‫إﺳﺘﻤﺎرة إﺟﺮاءات اﻟﺘﺴﺠﻴﻞ و اﻟﺘﺮﺧﻴﺺ‬

Registration & Licensing Application form

‫ﺗﺴﺠﻴﻞ ﺟﺪﻳﺪ‬ ‫ﺗﻌﺪﻳﻞ ﺑﻴﺎﻧﺎت اﻟﺘﺴﺠﻴﻞ‬ ‫إﻟﻐﺎء اﻟﺘﺴﺠﻴﻞ‬

New Registration Registration Amendment Registration Cancellation

(‫اﻟﻤﺴﺘﺜﻤﺮ )ﺑﺎﻟﺪرﻫﻢ‬ ‫اﻟﺸﻜﻞ اﻟﻘﺎﻧﻮﻧﻲ‬

FZE LLC FZC LLC BLC BFC
Capital (In AED) Legal form

Company Name Option 1: ‫اﺳﻢ اﻟﺸﺮﻛﺔ‬

Option 2:
Option 3:

Required Activity ‫اﻟﻨﺸﺎط اﻟﻤﻄﻠﻮب‬

Registration Amendment ‫ﺗﻌﺪﻳﻞ ﺑﻴﺎﻧﺎت اﻟﺘﺴﺠﻴﻞ‬

Please select the required amendment ‫ﻳﺮﺟﻰ ﺗﺤﺪﻳﺪ ﻧﻮع اﻟﺘﻌﺪﻳﻞ اﻟﻤﻄﻠﻮب‬

‫إﺿﺎﻓﺔ ﺷﺮﻳﻚ‬ ‫اﻧﺴﺤﺎب ﺷﺮﻳﻚ‬ ‫ﺗﻐﻴﻴﺮ اﺳﻢ ﺷﺮﻛﺔ‬ ‫ﺗﻐﻴﻴﺮﻧﺸﺎط‬

Adding Partner Withdrawal of Partner Changing Co. name Changing Activity

‫ﺣﺬف ﻧﺸﺎط‬ ‫إﺿﺎﻓﺔ ﻧﺸﺎط‬ ‫ﺗﻐﻴﻴﺮ اﻟﺸﻜﻞ اﻟﻘﺎﻧﻮﻧﻲ‬ ‫ إدﺧﺎل ﻣﺪﻳﺮ‬/ ‫ﺗﻐﻴﻴﺮ‬
Cancel Activity Add Activity Change legal form Change/Appoint Manager

‫ ﺗﺨﻔﻴﺾ رأس اﻟﻤﺎل‬/ ‫زﻳﺎدة‬ ‫أﻳﻠﻮﻟﺔ رﺧﺼﺔ ﺑﻌﺪ اﻟﻮﻓﺎة‬ ‫دﻣﺞ ﺷﺮﻛﺔ‬ ‫أﺧﺮى‬
Reduce/Increase capital Dissolution of License Merging Companies Others

OWNERS / PARTNERS / MANAGERS’ INFORMATION ‫ ﻣﺪﻳﺮ‬/ ‫ اﻟﺸﺮﻛﺎء‬/ ‫ﻣﻌﻠﻮﻣﺎت اﻟﻤﺎﻟﻜﻴﻦ‬

‫م‬ ‫اﻻﺳﻢ‬ ‫اﻟﺠﻨﺴﻴﺔ‬ ‫ﺟﻮاز ﺳﻔﺮ‬ ‫ﺗﻌﻴﻴﻦ‬ ‫رﻗﻢ ﻫﺎﺗﻒ‬ ‫اﻟﺒﺮﻳﺪ اﻹﻟﻜﺘﺮوﻧﻲ‬
Sr. Name Nationality Passport No. Designation Telephone No. Email address
OWNER/MANAGER
1

LOCATION TYPE ‫ﻧﻮع اﻟﻤﻮﻗﻊ‬

‫ ﻧﻘﺮﻧﺤﻦ اﻟﻤﻮﻗﻌﻴﻦ أﻋﻼه ﺑﺄن ﺟﻤﻴﻊ اﻟﺒﻴﺎﻧﺎت اﻟﺼﺎدرة ﻓﻲ ﻫﺬا اﻟﻄﻠﺐ واﻟﻤﺴﺘﻨﺪات اﻟﻤﺮﻓﻘﺔ ﺻﺤﻴﺤﺔ وﻋﻠﻰ ﻣﺴﺆوﻟﻴﺘﻲ‬/ ‫أﻗﺮ‬
I / We the undersigned acknowledge and undertake that all the information contained herein and all documents submitted are true and correct.

