BOI REGISTRATION
Please provide all required details to register your business with us
Business Name
*
E-mail
*
Confirmation Email
example@example.com
Is your company any of the following:
*
Please Select
None applicable
Securities reporting issuer
Governmental authority
Bank
Credit Union
Depository institution holding company
Money service business
Broker or dealer in securities
Securities exchange or clearing agency
Other Exchange Act registered entity
Investment company or investment adviser
Venture capital fund adviser
Insurance company
State-licensed insurance producer
Commodity Exchange Act registered agency
Accounting firm
Public utility
Financial market utility
Pooled investment vehicle
Tax-exempt entity
Entity assisting a tax-exempt entity
Large operating company
Subsidiary of certain exempt entities
Inactive entity
*If any of the above apply, your company may be exempt from this filing. By continuing with this form you acknowledge that you want to proceed with this filing*
EIN Number "No Dash"
*
9 digit Tax ID Numer
Confirm EIN Number "No Dash"
*
9 digit Tax ID Numer
DBA Name (If Any)
State of Formation
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Phone Number
*
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How Many Beneficial Owners are there?
*
Please Select
1
2
3
4
5
A beneficial owner is an individual who either directly or indirectly: (1) exercises substantial control over the reporting company, or (2) owns or controls at least 25% of the reporting company’s ownership interests
Beneficial Owner 1
*
First Name
Last Name
Beneficial Owner 1 - Residential Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Beneficial Owner 1 - Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Beneficial Owner 1 -Please upload your ID required for submission . An identifying number from an acceptable identification document such as a nonexpired passport or U.S. driver’s license
*
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Beneficial Owner 1- Identifying number from the passport or U.S. driver’s license that was just uploaded.
Beneficial Owner 2
*
First Name
Last Name
Beneficial Owner 2 - Residential Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Beneficial Owner 2 - Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Beneficial Owner 2-Please upload your ID required for submission . An identifying number from an acceptable identification document such as a nonexpired passport or U.S. driver’s license
*
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Beneficial Owner 2- Identifying number from the passport or U.S. driver’s license that was just uploaded.
Beneficial Owner 3
*
First Name
Last Name
Beneficial Owner 3 - Residential Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Beneficial Owner 3 - Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Beneficial Owner 3-Please upload your ID required for submission . An identifying number from an acceptable identification document such as a nonexpired passport or U.S. driver’s license
*
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Beneficial Owner 3 Identifying number from the passport or U.S. driver’s license that was just uploaded.
Beneficial Owner 4
*
First Name
Last Name
Beneficial Owner 4 - Residential Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Beneficial Owner 4 - Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Beneficial Owner 4-Please upload your ID required for submission . An identifying number from an acceptable identification document such as a nonexpired passport or U.S. driver’s license
*
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Beneficial Owner 4- Identifying number from the passport or U.S. driver’s license that was just uploaded.
Beneficial Owner 5
*
First Name
Last Name
Beneficial Owner 5 - Residential Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Beneficial Owner 5 - Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Beneficial Owner 5-Please upload your ID required for submission . An identifying number from an acceptable identification document such as a nonexpired passport or U.S. driver’s license
*
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Beneficial Owner 5- Identifying number from the passport or U.S. driver’s license that was just uploaded.
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Was your company formed on or before 12/31/2023
*
Please Select
YES
NO
Only reporting companies created or registered on or after January 1, 2024, will need to report their company applicants. A company that must report its company applicants will have only up to two individuals who could qualify as company applicants: The individual who directly files the document that creates or registers the company; and If more than one person is involved in the filing, the individual who is primarily responsible for directing or controlling the filing.
Company Applicant - Person who Registered the Company
*
First Name
Last Name
Company Applicant - Residential Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Applicant - Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Company Applicant ID -Please upload your ID required for submission . An identifying number from an acceptable identification document such as a nonexpired passport or U.S. driver’s license
*
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I certify that I am authorized to fill out this information and give authorization to the Law Offices of Rina Feld PA to submit this BOI reporting information on behalf of the reporting company. I further certify, on behalf of the reporting company, that the information contained in this BOIR is true, correct, and complete.
*
Yes
PAYMENT
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BOI Registration
$
195.00
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