ENTERPRISE

For:

FORM "A"

CERTIFICATE
NO....

...............

SOCIAL SECURITY No ......................... .:......

REGISTRATION OF BUSINESS NAMES

REGISTRATION
FEE: #

(b)

BIGGYNET ENTERPRISE
Business Name ............................................................... :....:................;.................................................
GENERAL B I E R C U. T. .
. . . .
General nature of the Business ....................... ........................................... :..................:...........................

(c)

NO 2 I/1Y B
NEAR:IC P O L Y ~ T A E O R m I
Principal Place of Business .........................................................................................................
:........

(a)

(d)

..

:,

...........................................................................................................................................................
.....
Pa 0 ; BOX 23 P. ...............
I(ETAFI ti.. SFscOHBJ
,. .,
Postal Address .......................................
.....................................................................
S A E M A
(i)
DISTRICT ......................................
(ii) REGION ........................................
VESTERN
..
.0246848625
(iii) TEL. No.
....................................
(iv) E-MAE .........................................
FAX

(e)

All other places (if any) at which business is carried on ...........:. ......:... .........................:...........................

(i)

W1SDI.M EHAME AGBOZO

Present &st name and surname ..................................................................................
..;..............

(ii)
(iii)

Any former first name or surname ..:........................ :...:.........i.. ..:.............................:. .................

(iv)

Nationality of origin (if any than above) ...................

Nationality

....GmAXm...............................

Passport No

..............................................

.:. ...:............................................................

.....................................................................................................................................................
m
..............
(v)
SEX ..................................................
(vi) MARITAL STATUS .........%&$?.R&@.
(vii) The usual residence and other business occupation (if any) of the person registering .........:.........
WNOa 2 1/19 B *U1 NEAR I POLY TUORADI
...................................................................................................................................................
i 5 DECBMIBR,
~ ~
,1984
. .
.
(viii) Date of birth ..................................................................
;......................
i .......................
i ....;......-.
30TE
U
C
H
,
2007
:.
Date of commencement of the business ...:.. ...................................................................................... :.....
12TH
APRIL
Dated this .......................................
day of ....................................................
20......
.....................
.

(g)

--

rRtm

.....
mPm

...............

Sig. of Person Registe*

'(See Instruction Ove

f.

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