BOI Report

Beneficial Ownership Information Report
Legal Business Name*
Fictitious Name (if applicable)
EIN (Employer Identification Number)
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Year of Formation*

After January 1, 2024Before December 31, 2023
Has KIS Consult incorporated your business?*

YesNo
How many Members owns 25% or more of the business?*
Is there any individual that owns less than 25% or no interest but has substantial control in the company? Ex: Manager, CFO, President*

YesNo
How many Managers, CFOs, Presidents?
Beneficial Owner #1*

First NameLast Name
Beneficial Owner #2*

First NameLast Name
Beneficial Owner #3*

First NameLast Name
Beneficial Owner #4*

First NameLast Name
Date of birth 1*

MonthDayYear
Date
Date of birth 2*

MonthDayYear
Date
Date of birth 3*

MonthDayYear
Date
Date of birth 4*

MonthDayYear
Date
Residential Address 1*
Full address required including Zip code and County
Residential Address 2*
Full address required including Zip code and County
Residential Address 3*
Full address required including Zip code and County
Residential Address 4*
Full address required including Zip code and County
REQUIRED

Please submit a copy or a high quality picture of one of the following personal documents:

- Passport (Any citizenship)

- State ID (Identification or Drivers License)
#1 Identification Document - File Upload*

Cancelof
#2 Identification Document - File Upload*

Cancelof
#3 Identification Document - File Upload*

Cancelof
#4 Identification Document - File Upload*

Cancelof
How would you like to pay for this service?*

ZelleACH (If you have an US bank account)Credit card (3.5% additional fee)Pix
Name of person submitting this form*

First NameLast Name
Email of person submitting this form*
example@example.com
Phone number of person submitting this form*
Signature of person submitting this form*

Clear
Should be Empty:

Beneficial Ownership Information Report