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THE UNITED STATES VIRGIN ISLANDS OFFICE OF THE LIEUTENANT GOVERNOR DIVISION OF CORPORATIONS AND TRADEMARKS APPLICATION FOR REGISTRATION OF A TRADE NAME – TNR12 • A trade name is not considered registered unless and until you are in receipt of the certified Certificate of Trade Name is issued by this office. You are cautioned against relying on an unofficial representation. The Office of the Lieutenant Governor nor the Division of Corporations and Trademarks shall not be held responsible for any costs incurred as a result of a client moving forward without proper registration. • The Director reserves the right to reject any application for registration. • This form is for use by sole proprietors, partnerships or associations of individuals. • This form cannot be used for Corporations, LPs, LLPs, LLLPs or LC. • This form must be completed in its entirety. Failure to do so will result in rejection of the application document. • One (1) original application, with original signature(s) and original notary authentication, must be submitted. • The application must be submitted free of obliterated text (no strike through marks, no corrective fluid/tape). Evidence of obliteration will result in the rejection of the application document. • A trade name registered in accordance with the provisions of V.I.C. title 11, Chapter 21, shall not be the same as nor so similar as to cause confusion with the trade name of any person, partnership, association or corporation, foreign or domestic, doing business under such trade name in the United States Virgin Islands. This office will make that determination. • A fee of $25 must accompany this application. If the application is mailed, be certain to include a check or money order payable to the GOVERNMENT OF THE VIRGIN ISLANDS. The envelope must be addressed to THE OFFICE OF THE LIEUTENANT GOVERNOR – DIVISION OF CORPORATIONS AND TRADEMARKS; 5049 KONGENS GADE; ST. THOMAS, VIRGIN ISLANDS 00802. • A fee of $250.00 guarantees 24-hour processing of this application document. • All trade name registrations must be renewed bi-annually (every two (2) years), on the anniversary of original registration, at a fee of $50.00. Failure to do so will result in the cancellation of the registration. 5049 Kongens Gade Charlotte Amalie, Virgin Islands 00802 Phone - 340.776.8515 Fax - 340.776.4612 1105 King Street Christiansted, Virgin Islands 00820 Phone - 340.773.6449 Fax - 340.773.0330 FORM TNR12 THE UNITED STATES VIRGIN ISLANDS OFFICE OF THE LIEUTENANT GOVERNOR DIVISION OF CORPORATIONS AND TRADEMARKS APPLICATION FOR REGISTRATION OF TRADE NAME VIRGIN ISLANDS CODE – TITLE 11 – CHAPTER 21 LAST NAME FIRST NAME EMAIL ADDRESS BEST DAYTIME CONTACT NUMBER(S)/CELL PHONE TERRITORY or STATE OF ________________________________________________________ ) JUDICIAL DISTRICT or COUNTY OF ________________________________________________________ ) The undersigned parties, comprising a co-partnership or an association of individuals other than a corporation, conducting or intending to conduct a business in the United States Virgin Islands, hereby requests that the trade name, set forth below, under which said business shall be conducted, be registered in accordance with the provisions of Chapter 21, Title 11 of the Virgin Islands Code, and we certify the following: PLEASE TYPE OR PRINT TRADE NAME _______________________________________________________________________________________ NATURE OF BUSINESS _______________________________________________________________________________________ LOCATION OF BUSINESS _______________________________________________________________________________________ _______________________________________________________________________________________ CITY ISLAND ZIP CODE True and real names of all persons and/or entities wishing to register this trade name must appear below. Persons or entities who currently reside in the United States Virgin Islands must complete and sign page one, below, and submit this application under notary acknowledgement. Should there be more than two (2) organizers, please submit the name, full mailing address, email address and signature of each additional member, under notary acknowledgement, on a second sheet, making that sheet an addendum to this application. Persons and/or entities that do not reside, or are not of the United States Virgin Islands, must skip the section below and continue onto Page 2. If the organizers are not residents of, and are not currently residing in the United States Virgin Islands, a Resident Agent must be named. A Resident Agent is an individual designated to receive service of process when a business entity is a party in a legal action, such as a summons or lawsuit. The Resident Agent must reside in the United States Virgin Islands. The Resident Agent must submit, under notary acknowledgement, a Consent of Resident Agent Form. Failure to submit the Consent of Resident Agent Form will render this application null and void. I DECLARE, UNDER PENALTY OF PERJURY, UNDER THE LAWS OF THE UNITED STATES VIRGIN ISLANDS, THAT ALL STATEMENTS CONTAINED IN THIS APPLICATION, AND ANY ACCOMPANYING DOCUMENTS, ARE