Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1698841651431.pdf (Saint Vincent and the Grenadines)
COMPANIES ACT OF 1994 (Section 194) LOCAL COMPANY ANNUAL RETURN Form 28 1.

Company Name and Registered Office Address 2.

Company No.

3.

Reporting Period Return for the year ending December 31, 20 4.

Registered Office 5.

Main type(s) of business activity a Has there been a change in the location of the registered office during the reporting period?

b.

If yes, has Form 4 been filed?

Yes Yes No No 6.

Directorship a.

Has there been a change of director(s) during the reporting period?

b.
b.

If yes, has Form 9 been filed?

Yes Yes No No 7.

Name and Address of Secretary 8.

Corporate registers and records a.

Are the company registers and records kept at an address different from that of the registered office?

b.

If yes, state the address where kept and the name of any agent appointed to prepare and maintain same.

Yes No 9.

Financial Statements a.

Is the company a public company?

b.

Does the gross revenue of the company exceed $4,000,000.00?
c. Do the assets of the company exceed $2,000,000.00?

d. If yes to a., b. or c. above, have financial statements been filed in respect of the reporting period?

Yes Yes Yes Yes No No No No 10.

Summary of Share Capital 11.

Jurisdictions in which the company carries on business Classes of Shares No of Shares in Class a.

Does the company carry on business outside St. Vincent and the 1.

2.

3.

4.

5.

Grenadines?

Yes No b.


If yes, list the jurisdictions outside of St. Vincent and the Grenadines where the company carries on business.

Confirm that a Share Capital Schedule in Form 28:A been Yes completed and attached to this Return?

12.

Real Property a.

Has the company acquired a legal or equitable interest in land?

Yes No 13.

Corporate relationships a.

Is the company affiliated with or controlled by another company?

b.
b.

If yes, name the affiliated companies and describe the nature of the corporate relationship using ss.538-540 definitions.

Yes No Name of Affiliated Company Relationship 1 2 3 14.

Certificate I, information contained herein is true and correct to the best of my knowledge and belief.
, hereby certify that I am authorized by the reporting company to make this Return and that the Signature of Officer/Director Official use only Date COMPANIES ACT OF 1994 (Section 194) LOCAL COMPANY ANNUAL RETURN SHARE CAPITAL SCHEDULE Form 28A of for the period ending December 31, NAMES AND ADDRESSES OF PAST AND PRESENT SHAREHOLDERS1 ACCOUNT OF SHARES NAME RESIDENTIAL ADDRESS 2Particulars of shares held or transferred since the date of the last Return, or in the case of the first return, since the incorporation of the Company, by persons who are still members 3Particulars of shares transferred since the date of the last Return, or in the case of the first Return, since the incorporation of the Company, by persons who have ceased to be members Class Number issued4 Date of issue or registration of transfer Class Number Date of registration of transfer REMARKS Signed by: Date COLUMN TOTAL 1 State first name, middle initial(s), last name and residential address of each shareholder.
2 Where any shares have been converted into stock the amount of stock held by each member is to be shown.

3 The date of registration of each transfer should be given as well as the number of shares transferred on each date.

Particulars should be placed opposite the name of the Transferor.

The name of the Transferee may be inserted in the Remarks column immediately opposite the particulars of each transfer.
4 The aggregate number of shares held (and not the distinctive numbers) must be stated and the column totaled to agree with the number stated to have been taken up in the Item 10 Summary.