APPLICATION FORM
ADMISSION OF A COMPANY TO AN ECONOMIC ZONE

Not to be filled in by the applicant

Number
Date of receipt
Date promised

1. Data of the applicant[1]:

Name / Exploitatie Maatschappij E-Zone Vredenberg N.V.
Address / c/o E-Commerce Park N.V.
Telephone number / +599-9-433-8808
Fax number / +599-9-433-8809
E-mail address /

2. Data of the company:

Name of the company
Contact
Mailing address
Telephone number
Fax number
E-mail address
E-zone[2] / E-Zone Vredenberg
Tax identification number
Operation(s)
Products / services to be supplied[3]
Description of customers to be and where they are established
Manner in which service to domestic territory is prevented
Substantiated estimate of the new jobs to be created within 3 years
Indication of the transport movements of goods and/or persons
Manner in which flows of goods are processed in the administration


Financial Forecast:

Year 1 / Year 2 / Year 3
Total revenue
Total (direct/indirect) expenses
Net result
Year 1 / Year 2 / Year 3
Total Investments
Profit margin (%)

3. Space for remark(s), if any:

By signing this application the applicant declares to have completed this form truthfully.

Incomplete applications will not be considered!

Name Signature Date
Documents to be submitted:

q  Articles of incorporation of the company;

q  A copy of the shareholders' register and supplemental official documents evidencing the name(s), address(es), place(s) of residence and “tax identification”[4] number(s) of all the owner(s) up to the ultimate beneficial owner(s) of the company or the formal name and the “tax identification” number of the company, if the ultimate beneficial owner is a company quoted on the stock exchange; copy of valid passport of each UBO;

q  Proof of registration with the Chamber of Commerce;

q  Copy of business permit or

q  Proof of business permit application;

q  Evidence of the company keeping a bank account with at least one bank established in the Netherlands Antilles or

q  Evidence of the management of the company being conducted by a Trust office established in the Netherlands Antilles, supervised by the Supervisory Board for trust businesses (this applies only to companies in the gaming sector);

q  Proof of the tax identification number;

q  A statement to the effect that consultations have been started with the customs department (Technical Affairs Department) with regard to the specific customs regulations. ECP takes care of this part once all other papers are submitted.

4

[1] Administrator or his authorized representative.

[2] Economic zone in which the company will establish itself.

[3] There should be evidence whether the E-zone involved is one with or without goods movements.

[4] The “tax identification” number may be replaced with a copy of the passport.