(For use by sole proprietors, partnerships or associations of…

(For use by sole proprietors, partnerships or associations
of individuals other than corporations)                                    Daytime Telephone No. ________________________


                                                   CERTIFICATE
               For Registration of Trade Name under Title 11, Chapter 21 of the Virgin Islands Code
                                                             -----o-----
To: The Lieutenant Governor of the Virgin Islands

TERRITORY OF THE VIRGIN ISLANDS
JUDICIAL DISTRICT OF ST.____________________________

        The undersigned parties, comprising a co-partnership or an association of individuals other than a
corporation conducting or intending to conduct a business in the Virgin Islands, hereby request that the trade
name set forth below, under which such business shall be conducted, be registered in accordance with the
provisions of Chapter 21, Title 11 of the Virgin Islands Code, and we certify the following:

Print    Trade Name:        ______________________________________________________________________

Print    Nature of Business:          ________________________________________________________________

Print    Location of Business:        ________________________________________________________________

         True and real names of all parties conducting
         or having an interest in the business                                             P.O. Box Address

Print    __________________________________________                        _____________________________________

         __________________________________________                        _____________________________________

         __________________________________________                        _____________________________________

         __________________________________________                        _____________________________________

         __________________________________________                        _____________________________________

         __________________________________________                        _____________________________________

         (Partners or members of the association, residing in the Virgin Islands sign below. Non-resident
         partners or members sign on reverse side of this form.)

Sign     _______________________________________                           _____________________________________

         _______________________________________                           _____________________________________

         _______________________________________                           _____________________________________

Subscribed and sworn to before me this ________ day of ________________________ _______.


                                                                 ___________________________________
*Registered Tradenames must be renewed every 2 years.                         Notary Public
                                                              (Over)
Non-Resident partners or members of association sign below:
STATE OF _____________________________________________ )

COUNTRY OF __________________________________________ )

        The undersigned, non-resident of the Virgin Islands, doing business in the Virgin Islands as partner or
member in the firm under the trade name _________________________________________
________________________________________ hereby subscribes to the certificate on the reserve side of this
form, and appoints _________________________________________________________ a person residing and
having an office or place of business located at ___________________________
__________________________________________________________________________________ as his
agent upon whom process against the undersigned may be served in an action founded upon a liability incurred
in the Virgin Islands.
                                                  ______________________________________________
                                                                       Signature

        Subscribed and sworn to before me this _______ day of _____________________, _________.

                                                    ______________________________________________
                                                                        Notary Public

STATE OF _____________________________________________ )

COUNTRY OF __________________________________________ )

        The undersigned, non-resident of the Virgin Islands, doing business in the Virgin Islands as partner or
member in the firm under the trade name _________________________________________
________________________________________ hereby subscribes to the certificate on the reserve side of this
form, and appoints _________________________________________________________ a person residing and
having an office or place of business located at ___________________________
__________________________________________________________________________________ as his
agent upon whom process against the undersigned may be served in an action founded upon a liability incurred
in the Virgin Islands.
                                                  ______________________________________________
                                                                       Signature

        Subscribed and sworn to before me this _______ day of _____________________, _________.

                                                    ______________________________________________
                                                                        Notary Public

Certificate of county clerk or similar officer must accompany the notary's acknowledgment.

        Section 1204, Title 11 of the Virgin Islands Code provides:

        "A trade name registered in accordance with the provisions of V.I.C. Title 11, Chapter 21 shall not be the
same as nor so similar as to cause confusion with, the trade name of any person, partnership, association or
corporation, foreign or domestic, doing business under such trade name in the Virgin Islands."

        A fee of $25.00 must accompany two originally executed certificates. If the certificates are mailed, attach a
money order or check payable to the "Government of the Virgin Islands", but address the envelop to "Office of the
Lieutenant Governor, Division of Corporation and Trademarks, Kongens Gade No. 5049, St. Thomas, VI 00802".