Classification: Internal

APPLICATION TO SET UP A BUSINESS – FZ-LLC (Natural & Corporate Person)

Request Details:
Proposed Name of Company:
English: Arabic:
(First Choice)
Proposed Name of Company:
English: Arabic:
(Second Choice)
Proposed Name of Company:
English: Arabic:
(Third Choice)
Business Segment1:
Activity
Activity Name1:
No.1:
Activity Description:
Share Capital:
Par Value of Shares2
No. of Member(s):
1
Enter relevant Segment and Activity name and number as per Dubai Development Authority Decision No.01 of 2021
2
The amount of each Share must be a minimum of One Thousand Dirhams or multiples thereof

1. Member(s) Information: (Natural Person)

Personal Details
Middle
First Name: Last Name:
Name:
Passport
Passport No.:
Issue Date:
Passport
Nationality: Expiry
Date:
Date of Birth: Gender:
Email Address: No. of
National ID: Shares
National ID
National ID
Expiry
Issue Date:
Date:

Address Details in UAE

Area: Street:
Building
City:
Name/No.:
P.O.Box No.:
Residence
Phone:
Mobile No. 02:
Mobile No. 01:
(Optional)

Address Details in Home Country

City: Country:
Residence
Phone:
Mobile No.:
*If more than one Member, please provide the information in a separate sheet and attach with this Application.

2. Member(s) Information (Corporate Person):

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Company Name: English: Arabic:

Registration No.:
Date of
Incorporati
on:
License Issuing
Authority:
Nationality: No. of Shares:

Address Details

Address:

City: Country:
Office Phone
No.
Mobile No.:

P.O. Box No.:

Email Address:
Website
Address:
*If more than one Member, please provide the information in a separate sheet and attach with this Application

Company Representative Details

Company
Representative
Name:
Email Address: Mobile No.:

3. Director(s) Information:

Personal Details
Middle
First Name: Last Name:
Name:
Passport Issue
Passport No.:
Date:
Passport Expiry
Nationality:
Date:
Date of Birth: Gender:
National ID
Number:
Issue Date: Expiry Date

Address Details in UAE

Address:
Area: Street:
Building City:

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Name/No.:
Email Address:
P.O.Box No.:
Residence
Phone:
Mobile No. 02:
Mobile No. 01:
(Optional)

Address Details in Home Country

Address:
City: Country:
P.O. Box No.:
Residence
Phone:
Mobile No.:

*If more than one Director, please provide the information in a separate sheet and attach with this Application
4. General Manager Information:
Personal Details
Middle
First Name: Last Name:
Name:
Passport Issue
Passport No.:
Date:
Passport Expiry
Nationality:
Date:
Gender: Date of Birth:

National ID Issue Date:

Number: Expiry Date:

Address Details in UAE

Address:
Area: Street:
Building
City:
Name/No.:
P.O. Box No.:
Email Address:
Residence
Phone:
Mobile No. 02:
Mobile No. 01:
(Optional)

Address Details in Home Country

Address:
City: Country:
P.O. Box No.:
Residence
Phone:
Mobile No.:

Ultimate Beneficial Ownership (“UBO”) Declaration

Introduction:
UAE Federal Law 20 of 2018 on Anti Money Laundering and Countering the Financing of Terrorism,
Cabinet Decision No. 10 of 2019 issued under the AML Law and Cabinet Decision No. (109) of 2023

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Regulating the Beneficial Owner Procedures (the “AML Law”) require business licensing agencies in
the UAE to identify the ultimate individual beneficial Owner(s) of businesses licensed by them.
The Dubai Development Authority (the “Authority”) requires all the business partners it licenses
(whether as FZLLCs or Branch Offices – “Business Partners”) to disclose their ultimate beneficial
owners.
Who is the UBO?
The Beneficial Owner of the Legal Person shall be whoever person that ultimately owns or controls,
whether directly through a chain of ownership or control or by other means of control such as the right
to appoint or dismiss the majority of its Directors, 25% or more of the shares or 25% or more of the
voting rights in the Legal Person.
 The Beneficial Owner may be traced through any number of Legal Persons or arrangements of
whatsoever kind.
 If two or more natural persons jointly own or control a ratio of capital in the Legal Person, all of
them shall be deemed as jointly owners or controllers of such ratio.
 If, after all reasonable means have been taken, no natural person is identified as an ultimate
Beneficial Owner, or there is reasonable doubt that any natural person identified as an ultimate
Beneficial Owner is the true Beneficial
 Owner in the Legal Person; then the natural person who controls the Legal Person by other
means of control shall be deemed as the Beneficial Owner.
It is important to note that the UBO is not necessarily the shareholder. (For example, an overseas
company called ABC Limited owns 100% of the shares in a free zone company called XYZ FZLLC. Bill
and Ted each own 50% of the shares in ABC Limited. The UBOs of XYZ FZLLC are Bill and Ted (not ABC
Limited).
It is a condition of issue and renewal of a license to a Business Partner in the Dubai Development
Authority Free Zone that a Business Partner provides UBO information to the Authority and updates
that UBO information as and when the UBO changes.

