TRUST APPLICATION FORM

If you have decided to establish a Offshore Trust please fill the necessary details in the form below 
and SUBMIT or if you prefer, print filled in form and FAX to one of our fax numbers stated below.

Please give desired name, list 3 in order of preference 

Please cause a Trust to be established under the Law and Forum of
(state preferred jurisdiction)

with Beneficiaries as indicated below:

Dormant - holding shares or assets       Active  

Principal Settlor
Title: Name:

Address

Tel no: Fax no:

Date of birth

Occupation

Nationality

Tel no: Fax no:

Date of birth

Occupation

Nationality

Do you wish Waimea Bay Limited to provide a Protector of the Trust?
Yes No
If "No", please provide the following information regarding your Protector.

Protector Name 


Address 

Telephone number

Fax number


Full details of current  bankers for  reference  purposes


Date of birth


Occupation

Nationality

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

Principal Beneficiary: Title:
Full Name and address

Additional Beneficiaries

Full Name and address


Full Name and address

Full Name and address

• ( note: unless instructed to the contrary the trust will be created with a standard settled amount of cash )

• Standard Settled Amount ( tick if appropriate ) 

• If no, state settled property  

• Please give full description on your wishes regarding the administration of the Trust in so far as it 
  applies to income and capital both during the lifetime of the settlor(s) and after your death.
  
  
• Income under the said trust shall be distributed as follows:
  A. Paid to the beneficiaries monthly quarterly semi-annually annually or
  B. Accumulated and added to capital until notice by Settlor
  

Do you wish us to arrange for one of its Trust companies to act as your Trustee? Yes No

IF "No", please provide the following information regarding your Trustee.

Full name of Trustee


Address 

Telephone number

Fax number

Application for Trust Services

Do you wish Waimea Bay Limited to provide:
( tick as appropriate )

Accountants for your trusts 
Annual Trustee services - dormant Trust/Settlement 
Annual Trustee services - active Trust/Settlement 
Bank account signatories 
Attorney at law for your trust
Investment advisers for your trust

Documents to be forwarded by

Regular Airmail Service Courier Service (Additional Cost of US $60)

13. Method of Payment

Total amount payable: US Dollars

Payment Method: Credit Card. Bank Transfer; Bankers Draft;
Other please specify

Payment by Credit Card
[where this is the method of payment, the following credit card details are required] -

Charge my: Visa card Mastercard American Express Diners card

Name embossed on card:

Card Number:


Starting Date: Expiry Date:

Address to which credit card statements are sent:

Postcode:


Country :

ALTERNATIVE FORMS OF PAYMENT

As an alternative form of payment you could:

(a) Remit the funds to:

Bank Austria AG, Oberer Kirchenplatz 2, 9500 Villach, Austria.
Swift Code: BKAUATWW
US$ Account No: 790 120 266
Account Name: Waimea Bay Limited
Reference: Name of Trust.

Please be sure to inform us in your application or message to us a copy of details of the bank transfer instructions
clearly showing the remitting bank, the name of the account from which the funds were sent, the date of the transfer
and the amount and currency transferred date, your bank should provide this to you. If payment is being made directly
to our bank account then it is important that a reference is made to the proposed trust name so that payments can be correctly identified.

Payment by Bank Transfer [where this is the method of payment, the following details of the payer's account should 
be inserted]
Bank name:
Bank branch:
A/C name:
A/C number:
Date of transfer
Transfer Reference

b) Bank Draft

If you prefer you can send a cheque, Bank Draft or International Money Order to:
Waimea Bay Limited, 3422 Old Capitol Trail, Suite 786, Wilmington, DE 19808, U.S.A.

Please read this carefully!

Clicking on the SUBMIT button below will constitute submission of this form as well as acceptance of Waimea Bay Limited's  Terms & Conditions of Business. Upon receipt of this form, Waimea Bay Limited shall be entitled to act upon 
the instructions contained in it, including any payment instructions. Therefore, the information supplied in this form 
should be carefully checked for correctness before submission. In the case of accidental submission, Waimea Bay Limited should be notified immediately.

Unless a postal response has been requested, the applicant should receive an email or fax confirmation from 
Waimea Bay Limited. within 5 business days after successful submission of this form.

Applicant's Statement

By clicking on the SUBMIT button below,
I submit this form to Waimea Bay Limited in accordance with the above terms.