1. GENERAL FISHING VESSEL INFORMATION

Vessel Name

Registration Number

Data First Registered in

Nationality of Benefical
Ownership of Vessel

Type of Fishing Vessel

Gross Tonnage

Lenght Overall (In metters)

Type of Gear

CARRYING CAPACITY
(State metric tons or short tons)

List all Areas Fished

List all Species Fished, Primary Target Species, Other Species

2. DETAILS OF FISHING

     ANNUAL QUANTITIES CAUGHT IN TONS OF EACH SPECIES STATING CORRESPONDING AREA CAUGHT

Quantity

Species

Area Caught

Method of Processing or Landing Fish

Ports of Delivery of cath

       DO YOU EMPLY FISHING AIDS OR SPECIAL DEVICES?
       e.g. Temporary FADs, if yes please state what types

     YES    NO

       DO YOU CURRENTLY HAVE A VESSEL MONITORING SYSTEM (VMS) ON  
       BOARD?

     YES    NO

       DO YOU KEEP RECORDS OF CATCHES? LOG BOOKS?

     YES    NO

3. GENERAL INFORMATION

Your Name and Surname

Company which you represent

Passport

Country

Zip Code

City

State

Building

Floor

Office

Phones

Fax

Email

P. O. Box

Please Forward Documents
to the Following Address

4. PREFERRED COURIER SERVICE

TNT DHL FEDEX Other

5. STATEMENTS

Let this statement serve as a true and lawful declaration that all the information herein contained is true and correct and that the company that I wish incorporate will only be used for lawful purposes. U also certify that I have received legal counsel from an Attorney at Law from the jurisdiction of said company and, in the case of juridical persons, that the client was advised to obtain legal counsel.

6. FAX REQUIRED INFORMATION

Provided it is first time you contact our organization, then you are kindly requested to submit within the next 24 hours (by fax or e-mail), the following documents. Si ha contactado por vez primera a nuestra oficina, dentro de las 24 horas siguiente al envi? de su solicitud de incorporaci?n deber? hacernos llegar v?a fax o por email los siguientes documentos: Passport copy of interested person / Copia de Pasaporte del requirente Passport copies of Directors (if applicable) / Copia de Pasaporte de los Directores Copy of document in the form of utility bill, credit card statement, etc., confirming your address domicile / Copia de cualquier documento que confirme su direccion f?sica Cliente identification form (Gerli & Co.Due diligence form) / Formulario de Identificaci?n del Cliente. I AGREE WITH THE ABOVE