The Authority reserves the right to request any Business Partner to supply documentation and other
information to evidence information made in the UBO declaration.
Certain Business Partners are exempt from making a UBO declaration. Those exceptions are set out in
Section 2 of this form. Unless a Business Partner is entitled to a Section 2 exception, the UBO
declaration must be completed.

Shareholder
Name
% shares in FZ-
LLC
Date of Owning
shares
Number of Shares
Value of Shares

Section 1:
1.1 Exception from providing Ultimate Beneficial Owner(s) (UBO)
Information

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("If you select 'Yes' in this section, indicating that the exemption from providing UBO information applies to you,
the submission of the UBO declaration will not be required. Please be aware that all other sections of this form
remain mandatory and must be completed.”)
I/We declare that the corporate member of the FZLLC is: (Please tick the appropriate box)
Owned by a company listed in a regulated market subject to the disclosure
Yes
requirements imposing sufficient transparency requirements of the Real
No
Beneficiary or a subsidiary company owned by the majority of such listed company.

Yes Wholly owned by the UAE Local or Federal Government, or any-other companies
No wholly owned by such companies.
s

1.2 Details of Ultimate Beneficial Owner(s) (UBO) – Corporate Members

Is the corporate member owned by another corporate entity? Yes No
If yes, list the entities that own the corporate member(s), ownership type, percentage of ownership.
Percenta Percenta
Corporate ge of ge of
Ownership Type UBO Name1
Member(s) Name shares in Ownersh
FZ-LLC ip

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If ownership type is corporate, provide the details of all the corporate entities.
Registrat Date of
Place of
Full Legal Name ion Incorporatio Registered Address
Registration
Number n

1
Ownership structure diagram is required for each entity listed and UBO Details (along with the ownership
structure diagram, the minimum requirements of the details shared about each corporate entity’s UBO must
include their “Full Name, Nationality, and Passport copy”).
Section 2:
2.1 The declaration of the Individual shareholder. (If selected, the submission of the
UBO declaration will not be required)
I/We hereby declare that the individual shareholder(s) is the Ultimate Beneficial Owner of the
Company and there is no more UBO(s) of the Company other than the individual shareholder(s) of
the Company.
2.2 Details of Ultimate Beneficial Owner(s) (UBO) – Individuals through
ownership/control
For a Company, a UBO is any individual who (Please tick the type of UBO):
Ultimately owns or controls whether directly or indirectly 25% or more of the shares or voting rights in
the business;
Holds the right, directly or indirectly, to appoint or remove a majority of the board of directors;
Has the right to exercise, or actually exercises, significant influence or control over the corporate body;
Exercises ultimate control over the management; or
Controls the corporate body.
2.2.1 Date on which the person became a Beneficial Owner (01-Jan-21)
Personal Details

First Name: Last Name:

Passport Issue
Passport No.:
Date:
Passport Expiry
Nationality:
Date:

Date of Birth: Place of Birth:

Passport Place of
Issue / Issuing
Authority:

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Address Details in UAE

Area: Street:
Building
City:
Name/No.:
P.O.Box No.:

Residence Phone:
Mobile No. 02:
Mobile No. 01:
(Optional)

Address Details in Home Country

City: Country:

Residence Phone:

Mobile No.:

2.3 Additional Details of Ultimate Beneficial Owner(s) (UBO)

The number of other legal persons which the Beneficial Owner owns, manages or controls
accordingly:
0-1 2-3 4-5 6-7 8-9
More than 10

2.4 Nominee Arrangement Confirmation:

A nominee agreement is a legal or informal relationship wherein an individual or company agrees to act as a
nominee holding shares for and on behalf of another company or individual. The nominee holds the legal title to
the shares but is not entitled to the benefits that arise out of the shares.”

Are you acting as a nominee shareholder on behalf of a third party? YES No

Are you acting as a nominee director on behalf of a third party? YES No

2.5 Legal Representative’s Information: (if any)

Provide the Registrar with the name of a natural person residing in the State and authorized to disclose to the
Registrar all data and information required under the AML law.

Full Name:

Current
Address:
Email
Mobile No.:
Address:

Nationality:

Section – 3
Politically Exposed Person (PEP) Assessment
Politically exposed persons are individuals or international entities who are or have been entrusted with
prominent public functions and their immediate family members and close associates in the United Arab Emirates
or a third country.

