GAZ
Ý
MA
Ð
USA
SERBEST L
Ý
MAN VE BÖLGES
Ý
FAAL
Ý
YET
MÜRACAAT FORMU
FAMAGUSTA
FREE PORT & ZONE
OPERATION
APPLICATION FORM
Port
Ý
SB
Ý
Cyprus Free Zone & Marine Logistics Services Ltd.
SERBEST BÖLGE VE L
Ý
MAN
Ý
ª
LETMES
Ý
FREE TRADE ZONE & PORT MANAGEMENT
Gazi Ma
ð
usa Serbest Bölge ve Liman
ý
G.Ma
ð
usa - KKTC
Famagusta Free Trade Zone & Port
Famagusta – TRNC
Tel: +(90) 392 365 63 90(Pbx)
Fax:+(90) 392 365 63 95
e-mail: info@portisbi.com
1-FALÝYET RUHSATI TALEP EDENÝN Operation Applicante
TESCÝL EDÝLMESÝ TASARLANAN KURULUªUN Proposed Establishment To be Registred
ADI TELEFON : 365 63 90
Name :……… FAKS : 365 63 95 EMAIL :
ADRESÝ
Adress: MAGOSA SERBEST BÖLGESÝ FALÝYETE GEÇME TARÝHÝ
Proposed Date Of Operation
BÖLGEDE YAPACAÐI FALÝYET Proposed Zone Oprtation
SERMAYESÝ ÖDENMݪ SERMAYÝSÝ ORTAK SAYISI
Authorised Capital Paid-up Capital Number of
Partners
………USD__________________...USD
YERLÝ PAYI YABANCI PAYI
Local Partners Share ______________ Foreign Partners Share
BAªLICA ORTAKLARIN ADLARI UYRUÐU ÖDENMݪ SERMAYE TURAR
Name of Main Partner Nationality Paid-up Capital Amount
(VARSA) KKTC’DEKÝ TEMSÝLCÝNÝN ADI (Ýf any) Representatives Name in TRNC.
PORT ÝSBÝ CYPRUS FREE ZONE MARÝNE & LOGÝSTÝC SERVÝCE LTD. ADRESÝ
Adress
MAÐUSA SERBEST BÖLGE
TELEFON 365 63 90 PHONE
FAKS 365 63 95 FAX
VARSA ANA ªÝRKETÝN ADI (If any) Home Company’s Name ADRESÝ
Adress
ANA FALÝYET Main Line Of Business
TELEFON: PHONE FAXS FAX EMAIL
KURULUª YILI SERMAYESÝ ÖDENMݪ SERMAYE
Year of Establishment Authorised Capital Paid-up Capital
___________________ ________________ ____________________
VARSA KENDÝSÝNÝN, ORTAKLARININ KKTC VE/VEYA DÝÐER SERBEST BÖLGE VEYA ÜLKELERDEKÝ FAALÝYETLERÝ
(If any) Applicant’s and/or Partners Operation in TRNC Or Any Other Free Zones or Countries
FALÝYET KONULARI ÜLKE BÖLGE ADI YATIRIM TUTARI(ABD$) Activities Country Name of Zone Investment Amount (US$)
2-YAPMAK ÝSTEDÝÐÝNÝZ BÖLGE FAALÝYETÝ (UYGUN KARELERÝݪARETLEYÝNÝZ) Proposed Zone Operation ( Mark Relevant Boxes)
ÜRETÝM X Production ALIM, SATIM X Purchasing, Selling DEPOLAMA X Storing
AMBALAJLAMA, ETÝKETLEME, MARKALAMA X Packing, Labelling, Marking
MONTAJ, DEMONTAJ X Assembling, Disassembling BAKIM, ONARIM X Repair, Maintenance MAKÝNE PARKI X Machinery Parking
TÝCARÝ VE SINAÝ GÖZETÝM G
Survey
BANKACILIK G
Banking
SÝGORTACILIK G
Insurance
DÝÐERLERÝ ( AªAÐIDA BELÝRTÝNÝZ) G
Other (Specify Below)
3- TALEP EDÝLEN ALAN Required Area
