THE UNITED STATES VIRGIN ISLANDS OFFICE OF THE LIEUTENANT GOVERNOR DIVISION OF CORPORATIONS AND TRADEMARKS ANNUAL REPORT – DOMESTIC AND FOREIGN CORPORATION CORPORATE FILINGS AND REQUISITE TAXES ARE DUE, EACH YEAR, ON OR BEFORE JUNE 30th. AVOID PENALTIES AND INTEREST BY PAYING ON TIME. TODAY’S DATE TAX CLOSING DATE EMPLOYER IDENTIFICATION NO. (EIN) SECTION 1 CORPORATION NAME __________________________________________________________________________________________________________ ADDRESS OF MAIN OFFICE __________________________________________________________________________________________________________ ADDRESS OF PRINCIPLE USVI OFFICE __________________________________________________________________________________________________________ DATE OF INCORPORATION __________________________________________________________________________________________________________ COUNTRY/STATE OF INCORPORATION __________________________________________________________________________________________________________ AMOUNT OF AUTHORIZED CAPITAL STOCK AT CLOSE OF FISCAL YEAR __________________________________________________________________________________________________________ AMOUNT OF PAID-IN CAPITAL CAPITAL AT CLOSE OF FISCAL YEAR __________________________________________________________________________________________________________ AMOUNT OF CAPITAL USED IN CONDUCTING BUSINESS WITHIN THE USVI DURING THE FISCAL YEAR ________________________________________________________________________________________________ SECTION 2 NAMES AND ADDRESSES OF ALL DIRECTORS AND OFFICERS OF THE CORPORATION AT THE CLOSE OF FISCAL YEAR ANDEXPIRATION DATES OF TERMS OF OFFICE – NAME/TITLE ADDRESS TERM EXPIRATION I DECLARE, UNDER PENALTY OF PERJURY, UNDER THE LAWS OF THE UNITED STATES VIRGIN ISLANDS, THAT ALL STATEMENTS CONTAINED IN THIS APPLICATION, AND ANY ACCOMPANYING DOCUMENTS, ARE TRUE AND CORRECT, WITH FULL KNOWLEDGE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE SUBJECT TO INVESTIGATION AND THAT ANY FALSE OR DISHONEST ANSWER TO ANY QUESTION MAY BE GROUNDS FOR DENIAL OR SUBSEQUENT REVOCATION OF REGISTRATION. TREASURER PRESIDENT ________________________________________________________________________________ ______________________________________________________________________________ SIGNATURE DATE SIGNATURE DATE ________________________________________________________________________________ ______________________________________________________________________________ PRINTED FIRST NAME AND LAST NAME PRINTED FIRST NAME AND LAST NAME • IF THE LAST REPORT DOES NOT COVER THE PERIOD IMMEDIATELY PRECEDING THE REPORT PERIOD COVERED BY THIS REPORT, A SUPPLEMENTARY REPORT ON THE SAME MUST BE FILED, BRIDGING THE GAP BETWEEN THE TWO REPORTS. • THIS REPORT IS NOT CONSIDERED COMPLETE UNLESS ACCOMPANIED BY A GENERAL BALANCE SHEET AND PROFIT AND LOSS STATEMENT FOR THE LAST FISCAL YEAR, AS REQUIRED BY THE VIRGIN ISLANDS CODE. FINANCIAL STATEMENTS SHOULD BE SIGNED BY AN INDEPENDENT PUBLIC ACCOUNTANT. • FOREIGN SALES CORPORATIONS THAT ARE REGISTERED WITH THE SECURITY AND EXCHANGE COMMISSION MUST FRNISH EVIDENCE OF SUCH REGISTRATION AND COMPLY WITH BALANCE SHEET AND PROFIT AND LOSS STATEMENTS. FCSS THAT ARE NOT REGISTERED WITH THE COMMISSION ARE EXEMPT FROM FILING THE GENERAL BALANCE SHEET AND THE PROFIT AND LOSS STATEMENT. 5049 Kongens Gade Charlotte Amalie, Virgin Islands 00802 Phone - 340.776.8515 Fax - 340.776.4612 1105 King Street Christiansted, Virgin Islands 00820 Phone - 340.773.6449 Fax - 340.773.0330