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3.1 PEP Association

A. Do you or any of immediate family member or business / close associate (currently or
formerly) qualified as one of the PEPs
Not Applicable PEP (Self) Closely Related to Closely Associated with PEP
PEP

i. If closely related to PEP, then please tick the type:

a spouse
a partner considered by national law as equivalent to a spouse
a child
a spouse or partner of a child
a brother or sister (including a half-brother or half-sister)
a spouse or partner of a brother or sister
a parent
a parent-in-law
a grandparent
a grandchild
others: (Please specify details in below text box)

ii. If closely associated to PEP, then please tick the type:

a joint beneficial owner of a legal person or legal arrangement, or any other close business

relationship, with UBO

the sole beneficial owner of a legal person or legal arrangement known to have been set up for

the benefit of UBO

a beneficiary of a legal arrangement of which UBO is a beneficial owner or beneficiary; or a

person in a position to conduct substantial financial transactions on behalf of UBO

others: (Please specify details in below text box)

iii. Jurisdiction risk of the country in which the individual PEP his/her political
position:

Dropdown list of all countries with quick search options

3.2 Source of Funds and Wealth

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If you are a politically exposed person and/or the Beneficial Owner of a Legal Entity, please specify the source
of property and assets which are, or will be the subject of the relevant legal entity:
Income Income Income Income
Details Details
Source Country Source Country
Salary and Dropdown list Dropdown list
Savings
Earnings of countries of countries
Return from
Sales of real Dropdown list Dropdown list
Capital from
estate of countries of countries
abroad
Sales of Damages/
Dropdown list Dropdown list
financial of countries
Compensatio of countries
assets n
Investment Dropdown list Dropdown list
Inheritance
proceeds of countries of countries

Dropdown list Royal family Dropdown list

Trust of countries stipend of countries

Dropdown list Dropdown list

Loan of countries
Others of countries

UBO DECLARATIONS AND UNDERTAKINGS

 I/We hereby declare that the information provided in this declaration is true and accurate and if such
information changes, I/We will promptly notify the Authority within 15 days of such amendment or change.
 I/We hereby undertake to notarize and/or attest any document or passport copy submitted along with this
declaration, if required by the Authority.
 I/We acknowledge that if any information provided by me/us is subsequently found to be untrue, inaccurate
or misleading the Authority may suspend or terminate our licence.

 I/We hereby authorise the Authority to make any enquiries from any person or entity, it may deem necessary
in connection with this declaration.
 I/We understand that the Authority may decline my declaration without being required to provide any reason

Notes:
 Please submit a separate Declaration Form for each UBO should there be more than one individual who
falls under the definition of a UBO.
 Please attach a copy of valid passport or Emirates ID card

GENERAL DECLARATIONS AND UNDERTAKINGS

The Undersigned, Members/Board of Directors/Authorized Legal Representative of M/s. ____________________, (the

FZ LLC Company) hereby gives the following declarations and undertakings in favour of the Dubai Development
Authority (“DDA”):

1. The Undersigned agrees, confirms and undertakes the following:

1.1 to ensure satisfactory compliance with any or all laws, regulations, guidelines, processes, checklists and
procedures (collectively “DDA Rules”) and its all amendments thereof, so far as the same is applicable to
conducting business in the Zone, with a view to ensuring that there is no breach or infringement of DDA
Rules.
1.2 that the DDA Rules have been carefully reviewed and all information provided in this Application is entirely
accurate and up to date.
1.3 to carry on activities as per the Company AOA and to not carry on any other trading activity without DDA
prior written approval.
1.4 to settle all fee(s) that are applicable as a result of this Application.
1.5 to obtain all requisite approvals, clearances/certificates/sanctions and or NOC from Government Agencies or
from relevant entities (collectively “Approvals”) and to submit the Approvals so obtained to DDA, to the
satisfaction of DDA.

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1.6 To authorise DDA to make any enquiries from any person or entity it may deem necessary in connection
with this Declaration and the information contained in the Application.
2. The Undersigned hereby declares that the “Application Form”, which this Declaration is a part of, contains
accurate, truthful, and complete information. I am aware of all legal consequences in the event the
provided information in the Application Form being deliberately stated incomplete, misleading or untruthful.
I am also aware that providing incomplete, misleading or untruthful information in the document
“Application Form” may result in rejection or revocation and that DDA may withhold its approval for the
Application Form without being required to provide any reason.
3. The Undersigned hereby gives consent to DDA for the processing, preservation and sharing of personal
data submitted in this Application, as and when required.
4. I acknowledge and confirm that DDA may request at its sole discretion any other additional information or
documentation and shall comply with it. Any delay to provide such other documents of information may
have an adverse effect on the outcome of the Application and will delay processing or cancel the
application.
5. I acknowledge that if any documents is required to be duly notarized and attested up to the level of the UAE
Embassy and being submitted in its original form, the Undersigned confirm and undertakes to provide such
documents immediately after initial submission(s) has been approved, or otherwise commit and obligate
itself to submit the aforesaid document(s) within sixty (60) days from the receipt of the initial approval. In
event of failure to do so, the Undersigned acknowledge that DDA may impose restrictions, conditions or
constraints with regard to my Application including without limitation withholding the issuance of the
Company AOA, suspension of license, impose penalties and such other acts which the DDA may deem
reasonable.

6. The Undersigned being the signatory to this document has/have all necessary authority to provide this
declaration and undertaking and the Undersigned has the capacity and authority to make this application
for Incorporation with DDA.

Specimen Signature Card

Name : Position:

Signature:

Name : Position:

Signature:

Name : Position:

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Signature:

Name : Position:

Signature:

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