ÝNªAATIN TABAN ALANI (M )2 Base Area Of the Construction (m2)
TALEP EDÝLEN AÇIK ALAN (M ) 500M22 Reguired Open Areas (M )2
ÝNªAATIN KAT SAYISI
Number of Floors 1 KAT
ÝNªAATIN TÝPÝ SUNDURMA Type Of Construction
4- TALEP EDÝLEN OFÝS VE ݪYERÝ
TALEP EDÝLEN OFÝS SAYISI
Number of Required Office _____________________ KAPALI AÇIK
Closed Open
TALEP EDÝLEN ALAN (M )2
Required Area (M )2 ______________________________________________
5- YATIRIM HARCAMALARI (CARÝ YIL FÝYATLARI ÝLE) Investment Expenditures (In Current Years Prices)
YAPILACAK ÖDEMELER (ABD $) Payments To Be Made (US $)
KKTC’YE To TRNC DIªARIYA Abroad BÝNA USD Construction
MAKÝNE, TEÇHÝZAT USD Machinery and Equipment
ݪ GÜCÜ Manpower DÝÐERLERÝ USD Others TOPLAM Total USD TAHMÝNÝ DÖVÝZ YATIRIM TUTARI
The Estimated Amount of Foreign Currency to be Invested ___________________________
6- ORTALAMA YILLIK ݪLETME HARCAMALARI (CARÝ YIL FÝYATLARI
ÝLE)
Average Annual Operating Expenditures (In Current Year’s Prices) YAPILACAK ÖDEMELER (ABD $)
Payments To Be Made (US $) KKTC’YE
To TRNC DIªARIYA Abroad
HAMMADDE VE ARA MALLARI Raw and Intermediate Goods
ݪGÜCÜ Manpower
KREDÝ, ANA PARA VE FAÝZ Credit, Pricipal And Interest GAYRÝ MADDÝ HAKLAR Intangible Rights KÝRA Rent SÝGORTA Insurance DÝÐERLERÝ Others TOPLAM Total
7- ÝHTÝYAÇLAR Requirements SU Water _________________X_________________________ M /GÜN3 M /Day3 ELEKTRÝK KWA Elektricity ________X______________________________ KWA TELEFONLAR ADET Phones _________________________________________Unit TELEKS ADET Telex __________________________________________ Unit FAX ADET Fax ___________________________________________ Unit 8- ORTALAMA YILLIK ÝSTÝHDAM
Average Annual Expendiare
KKTC UYRUKU Citizen YABANCI Foreign TOPLAM Total YÖNETÝCÝ Administrators BÜRO PERSONELÝ Office Personnel VASIFLI ݪCÝ Quailified Workers
TOPLAM Total
9- FAALÝYETÝNÝZLE ÝLGÝLÝ ÇEVRE KÝRLÝLÝÐÝNÝ NASIL ÖNLEYECEKSÝNÝZ. AÇIKLAYINIZ.
Describe how you intend to prevent Environmental pollution ÇED RAPORU ÇERÇEVESÝNDE FAALÝYET GÖSTERECEKTÝR
10- BÖLGE FAALÝYETÝ VE TAMAMLAYICI ݪLEMLER Zone Operation and complementry Activities
10-1. ÜRETÝM Production
ÜRETÝM METODUNUZU VE/VEYA ݪLEMLERÝNÝ AKIM ªEMASI ÝLE/ AÇIKLAYINIZ (EK 12.2)
Describe your production process and/or Methods with a Folwchart (Enc. 12.2)
ÜRETÝM LÝSANS ALTINDA MI? (PATENT, MARKA VB) Production Under Licence? (Patent, trademark etc.)
