Instructions:
  1. Print out this form by clicking the print button on your browser.
  2. Fill out the form completely, by hand is fine.
  3. Fax the form to us at + (507) 269-2548, along with a legible copy of 
    the founder's (and protector's, if that option is chosen) passport or other
    government issued photo I.D. (such as a driver's license).
  4. Make payment by wire transfer to our account, as follows:

CITIBANK NEW YORK, N.Y

New York, New York

ABA 021000089   (Within the United States)

CHIP 002  (Out of the United States)

SWIFT CITIUS 33

In favor of

BANCO GENERAL PANAMA, s.a., PANAMA

Panamá, Rep. de Panamá

Cuenta  No.: 10951934

For further credit to:

Garibaldo Y Asociados

Acct. No.: 03-95-01-035200-6

OR

  1. Send certified check to our address in Panama, along with copies of the founder's (and protector's, if that option is chosen) passport or other government issued photo I.D. (such as a driver's license).

Information Needed for Filing of a

PANAMANIAN PRIVATE FOUNDATION

1.      Foundation Name :                                                                       

2.      Foundation Purpose:                                                                               

                                                                                                                                    

                                                                                                                                    

3.      Capital :                                                                                       

4.      Foundation Council :

President :    Name:                                                                        

                          Address:                                                                                          

                                                                                                                                   

Secretary :    Name:                                                                        

                           Address:                                                                                         

                                                                                                                                   

Treasurer :    Name:                                                                       

                           Address:                                                                                         

                                                                                                                                   

Minimum of 3 natural persons.

  OR :          Name:                                                                             

                            Address:                                                                                         

                                                                                                                                   

                                                1 juridical person.

  5.      Protector or Fiduciary (if any) :

Name:                                                                             

Address:                                                                         

                                                                                     

               Passport or SS#:                                                                                          

                Nationality:                                                                         

 

6.   Authentication required? :               YES                       NO

 

7.   Founder’s Name:                                                                         

                  Address:                                                                          

                                                                                                         

                           Fax:                                                                                                  

                 Telephone:                                                                        

                 E-mail:                                                                                

               Passport or SS#:                                                                                          

 

8.   Attorney / Firm Name:                                                                

9.      Address :                                                                                       

                                                                                                          

      e-mail address:                                                                           

10.      Recommended by :                                                                     

 

11.      Other instructions :                                                                   

                                                                                                         

                                                                                                         

                                                                                                           

 

         _______________________  
       
           Founder's Signature

 

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