Application

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APPLICATION FOR TRUST

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(IPC accepts payment by Wire Transfer, Check or Money Order)

Desired Name of Trust - In order of preference:

#1

#2

#3

#4

Reason for Trust Formation:

Applicant Details - Please Print:

Full Name

Former Name

Nationality

Occupation

Address (street)

Address (city, state, country)

Fax

Telephone

E-Mail

Identification

Settlor Details

Athena to supply a "Foreign Settlor"
Yes
No
Please complete below if you will supply the Settlor:

Settlor Details - Please Print:

Full Name

Former Name

Nationality

Occupation

Address (street)

Address (city, state, country)

Fax

Telephone

E-Mail

Identification

Due Diligence

Please provide an original written reference from a bank or similar financial institution who has known the applicant at least two (2) years.

Trustee Details

Athena to supply a "Trustee Company"
Yes
No
Please complete below if you will supply the Settlor:

Trustee Details - Please Print:

Full Name

Former Name

Nationality

Occupation

Address (street)

Address (city, state, country)

Fax

Telephone

E-Mail

Identification

Co-Trustee or Successor-Trustee Details

Full Name

Former Name

Nationality

Occupation

Address (street)

Address (city, state, country)

Fax

Telephone

E-Mail

Identification

Income of Trust

Do you wish to be named beneficiary? Yes No

Do you wish to be irrevocably excluded as a beneficiary? Yes No

Do you wish your spouse (if any) to be named beneficiary? Yes No

Parties to Benefit

Please provide all beneficiary information below - this information is for completion of Trust. The individuals will not be contacted except as outlined in the Trust Settlement

Beneficiary 1

Full Name

Relationship

Nationality

Occupation

Address (street)

Address (city, state, country)

Fax

Telephone

E-Mail

Date of Birth

Beneficiary 2

Full Name

Relationship

Nationality

Occupation

Address (street)

Address (city, state, country)

Fax

Telephone

E-Mail

Date of Birth

Beneficiary 3

Full Name

Relationship

Nationality

Occupation

Address (street)

Address (city, state, country)

Fax

Telephone

E-Mail

Date of Birth

Desired Name of International Business Company (IBC)

#1

#2

#3

#4

PLEASE READ & SIGN THIS AUTHORIZATION
AND RETURN BY FAX OR MAIL

I certify that the information I have provided above is true and accurate. I acknowledge that that I have not been offered nor received legal, tax or accounting advice and agree that I will obtain my own legal and tax advice from a qualified professional (or to assume, the risk of not doing so) in regard to the establishment of a Belize Trust, its use and/or the use of the services of Athena Trust Services Limited. or its associates or agents. I understand that the formation of this Company may have tax and legal reporting implications for me personally.

I also declare and confirm that the Trust & IBC will not be used for money laundering, terrorist activities, receiving or utilizing the proceeds of drug trafficking, soliciting funds from the general public, offering investment advice to the general public, the operation and administration of collective investment schemes, or any other purpose which is illegal under the place of incorporation or management.

Signature of Applicant

Date

Name of Applicant

**These forms must accompany the application (for both corporate due diligence and banking requirements)

1.) A  notarized copy of your Passport or other form of government issued photo identification must accompany the application.

2.) A copy of an Utility Bill (e.g. - gas, water, electric, etc.) showing name and address.

3.) An original Bank Reference Letter (email IPC for "Sample")

4.) A Second Professional Reference Letter (Lawyer or Accountant preferred - showing time of association and that the relationship is good)

TO FORWARD APPLICATION

(NOTE: Fax application to reserve company name first - then follow up with original by OVERNIGHT COURIER or EXPRESS MAIL)

FORWARD THIS COMPLETED APPLICATION ALONG WITH FULL PAYMENT OF $ 4,500 US. MAKE CHECK OR MONEY-ORDER PAYABLE TO "IPC". DO NOT SEND CASH.

YOUR COMPLETED TRUST WILL BE SENT BY FEDERAL EXPRESS OVERNIGHT COURIER.

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Please note...
IPC Corporate Services LLC does not render any
legal, tax or accounting advice
whatsoever

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