Authorisation to Setup a New Corporate Trustee

Preferred Company Name:

Office Address:

SHAREHOLDER / DIRECTOR / SECRETARY / PUBLIC OFFICER: (Delete whichever is not applicable)

Given Name: *

Family Name: *

Type of Shares: *

No. of Shares:

Residential Address:

Date of Birth:

Place of Birth:

Beneficially Held: *

TFN: *

Authorisation to register the Corporate Trustee

Trust Name:

State of Incorporation:

New Business (Y/N):

Business Activity:

ABN Registration (Y/N):

(Registration Date):

TFN Registration (Y/N):

Signature: *

Date: