New Corporate Trustee & Trust Order Form

Corporate Trustee Company Name - Option 1

Corporate Trustee Company Name - Option 2

Discretionary Trust Name

Trust Settlement

State of Registration

Principal Place of Business

Party Details - Director / Shareholder / Beneficiary #4 (If Applicable)

Surname

Given Name/s

Former Surname (If Applicable)

Address

Phone

Date of Birth

Place of Birth

Tax File Number

Director ID

As Trustee For (If not Beneficially Held)

Total Amount of Shares

Shares Beneficially Held (Y/N)

Party Details - Director / Shareholder / Beneficiary #1

Surname

Given Name/s

Former Surname (If Applicable)

Address

Phone

Date of Birth

Place of Birth

Tax File Number

Director ID

As Trustee For (If not Beneficially Held)

Total Amount of Shares

Shares Beneficially Held (Y/N)

Party Details - Director / Shareholder / Beneficiary #2 (If Applicable)

Surname

Given Name/s

Former Surname (If Applicable)

Address

Phone

Date of Birth

Place of Birth

Tax File Number

Director ID

As Trustee For (If not Beneficially Held)

Total Amount of Shares

Shares Beneficially Held (Y/N)

Party Details - Director / Shareholder / Beneficiary #3 (If Applicable)

Surname

Given Name/s

Former Surname (If Applicable)

Address

Phone

Date of Birth

Place of Birth

Tax File Number

Director ID

As Trustee For (If not Beneficially Held)

Total Amount of Shares

Shares Beneficially Held (Y/N)