TRUE AND CORRECT, WITH FULL KNOWLEDGE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE SUBJECT TO INVESTIGATION AND THAT ANY FALSE OR DISHONEST ANSWER TO ANY QUESTION MAY BE GROUNDS FOR DENIAL OR SUBSEQUENT REVOCATION OF REGISTRATION. ______________________________________________________ _______________________________________________________ FIRST NAME LAST NAME MAILING ADDRESS ______________________________________________________ _______________________________________________________ SIGNATURE CITY ISLAND ZIP CODE ______________________________________________________ EMAIL ADDRESS ______________________________________________________ _______________________________________________________ FIRST NAME LAST NAME MAILING ADDRESS ______________________________________________________ _______________________________________________________ SIGNATURE CITY ISLAND ZIP CODE ______________________________________________________ EMAIL ADDRESS SUBSCRIBED AND SWORN TO BEFORE ME THIS _____________ DAY OF ___________________________________, _______________. _________________________________________________ Notary Public ________________________________________ My Commission Expires FOR OFFICIAL USE ONLY DATE RECEIVED RECEIVED BY PAYMENT RECEIVED PAYMENT TYPE RECEIPT NO. NOTE: This must be a physical address. FORM TNR12 NON-RESIDENT PARTNERS OR MEMBERS OF ASSOCIATION, PLEASE COMPLETE THE FOLLOWING – TERRITORY or STATE OF ________________________________________________________ ) JUDICIAL DISTRICT or COUNTY OF ________________________________________________________ ) The undersigned, non-resident of the United States Virgin Islands, doing business in the United States Virgin Islands, as a partner or member in the firm, under the trade name _______________________________________________________________________________________________________ hereby subscribes to the application for registration of trade name and appoints _____________________________________________________________________________________________, a person residing in the United States Virgin Islands and having an office or place of business located at__________________________________________________________________________________ as his Resident Agent upon whom process against the undersigned may be served in an action founded upon a liability incurred within the United States Virgin Islands. I DECLARE, UNDER PENALTY OF PERJURY, UNDER THE LAWS OF THE UNITED STATES VIRGIN ISLANDS, THAT ALL STATEMENTS CONTAINED IN THIS APPLICATION, AND ANY ACCOMPANYING DOCUMENTS, ARE TRUE AND CORRECT, WITH FULL KNOWLEDGE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE SUBJECT TO INVESTIGATION AND THAT ANY FALSE OR DISHONEST ANSWER TO ANY QUESTION MAY BE GROUNDS FOR DENIAL OR SUBSEQUENT REVOCATION OF REGISTRATION. ______________________________________________________ _______________________________________________________ FIRST NAME LAST NAME MAILING ADDRESS ______________________________________________________ _______________________________________________________ SIGNATURE CITY ISLAND ZIP CODE _____________________________________________________________ EMAIL ADDRESS Subscribed and sworn to before me this ______________ day of ________________________________, _________ _____________________________________________ Notary Public ______________________________ My Commission Expires The undersigned, non-resident of the United States Virgin Islands, doing business in the United States Virgin Islands, as a partner or member in the firm, under the trade name _______________________________________________________________________________________________________ hereby subscribes to the application for registration of trade name and appoints _____________________________________________________________________________________________, a person residing in the United States Virgin Islands and having an office or place of business located at__________________________________________________________________________________ as his Resident Agent upon whom process against the undersigned may be served in an action founded upon a liability incurred within the United States Virgin Islands. I DECLARE, UNDER PENALTY OF PERJURY, UNDER THE LAWS OF THE UNITED STATES VIRGIN ISLANDS, THAT ALL STATEMENTS CONTAINED IN THIS APPLICATION, AND ANY ACCOMPANYING DOCUMENTS, ARE TRUE AND CORRECT, WITH FULL KNOWLEDGE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE SUBJECT TO INVESTIGATION AND THAT ANY FALSE OR DISHONEST ANSWER TO ANY QUESTION MAY BE GROUNDS FOR DENIAL OR SUBSEQUENT REVOCATION OF REGISTRATION. ______________________________________________________ _______________________________________________________ FIRST NAME LAST NAME MAILING ADDRESS ______________________________________________________ _______________________________________________________ SIGNATURE CITY ISLAND ZIP CODE _____________________________________________________________ EMAIL ADDRESS Subscribed and sworn to before me this ______________ day of ________________________________, _________ _____________________________________________ Notary Public ______________________________ My Commission Expires