OWNER / SHAREHOLDER SIGNATURE :

MANAGER SIGNATURE :

‫ وﻻ ﻳﻘﺒﻞ اﻟﻄﻠﺐ ﻓﻲ ﺣﺎل اﻟﻜﺸﻂ أو اﻟﺘﺼﺤﻴﺢ‬,‫ ﻳﺸﺘﺮط ﺗﻌﺒﺌﺔ اﻻﺳﺘﻤﺎرة ﻃﺒﺎﻋﺔ‬: ‫ﻣﻼﺣﻈﺔ‬
Note: Kindly fill the form by typing and and any correction made on the form will not be accepted.
 STAKEHOLDER/S INFORMATION
DESIGNATION: : ‫ﺗﻌﻴﻴﻦ‬
Designation ‫ﺗﻌﻴﻴﻦ‬ Designation ‫ﺗﻌﻴﻴﻦ‬ Designation ‫ﺗﻌﻴﻴﻦ‬ Designation ‫ﺗﻌﻴﻴﻦ‬ Designation ‫ﺗﻌﻴﻴﻦ‬
OWNER/MANAGER
‫ﺗﻔﺎﺻﻴﻞ‬
Details

‫ﻣﻘﻴﻢ ﻓﻰ اﻻﻣﺎرات‬ Yes / ‫ﻧﻌﻢ‬ Yes / ‫ﻧﻌﻢ‬ Yes / ‫ﻧﻌﻢ‬ Yes / ‫ﻧﻌﻢ‬ Yes / ‫ﻧﻌﻢ‬
UAE Resident No / ‫ﻻ‬ No / ‫ﻻ‬ No / ‫ﻻ‬ No / ‫ﻻ‬ No / ‫ﻻ‬

‫اﻻﺳﻢ اﻷول ﺣﺴﺐ‬

‫ﺟﻮاز اﻟﺴﻔﺮ‬
First Name
(as per passport)

‫اﺳﻢ اﻟﻌﺎﺋﻠﺔ ﺣﺴﺐ‬

‫ﺟﻮاز اﻟﺴﻔﺮ‬
Last Name
(as per passport)

‫ﺑﺮﻳﺪ اﻟﻜﺘﺮوﻧﻲ‬
Email ID

‫اﻟﺠﻨﺲ‬ Male / ‫ذﻛﺮ‬ Male / ‫ذﻛﺮ‬ Male / ‫ذﻛﺮ‬ Male / ‫ذﻛﺮ‬ Male / ‫ذﻛﺮ‬
Gender Female / ‫اﻧﺜﻰ‬ Female / ‫اﻧﺜﻰ‬ Female / ‫اﻧﺜﻰ‬ Female / ‫اﻧﺜﻰ‬ Female / ‫اﻧﺜﻰ‬

‫اﻟﺠﻨﺴﻴﺔ‬
Nationality

‫ﺗﺎرﻳﺦ اﻟﻤﻴﻼد‬
Date of birth
‫ﻣﻜﺎن اﻟﻤﻴﻼد‬
Place of birth

‫ﺗﺎرﻳﺦ اﻧﺘﻬﺎء اﻟﺠﻮاز‬

Passport Expiry
Date

‫اﻟﻌﻨﻮان‬
Address

‫رﻗﻢ اﻟﻬﺎﺗﻒ‬
Mobile Number

‫ﻧﺴﺒﺔ اﻟﺴﻬﻢ‬
0 0 0 0.00
Share Percentage

‫ﺗﻮﻗﻴﻌﺎت‬
Signature

AJMAN MEDIA CITY FREE ZONE APPROVAL :

AUTHORIZED SIGNATORY
‫ وﻻ ﻳﻘﺒﻞ اﻟﻄﻠﺐ ﻓﻲ ﺣﺎل اﻟﻜﺸﻂ أو اﻟﺘﺼﺤﻴﺢ‬,‫ ﻳﺸﺘﺮط ﺗﻌﺒﺌﺔ اﻻﺳﺘﻤﺎرة ﻃﺒﺎﻋﺔ‬: ‫ﻣﻼﺣﻈﺔ‬
Note: Kindly fill the form by typing and and any correction made on the form will not be accepted.