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: