Republic of the Marshall Islands

Foreign Investment Business License Application

For Decentralized Autonomous Organizations (DAO) LLC

It is a punishable offense if an applicant knowingly makes a false statement or uses or provides forged or misleading documents.

Application Type:

• New Application
• Renewal of Application
• Amendment of Application

Date: ____________________

Submitted by: ________________________________________

Administrative Details

(1) Name of the Proposed DAO LLC:

(2) Address of Principal Office at which the proposed DAO LLC will domicile:

Address: ___________________________________________

City: _________________ | State: _____ | Phone: _________________ | E-mail: _________________

(3) Person to be contacted regarding this application (for statistical purposes only):

Name: ___________________________________________

Citizenship: _________________ | Address: _________________ | Phone: _________________ | E-mail: _________________

(4) Will contact person be available for interview regarding this application?

• Yes
• No (If no, the registered agent will be responsible for representing application in interview)

(5) Name of local agent in RMI:

Name: ___________________________________________

Address: _________________ | Phone: _________________ | E-mail: _________________

Business Scope

(6) The nature of the proposed DAO LLC and the product or service to be provided (in sufficient detail to present a clear description of the proposed activity):

Type of Business

(7) Form of Business: (Check one only)

• Decentralized Autonomous Organization (DAO LLC)

(8) Nature of Business: (Check one only)

• Profit
• Not-For-Profit

Applicant Information

(9) Full name: ___________________________________________

(10) Date of Birth: ___________________ | (11) Nationality: ___________________

(12) Current Residence Address:

Street: ___________________________________________

City: _________________ | State: _________________ | Zip Code: _________________

(13) Residency for the past 5 years:

(14) Do you intend to reside in the RMI for more than 6 months?

• Yes
• No

(15) Marital Status: _________________ | (16) Citizenship: _________________

(17) Do you have dual citizenship?

• Yes (Please list both below)
• No (Please list one below)

(18) Please attach the DAO LLC Beneficial Owner Information Report (BOIR)

Applicant Declaration & Signature

(24) Declaration: I, _________________________ hereby declare that I filled, examined and filed this document and that it, including any accompanying schedules and statements, is to the best of my knowledge and belief true, correct, and complete.

For Official Use Only

Signatories