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Private Interests Foundations Form

First Name:

Last Name:

Email:

Complete Delivery Address:

Country:

State:

City:

Zip-Code:

Home Phone

Work Phone.

Fax:

THE NAME OF FUNDATION (The name shall include the word “foundation” to distinguish it from a natural person or from different kind of juridical person. For Example: Fundación de Venancio Herrera, Atlantic wildlife refugee Foundation.

Name 1:

Name 2:

Name 3:

Council:

I wish to use nominee council on my Foundation

President:
In case you wish provide your own council, complete the following information.

Full Name:

Nacionality:

Passport_Number:

Secretary:

Full Name:

Nacionality:

Passport_Number:

Treasurer:

Full Name:

Nacionality:

Passport_Number:

Power of Attorney:

Full Name:

Nacionality:

Passport_Number:

Additional Instructions:

* required files

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