The document appears to be a registration and licensing application form for Dubai World Central. It requests information such as company name, required business activities, capital investment amount, owner/shareholder/director details, and services required. The form is to be filled out and signed by the authorized applicant to apply for various licenses and registration needs.

1. P.O. Box 282228, Dubai, United Arab Emirates Tel: +9714 8141 111 Fax: +9714 8141 366 Email: license@dwc.ae
(Dubai World Central - L L C) (‫م‬ ‫م‬ ‫ذ‬ - ‫ﺳـﻨـﺘـــــــﺮال‬ ‫ورﻟــــــــﺪ‬ ‫)دﺑـﻲ‬
Registration & Licensing Application ‫اﻟﺘـــﺮﺧــﻴــــــــﺺ‬ ‫و‬ ‫اﻟﺘـــﺴـــــﺠـــﻴــــــﻞ‬ ‫إﺳـــﺘــــــﻤـــــــــﺎرة‬
‫اﻟﺸــــــﺮﻛــــﺔ‬ ‫إﺳــــــــﻢ‬Company Name
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‫اﳌﻄﻠـــﻮﺑـــﻪ‬ ‫اﻻﻧــﺸـــﻄـــﻪ‬ ‫وﺻــﻒ‬Required Activity Description
‫اﻟﻨﺸﺎط‬ ‫رﻣﺰ‬
Activity Code
‫اﻟﻨﺸﺎط‬
Activity
‫ﺣﺬف‬ ‫إﺿﺎﻓﺔ‬
Add/Delete
Invested Capital (In AED)
(min 300,000 AED)
:‫ﺑﺎﻟﺪرﻫﻢ‬ ‫اﳌﺴﺘﺜﻤﺮ‬ ‫ﻣﺎل‬ ‫رأس‬
‫درﻫﻢ‬ 300,000 ‫اﻻدﻰﻧ‬ ‫اﻟﺤﺪ‬ Fax:
Email: :‫اﻻﻟﻜﱰوﻲﻧ‬ ‫اﻟﱪﻳﺪ‬
:‫ﻓﺎﻛــﺲ‬
Tel:
PO Box:
:‫ﻫﺎﺗﻒ‬
:‫ب‬ ‫ص‬
‫اﻻﺳﻢ‬
Name
‫اﻟﻌﻨﻮان‬
Address
‫إﺿﺎﻓﺔﺣﺬف‬
Add/Del
‫اﻟﺘﺎرﻳﺦ‬
Date
‫اﻟﺘﻮﻗﻴﻊ‬
Signature
‫اﳌﺘﺤﺪة‬ ‫اﻟﻌﺮﺑﻴﺔ‬ ‫اﻹﻣﺎرات‬ ‫دوﻟﺔ‬ ‫ﰲ‬ ‫ﻟﻠﻤﻘﻴﻤﻦﻴ‬ ‫ﻓﻘﻂ‬ - ‫اﻟـﻌــــﺎم‬ ‫اﳌــﺪﻳــــﺮ‬General Manager (must be UAE resident)
Other
‫ﻧﺸﺎط‬ ‫ﺣﺬف‬
Cancelling Activity
‫ﻧﺸﺎط‬ ‫إﺿﺎﻓﺔ‬
Adding Activity
‫اﻟﻌﺎم‬ ‫اﳌﺪﻳﺮ‬ ‫اﻟﺴﻜﺮﺗﺮﻴ‬ ‫اﻻدارة‬ ‫ﻣﺠﻠﺲ‬ ‫أﻋﻀﺎء‬ ‫ﺗﻐﻴﺮﻴ‬
Change of Directors / Secretry / General Manager
‫اﻟﺘﺴﺠﻴﻞ‬ ‫إﻟﻐﺎء‬
Registration Cancellation
‫ﴍﻛﺔ‬ / ‫ﺗﺠﺎري‬ ‫اﺳﻢ‬ ‫ﺗﻐﻴﺮﻴ‬
