BOI filing assistance – MASERVIGESTION CORPORATION

BOI filing assistance Form

Please complete the following information.

Legal Business Name

Business Address

Address Line 1

City

State

Zip Code

Email Address

Contact Phone

Entity Type

Please upload Certificate of Formation / Incorporation

Choose File

Doing Business As (DBA) – If Applicable

EIN / FEIN

Please upload IRS EIN / FEIN Confirmation Letter (CP 575 o 147C)

Choose File

First Name

Last Name

Residential Address. If different, please specify

Address Line 1

City

State

Zip Code

If Other, please specify

Officer / Member Full Name

SSN / ITIN ( 999-99-9999)

Any changes made to the company (address, phone, partners)?

Identification Number (Passport or Driver’s License)?

Please upload Government ID all Ownership / Partners

Choose File

Name Ownership / Partners

Address

SSNN

Phone Number

Owner’s Percentage of Ownership

Authorized Person Name

Authorized Person Title

Owner

Member

Manager

President

Authorization Consent

I certify that the information provided is accurate and I authorize MASERVIGESTION CORPORATION to prepare and submit filings on my behalf with IRS, state agencies, and other authorities as required.

First Name

Last Name