Trust Application Form
Trust NameType of Trust
Jurisdiction
Country of Tax Residency
US FATCA Status
Global Intermediary Identification Number (GIIN) if applicable
Tax Identification Number – if applicable
Date of Settlement
Name(s) of Settlor(s)
Name(s) of Trustee(s)
Names of Beneficiaries
Contact Number
Email Address
Asset(s) to be stored (if known)
Financial Information
The Guernsey Financial Services Commission requires that we take all precautions to prevent the laundering of monies for the purposes of Terrorism or Crime (theHandbook for Financial Services Businesses on Countering Financial Crime and Terrorist Financing and as such Network Securities Ltd is required by Law to determine the source of wealth & funds that you have used to purchase the “Deposit” that is to be stored with Network Securities Limited. We may also at times in the future, at trigger points, be required to request additional information.
Please provide an explanation in relation to the source of funds used to purchase the assets being deposited with Network Securities Limited. Please note we may request documentary evidence to support this. Please refer to Appendix 1 of this Form for instruction on details required.
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Verification of Identity
As with the financial information, in order to be compliant with our local fiduciary authority regulations, we are required to obtain due diligence.
Please provide the following:
· Extract from the Trust Deed confirming legal status, name and date of establishment;
· Proof of Identity and address of the Trustees;
· Proof of Identity and address of the Settlor(s);
· Proof of Identity and address of any Beneficiary with a vested interest/likely to receive benefit.
For each individual, we require the following:
(1) An individual Application Form;
(2) A Certified Copy of current passport or National Identity card;
(3) Original or Certified copy of Proof of Permanent Residential Address (not more than 3 months old).
Authorised examples include:
· Utility Bills (not mobile telephone);
· Personal Tax Assessment;
· Statement of Bank Account/Credit Card Accounts;
· Local Tax Bill.
The documents must be certified by an authorised individual operating in an equivalent jurisdiction to Guernsey. For these purposes, an authorised individual should be one of the following:
Lawyer, Chartered Accountant, Serving Police or Customs Officer, Notary Public ‘Member of Judiciary, Senior Civil Servant, Actuary, an Embassy, Consulate or High Commissioner of the country of issue of the document, Director, Officer or Manager of a regulated financial services business (e.g. Bank Manager).
Additional information may be required in some cases.
In addition to this, the certifier should also provide the following information:
Full Name: ______
Position Held: ______
Telephone Number: ______
Permanent Address: ______
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Business stamp:
Disclaimer / Declaration
By signing and dating this document, you hereby agree to the following:
· All information given by you is true;
· You confirm that you are not involved in any criminal or money laundering activity and the funds used to purchase your deposit are not derived from any illegal activities; and
· You authorise Network Securities Limited to obtain independent verification of any information you have supplied.
Name of Signatory: ______
Position: ______
Signature: ______
Date: ______
Appendix 1 – Guidance for Source of Funds
Savings from Employment Income / · Annual income and bonuses this year and last year
· Nature of Employer’s business
· Employer’s name/address / · Last 3 months pay slips, or
· Confirmation from Employer of income and bonuses for last 2 years, or
· Bank Statements that clearly show receipt of the most recent 3 months regular salary payments from the named employer, or
· Latest accounts if self employed.
Maturing Investments or Encashment Claim / · Amount received
· From which company
· Date received
· How long held / · Letter/contract note from previous investment company giving notification of proceeds of maturing investment/ claim
Share Sale / · Sale value of shares sold
· Description of shares/funds
· How sold (i.e. through stockbroker or bank etc.) and name/address
· Date of sale
· How long each investment held / · Legal sale document(s) (e.g. contract notes)
Property Sale / · Sale value of property sold
· Full address of property sold
· How sold (i.e. through agent, by auction, private sale , including name/address )
· Date of sale
· How long property held / · Signed letter from Solicitor
· Completed sale contract
Company sale or sale of an interest in company / · Name & address of Company
· Total sale price
· Applicant’s share
· Nature of business
· Date of sale / · Signed letter from Solicitor, or
· Signed letter from UK Regulated Accountant, or
· Copy of contract of sale and sight of investment monies on Bank Statement
Inheritance / · Total amount received
· Name of benefactor
· Relationship to benefactor
· Date received / · Grant of Probate (with a copy of the will) which must include the value of the estate, or
· Bank Statements or
· Solicitor’s letter
Loan / · Amount of loan
· Why required
· Name & address of Loan Provider
· Date of loan / · Loan agreement or
· Recent loan statements
Gift / · Total amount
· Details of benefactor
· Reason for gift
· Relationship to benefactor
· Source of donated funds / · Letter from donor confirming details of gift and acknowledging the source of the donated funds
· Based on the SOW specified, the donor needs to provide supporting documentation as per the provisions of this table
Company Profits / · Copy of latest accounts, or
· A letter from a Regulated Accountant giving details of company profits over the last 2 years
Other income sources / · Nature of Income
· Amount
· Date Received
· Received from whom / · Appropriate supporting documentation, or
· Signed letter detailing funds from a Regulated Accountant
Network Securities is registered in Guernsey. No. 49267
Registered Office: Network House, 3 Jubilee Terrace, South Esplanade, St Peter Port, Guernsey, GY1 1AH