ANNUAL REPORT 
 
ON DOMESTIC OR FOREIGN CORPORATIONS 
 
(DUE ON OR BEFORE JUNE 30TH OF EACH YEAR) 
 
PURSUANT TO SECTIONS 371 AND 373, CHAPTER 1, TITLE 13 OF THE VIRGIN ISLANDS CODE, REQUIRING 
THE FILING OF ANNUAL REPORTS BY DOMESTIC AND FOREIGN CORPORATIONS, THE FOLLOWING 
STATEMENT IS FILED WITH THE OFFICE OF THE LIEUTENANT GOVERNOR. 
 
 
NAME OF CORPORATION ………………………………………………………………………………………………… 
 
ADDRESS OF MAIN OFFICE ………………………………………………………………………………………………. 
 
PRINCIPAL OFFICE IN THE VIRGIN ISLANDS ………………………………………………………………………….. 
 
RESIDENT OR AUTHORIZED AGENT IN THE V.I. ……………………………………………………………………… 
 
COUNTRY OR STATE OF INCORPORATION ……………………………………………………………………………. 
 
FISCAL YEAR COVERED BY LAST REPORT FILED ¹ ………………………………………………………………….. 
 
FISCAL YEAR COVERED BY THIS REPORT ² …………………………………………………………………………… 
 
AMOUNT OF AUTHORIZED CAPITAL STOCK AT CLOSE OF FISCAL YEAR ………………………………………. 
 
AMOUNT OF PAID-IN CAPITAL AT CLOSE OF FISCAL YEAR ………………………………………………………. 
 
AMOUNT OF CAPITAL USED IN CONDUCTING BUSINESS WITHIN THE VIRGIN ISLANDS DURING THE 
FISCAL YEAR ……………………………………………………………………………………………………………….. 
 
NAME AND ADDRESSES OF ALL DIRECTORS AND OFFICERS OF THE COMPANY AT THE CLOSE OF FISCAL 
YEAR AND EXPIRATION DATES OF TERMS OF OFFICE     *(Minimum of three different directors.)   
 
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DATED: ……………………………….. 
 
VERIFIED: …………………………………………………………... 
 
 
 
 
 
 
 
 
 
(President)  or  (Vice President) 
 
 
 
 
 
 
 
                    …………………………………………………………… 
 
 
 
 
 
 
 
 
 
(Treasurer)  or   (Asst. Treasurer) 
 
1. 
If the last report filed does not cover the period immediately preceding the period covered by this report, a supplementary report on the same 
must be filed, bridging the gap, between the two reports. 
 
2. 
THIS REPORT IS NEITHER COMPLETE NOR ACCEPTABLE 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 furnish evidence of such registration and 
comply with the balance sheet and P&L Statements. FSC’s that are not registered with the Commission are exempted from filing the General 
Balance Sheet and the Profit and Loss Statement.