Changing Trade/Co. Name
‫اﳌﺎل‬ ‫رأس‬ ‫ﺗﻐﻴﺮﻴ‬
Change of Capital
‫ﴍﻳﻚ‬ ‫اﻧﺴﺤﺎب‬
Withdrawal of Partner
‫ﴍﻳﻚ‬ ‫إﺿﺎﻓﺔ‬
Adding Partner
‫ﺟﺪﻳﺪ‬ ‫ﺗﺴﺠﻴﻞ‬
New Registration
Services Required ‫اﳌﻄﻠـﻮﺑـﻪ‬ ‫اﻟﺨـﺪﻣـﻪ‬ ‫ﻧــﻮع‬
‫اﻟﻮﺣﺪة‬ ‫ﻧﻮع‬Unit Type
Warehouse
Smart (Desk/Office)
Plots (AC/DLC) Office - Business Park
Permanent (Desk/Office) Retail - Business Park Other

2. P.O. Box 282228, Dubai, United Arab Emirates Tel: +9714 8141 111 Fax: +9714 8141 366 Email: license@dwc.ae
‫اﻻﺳﻢ‬
Name
‫اﻟﻌﻨﻮان‬
Address
‫اﻻﺳﻬﻢ‬ ‫ﻋﺪد‬
No. of Shares
‫إﺿﺎﻓﺔﺣﺬف‬
Add/Del
‫اﻟﺘﺎرﻳﺦ‬
Date
‫اﻟﺘﻮﻗﻴﻊ‬
Signature
Authorized Signatory ‫ﺑﺎﻟﺘﻮﻗﻴﻊ‬ ‫اﳌﻔﻮض‬
‫اﻻﺳﻢ‬
Name
‫اﻟﻌﻨﻮان‬
Address
‫إﺿﺎﻓﺔﺣﺬف‬
Add/Del
‫اﻟﺘﺎرﻳﺦ‬
Date
‫اﻟﺘﻮﻗﻴﻊ‬
Signature
Board of Directors ‫اﻹدارة‬ ‫ﻣﺠــﻠـــﺲ‬ ‫أﻋـــﻀــــﺎء‬
Secretary ‫اﻟﺴـــﻜـــﺮﺗــﻴــﺮ‬
‫اﻻﺳﻢ‬
Name
‫اﻟﻌﻨﻮان‬
Address
‫إﺿﺎﻓﺔﺣﺬف‬
Add/Del
‫اﻟﺘﺎرﻳﺦ‬
Date
‫اﻟﺘﻮﻗﻴﻊ‬
Signature
Registration & Licensing Approval ‫اﻟــﺘــﺮﺧﻴـــﺺ‬ ‫و‬ ‫اﻟﺘــﺴــﺠـﻴـﻞ‬ ‫ﻣــﻮاﻓــﻘــﺔ‬
:‫اﻻﺳــﻢ‬Name:
:‫اﻟﺘﺎرﻳﺦ‬Date:‫اﻟﺘﻮﻗﻴﻊ‬Signature:
‫اﻟﺘﺎرﻳﺦ‬
Date
‫ﻟﻠﻤﻨﺪوب‬ ‫اﳌﺘﺤﺮك‬ ‫اﻟﻬﺎﺗﻒ‬
PRO Mob
‫ﻟﻠﻮﻛﻴﻞ‬ ‫اﳌﺘﺤﺮك‬ ‫اﻟﻬﺎﺗﻒ‬
Agent Mob
‫ﻟﻠﺎﻤﻟﻚ‬ ‫اﳌﺘﺤﺮك‬ ‫اﻟﻬﺎﺗﻒ‬
Owner Mob
‫اﻟﺘﻮﻗﻴﻊ‬
Signature
‫ااﻷﺳﻢ‬
Name
and I hereby declare that the information in this form is true and correct as at
the date of signature.
‫اﻟﺘﻮﻗﻴﻊ‬ ‫ﺗﺎرﻳﺦ‬ ‫ﰲ‬ ‫ﻫﻮ‬ ‫ﻛﺎﻤ‬ ‫ﺻﺤﻴﺤﺔ‬ ‫اﻟﻨﻤﻮذج‬ ‫ﻫﺬا‬ ‫ﰲ‬ ‫اﻟﻮاردة‬ ‫اﳌﻌﻠﻮﻣﺎت‬ ‫ﺑﺄن‬ ‫أﴏح‬ ‫وأﻧﺎ‬
‫اﻧﻨﻲ‬ ‫أﻗﺮ‬ ‫أﻧﺎ‬‫ﻣﺮﻓﻖ‬ - ‫اﻟﻮﻛﺎﻟﺔ‬ /‫اﻟﻘﺮار‬ ‫ﻤﺑﻮﺟﺐ‬ ‫اﻟﻄﻠﺐ‬ ‫ﻣﻘﺪم‬ ‫ﻗﺒﻞ‬ ‫ﻣﻦ‬ ‫ﻣﺨﻮل‬
authorized by the applicant by resolution/POA (Enclosed)
‫اﻟﻄﻠﺐ‬ ‫ﻣﻘﺪم‬
the applicant
I confirm that I am ;
‫اﳌﺴـــﺎﻫــﻤــﻴــﻦ‬Shareholders