Beneficial Ownership Information (BOI)
Type of Filing
*
Initial Report
Correct Prior Report
Update Prior Report
Newly Exempt Entity
Entity Name
*
Alternative name (e.g trade name, DBA if applicable)
Incorporation State (State where the company was registered)
Registered Agent
*
Registered agent is the person or company designated to receive official government documents and legal notices on behalf of the company.
How many individuals, directly or indirectly, own at least 25% of the company?
*
Please Select
1
2
3
4
Tax Identification type
*
Please Select
EIN
SSN/ITIN
Foreign
Tax identification number
*
Owner Information
Owner 1
*
First Name
Last Name
Date of birth
*
Drivers License, State ID or Passport Number
*
Primary Contact Email
*
example@example.com
Upload identification provided
*
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Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Owner 2
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of birth
*
Drivers License, State ID or Passport Number
*
Upload identification provided
*
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of
Owner 3
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of birth
*
Drivers License, State ID or Passport Number
*
Upload identification provided
*
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Owner 4
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of birth
*
Drivers License, State ID or Passport Number
*
Any individuals NOT listed above, exercise substantial control over the company?
*
Yes
No
Please list below their name(s)
*
Upload identification provided
*
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Are you a client of Greenlight Financial? If yes, and have a credit card on file, please indicate whether we may charge the total amount of $550 to your credit card on file
*
Yes
No
Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit
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