and authorize YAU & CO. to make the relevant filing to Suruhanjaya Syarikat Malaysia (SSM) for registration of the Company (Sdn Bhd). Declare that I/we am not a bankrupt, that no act of bankruptcy/winding-up has been committed by me/us and there are no prosecution or bankruptcy/winding-up proceedings pending or instituted, or order obtained, against me/us; Declare that I/we have not been convicted whether within or without Malaysia of any offence and I/we have not been imprisoned for any offence within the period of five years immediately preceding the date of this declaration; Declare that I/we understand that my/our application herein shall be subject to the relevant Terms and Conditions, a copy of which is available at YAU & CO.’s website at www.yauco.com.my and that I/we have read and understood the Terms and Conditions and agree to be bound by the same; I/We agree to abide and be bound by the relevant terms and conditions applicable to the service applied for and all amendments, supplements and additions thereto made from time to time by YAU & CO.