MINISTRY OF FINANCE Business Licence Division BUSINESS ...

1 MINISTRY OF FINANCE Form A BUSINESS Licence Division BUSINESS REGISTRATION Please read instructions before completing this form. Important details are included in the instructions. Information on this form must be printed or typed. Each agency may request additional information depending on your type of BUSINESS . (See list of requirements) This form must be accompanied by approval from other government or regulatory agencies where required. 1 Applying For: New BUSINESS Change in Ownership Tax Return (Renewal) Change in Location Change in BUSINESS Name Change in Corporate Officers Change in Mailing Address Occasional Licence Cease BUSINESS Other Temporary Duplicate Licence 2 Ownership Type: Sole Proprietorship Partnership Privately Held Company Publicly Traded Company Limited Liability Partnership Limited Liability Company Government Entity Non-profit OWNER S INFORMATION Cellular.

2 Bahamian Foreign Owner s NIB #: Telephone: Control #: 3 Applicant/Owner s Name: 4 Facsimile: 5 Assessment No.: Date of Birth (D/M/Y) Street Name, Direction (N, S, E, W ) P. O. Box # 6 Address: Place of Incorporation or Formation: BUSINESS INFORMATION 7 Trading As: 8 Requesting Trade Name: 1. 2. 3. Street Name, Direction (N, S, E, W ) P. O. Box # Settlement Island 9 Location(s) of BUSINESS Operations: BUSINESS No.

3 : Telephone: Facsimile: 10 E-mail Address: Website Address: 11. List All Owners, Partners, Corporate Officers, Managers, Members, etc. (If individual ownership, list only one owner.) Attach Additional Sheets if Needed. (If others, please provide on a separate sheet) Last, First, MI : Residence Address (Street) NIB # Title Percent Owned Settlement Island Residence Telephone Last, First, MI.

4 Residence Address (Street) NIB # Title Percent Owned Settlement Island Residence Telephone 12. Date BUSINESS Started (D/M/Y): Number of Employees: Number of Anticipated Employees (if not yet employed) 13. TYPE OF BUSINESS Indicate all that applies to your BUSINESS . Service Retail Gaming Wholesale Vendor Restaurant Liquor Fishing/Fish Farm Manufacturing Transportation Not for Profit Home Based Music & Dance School Construction Hotel Agriculture/ Mixed Farming Food Processing Petroleum Industry Gasoline Station Telecommunication Financial Institutions Medical Supplies Health Services Mortgage Brokers Insurance Profession _____ Other _____ 14.

5 DESCRIBE PRODUCT(S) SOLD OR SERVICE(S) PROVIDED /(REASON FOR DUPLICATE Licence REQUEST) CHANGE IN OWNERSHIP OR ADDRESS LAST NAME FIRST NAME 15 NAME OF PREVIOUS OWNER CONTROL NUMBER BUSINESS Licence NUMBER 16 PREVIOUS ADDRESS CURRENT ADDRESS 2 of 10 APPLICATION IN RESPECT OF A CONTRACT (TEMPORARY Licence ) 17 IS THE APPLICATION IN RESPECT OF AN EXISTING CONTRACT? STATE: CONTROL NUMBER LOCATION OF BUSINESS NEW DATE OF COMPLETION ORIGINAL VALUE CHANGE IN VALUE IS THE APPLICATION IN RESPECT OF NEW CONTRACT?

6 STATE: VALUE CONTROL NUMBER LOCATION OF BUSINESS ADDRESS OF PRINCIPAL S BUSINESS 18. APPLICATION IN RESPECT OF REGISTERED INSURER Financial Information for the quarter(1st, 2nd, 3rd, 4th) and financial year: Quarter: Financial Year: 19. FINANCIAL INFORMATION Financial Information for Period of Operation in Prior Year: Turnover Gross Premium $ Tax Payable: $ 20.

7 AUTHORISATION OF THIRD PARTY TO PROTECT YOUR BUSINESS , NOTIFY THE BUSINESS Licence Division IMMEDIATELY OF ANY CHANGES TO THE INFORMATION BELOW. Please check appropriate authorisation boxes: a All Activities Pick Up Licence Sign Form File Tax Cellular: Agent s NIB #: Telephone: Control #: b Appointed Representative s Name: c Facsimile: d Assessment No.: Date of Birth (D/M/Y) Street Name, Direction (N, S, E, W ) P. O. Box # e Address: f Signature of Appointed Representative Print Name of Appointed Representative Date (D/M/Y) 19.

8 SIGNATURES 21. I CERTIFY THE INFORMATION PROVIDED IS TRUE, CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. **Signatures must be that of a responsible party. If a general partnership or joint venture, more than one signature is required. Legal signatures include: sole proprietor-owner, corporate officer, and managing member. **Signature Responsible Party / Original Print Name And Title Date (D/M/Y) **Signature Financial Certification (where applicable) Print Name And Title Date (D/M/Y) FOR OFFICIAL USE ONLY If Yes, State Date: Application Completed?

9 If No, Give Reason: If Yes, State Date: Licence Issued? If No, Give Reason Checks/Controls Completed by: Date: (Officer s Name) (D/M/Y) Approval Granted by: Date: (Officer s Name) (D/M/Y) APPLICATION ASSIGNED TO: Comments: Received By: Date: OUTSTANDING REQUIREMENTS The following checked requirements are needed to process the application.

10 PHYSICAL PLANNING (for zoning) John Davis/Ms. Stubbs 322-7550 POLICE (Determines if Location is acceptable sale of alcohol, music and dance) Inspector Kemp 322-1647 MINISTRY OF WORKS Building Control (Inspection of Building) Selena Curry/Mr. Robinson 322-4830 ENVIRONMENTAL HEALTH SERVICES (Sanitation Approval) Dwight Allen/ Lawrence Burrows/Sally Chisolm 322-8048 *Garbage Collection Contract REGISTRAR GENERAL DEPARTMENT Outstanding BUSINESS Name Fees (Prior to 2011), Certificate of Incorporation OCASSIONAL Licence Permission to use public space (responsible authority) Environmental health Services Approval (Food handlers permit)