HAYIR G No EVET G Yes NUMARASI Number ______________________________________
LÝSANS ANLAªMASI HAKKINDA KISA BÝLGÝ
Brief Description of the Licence Agreement ________
_____________________________________________
ORTALAMA YILLIK ÜRETÝM Averange Annual Procuntion
MÝKTAR Quantity DEÐER
Value
ÜRETÝLECEK BAªLICA MALLAR
TOPLAM Total 10-2. ALIM SATIM Purchasing 10-2.1 SATIN ALMA Purchasing ORTALAMA YILLIK Annual Averge KKTC’DEN From TRNC
From Abroad MÝKTAR DEÐER (ABD$ MÝKTAR DEÐER (ABD$ 10-2.2 SATIª Selling
SATILACAK BAªLICA MALLAR Main Goods To Be Sold
ORTALAMA YILLIK Annual Average KKTC’YE To TRNC DIªARIYA (ÝHRACAT) Abroad (Export) MÝKTAR Quantity DEÐER (ABD$) Value (US$) MÝKTAR Quantity DEÐER (ABD$) Value (US$) 10-.-3. DEPOLAMA
Storage DEPONUN CÝNSÝ Storage Type AÇIK Open KAPALI Close SOÐUK HAVA Cold Storage DÝÐER (AÇIKLAYINIZ) Other (Specify)
DEPOLANACAK BAªLICA MALLAR Main Goods To Be Stored
10-4. AMBALAJLAMA /ETÝKETLEME/MARKALAMA Packing/Labelling/Marketing
AMBALAJLANACAK/ETÝKETLENECEK/MARKALANACAJ MALLAR Goods To Be Packed/Labelled/Marked
ORTALAMA YILLIK MÝKTAR Annual Average Quantity
_____________________________
10-5. MONTAJ DEMONTAJ Assembling, Dessasembling
MONTAJI, DEMINTAJI YAPILACAK MALLAR ORTALAMA YILLIK MÝKTAR Goods To Be Assembled, Disassembled Annual Averge Quantity
_________________________________________ ___________________________
10-6. BAKIM, ONARIM Repair, Maintenance
BAKIM, ONARIM YAPILACAK MALLAR ORTALAMA YILLIK MÝKTAR Goods To Be Repaired, Maintained Annual Average
Quantity
_____________________________________ ___________________________
10-7. MAKÝNE PARKI Machiney Parking
PARK EDÝLECEK MAKÝNE ORTALAMA YILLIK MÝKTAR EN AÐIR MAKÝNA TONAJI Machinery To Be Parked Annual Average Quantity Weight Of the Heaviest Machine _____________________ ___________________________ ___________________________
11- BU FORMADAKÝ VE EKLERÝNDEKÝ MEVCUT DURUMLA ÝLGÝLÝ BÜTÜN BÝLGÝLERÝN DOÐRU OLDUÐUNU VE BU FORMDA BELÝRTTÝÐÝM HUSUSLARI YASA VE TÜZÜK HÜKÜMLERÝNE GÖRE YERÝNE GETÝRECEÐÝMÝ BEYAN EDERÝM VE TAAHHÜT EDERÝM.
I hereby Declare And Certify that All Information Given in this form and its Enclosure is Correct and all particulars will be accomplised in compliance with the Law and the provision of the Requlations.
ADI TARÝH
Name:……….. Date (Day7Month/Year) : .04.2013
GÖREVÝ YETKÝLÝ ÝMZA
Title :………….. Authorised Signature _____________________
ADRESÝ TELEFONLAR
Address: Phones : 365 63 90
KÝMLÝK/PASAPORT NO. FAKS
Identity/Passport No KKNO: 199127 Fax : 365 63 95 12- EKLER
Enclosures
EKLERÝN TOPLAM SAYFA ADEDÝ ... Total Number of Enclosed Sheets ... 12-1. ÝMZA SAHÝBÝNÝN YETKÝ BELGESÝ, ÝMZA SÝRKÜLERÝ
Power Of Attorney of the signatory
11-2. FÝRMA VE BÖLGEDEKÝ FAALÝYETÝ ÝLE ÝLGÝLÝ TANITICI BÝLGÝ Descriptive Information on the firm and ts Operation in the Zone. 11-3. TAMAMLAYICI BÝLGÝLER