BENEFICIAL OWNER

INFORMATION REPORT (BOIR)

by VastSolutionsGroup.com

A VastAssetDefense.com company

CLIENT INFORMATION

First Name *

Last Name *

Email *

Phone *

REPORTING COMPANY (ENTITY) INFORMATION

Company Legal Name *

DBA/Trade Name, If applicable *

Business Type *

Filing State *

Effective Date with the State *

Tax ID Type *

-Select-

EIN
SSN-ITIN (if EIN not available)
No elements found. Consider changing the search query.
List is empty.

Tax ID Number *

REPORTING COMPANY PRINCIPAL BUSINESS ADDRESS

United States Business Address

NOTE:

If you do not have a U.S. address, you can use the registered agent’s address on your entity formation documents.

Business Address 1 *

Business Address 2 *

State *

City *

Zip *

BENEFICIAL OWNER 1

a) exercises substantial control over a reporting company; OR

b) owns or controls at least 25 percent of the ownership interests of a reporting company.

First Name *

Middle Name

Last Name *

Country *

City *

Address 1 *

Address 2 *

NOTE:

The address in this section should be your personal residential address.

Zip *

Date of Birth *

Form of Identification *

-Select-

U.S. Driver's License
Foreign Passport #
No elements found. Consider changing the search query.
List is empty.

ID Number *

Please upload identification image. *

A digital file image of an unexpired U.S. driver's license or an image of a foreign passport, if you do not have a U.S. driver's license (jpg/jpeg, png or PDF format). Be sure that the image is of the front only of the id and the information is clearly visible (not blurry or glares on image).

Note: Attachment file names for BOIR can not contain spaces, and can only contain letters, numbers, or the following characters !@#$%()_-.=+[]|;~

In what capacity is this person considered a Beneficial Owner? *

BENEFICIAL OWNER 2

First Name

Middle Name

Last Name

Country

City

Address 1

Address 2

NOTE:

The address in this section should be your personal residential address.

Zip

Date of Birth

Form of Identification

-Select-

U.S. Driver's License
Foreign Passport #
No elements found. Consider changing the search query.
List is empty.

ID Number

Please upload identification image.

Note: Attachment file names for BOIR can not contain spaces, and can only contain letters, numbers, or the following characters !@#$%()_-.=+[]|;~

In what capacity is this person considered a Beneficial Owner?

BENEFICIAL OWNER 3

First Name

Middle Name

Last Name

Country

City

Address 1

NOTE:

The address in this section should be your personal residential address.

Address 2

Zip

Date of Birth

Form of Identification

-Select-

U.S. Driver's License
Foreign Passport #
No elements found. Consider changing the search query.
List is empty.

ID Number

Please upload identification image.

Note: Attachment file names for BOIR can not contain spaces, and can only contain letters, numbers, or the following characters !@#$%()_-.=+[]|;~

In what capacity is this person considered a Beneficial Owner?

BENEFICIAL OWNER 4

Middle Name

First Name

Last Name

Country

City

Address 1

Address 2

NOTE:

The address in this section should be your personal residential address.

Zip

Date of Birth

Form of Identification

-Select-

U.S. Driver's License
Foreign Passport #
No elements found. Consider changing the search query.
List is empty.

ID Number

Please upload identification image.

Note: Attachment file names for BOIR can not contain spaces, and can only contain letters, numbers, or the following characters !@#$%()_-.=+[]|;~

In what capacity is this person considered a Beneficial Owner?

IMPORTANT: PLEASE READ THIS STATEMENT AND SIGN BELOW

By signing this form, I certify that all of the above information is true, correct and complete. I authorize VastSolutionsGroup.com to file this information with the U.S. Department of the Treasury's Financial Crimes Enforcement Network (FinCEN) to comply with the Beneficial Ownership Information Reporting Requirements (reporting rule 1010.380 in Title 31 of the Code of Federal Regulations).

I understand that the willful failure to report complete or updated beneficial ownership

information to FinCEN, or willful provision of or attempt to provide false or fraudulent

beneficial ownership information may result in a civil or criminal penalties, including civil penalties of up to $500 for each day that the violation continues, or criminal penalties including imprisonment for up to two years and/or a fine of up to $10,000.

Additionally, I agree to the Terms of Service found HERE and to pay $200 per entity submitted. Please refer to FinCEN GUIDE and FAQ for assistance and ensure that all information is accurate and comprehensive prior to submitting this form. Click HERE for support.

Signature *

Clear

Date *