Annual Report for FSM Foreign Investment Permit Holder

Name of applicant:

Your Email (required)

Subject

Name(s) of business (if different):

Address of Principal office:
     In FSM:

     Outside FSM:

Name and address of registered agent in the FSM:

Date on which business was commenced:

FSM States in which holder is engaged in business:

Did holder file an annual report for last year?  Yes No
If not, explain, why:

Form of applicant's business entity:
 Sole Proprietorship(individual)
 Partnership
     General Limited
       Formed under the laws of
 Corporation
     For Profit NonProfit
       Form under the laws of
 Joint Venture
 Other (please specify):

If the form of holder’s business entity is different that on the original permit application or the most recent annual report, explain why:

Unless they are already on file with the Secretary, attach copies of the organic documents of the business entity indicated above (for example partnership agreement, joint venture agreement, or, if a corporation, charter, article of incorporation and by laws). Include any amendments of those documents to the date of this report. If the organic documents are not in English, a notarized translation of them into English must also be submitted.

State the aggregate percentage of the applicant which is owned by citizens or governments of the FSM or legal entities wholly owned by such citizens or governments. % Any other person is considered a noncitizen.

List all noncitizens (or state there are none, if applicable) who hold a “substantial ownership interest” in applicant, as defined in section 203 of the FSM Foreign Investment Act:

Investigate and provide the following information for the applicant and for each noncitizen holder of a “substantial ownership interest” in the applicant, as defined in section 203 of the FSM Foreign Investment Act. Attach additional sheets if necessary. If any answer is “yes”, provide details.

     Has this person been convicted of a felony or crime of moral turpitude in the FSM, any State of the FSM, or any foreign jurisdiction during the prior 10 years? Yes No

     Has this person ever had a foreign investment permit canceled by the FSM or any of its States? Yes No

     Has this person now indebted to any government, citizen or resident of the FSM more than 30 days after adjudication of the debt by final and unappealable decision of an FSM state or national court or administrative body?
 Yes No

State the amount of capital invested in the FSM since the original permit application.
$
How much of this was in cash?

What form(s) did the rest of it take?

Identify the project or location of the investment

How much of this invested capital has been withdrawn from the FSM?

What percentage of holder’s “gross revenues” during the past year, as defined for purposes of the FSM National gross revenue tax, were derived from the bona fide sale of goods or services to nonresidents of the FSM (including persons just visiting the FSM)?%

How many employees does the holder have at this time?

How many of those employees are FSM citizens?
(Note: Employment must be calculated on the basis of full time equivalents (FTE’s) as defined in the FSM Foreign Investment Regulations.)

Have you attached any additional sheets to this form?  Yes No
If so, how many?