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Foundation Application Form - Helm Trust Company Limited

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PART B ‐ DETAILS ABOUT FOUNDER(S) / ULTIMATE CLIENT(S)<br />

1. Client Identification:<br />

We are required to verify the identity of all Founders, <strong>Foundation</strong> Council Members,<br />

Guardians, Beneficiaries and External parties. Our requirements are detailed in the last<br />

two pages of this <strong>Application</strong> <strong>Form</strong>.<br />

2. Details of Founder(s) / Ultimate Client:<br />

(Please photocopy this page before completion and use further copies if more than one<br />

Founder / Ultimate Client) and describe the nature of the relationship between them.<br />

Full Name:<br />

_______________________________________________________<br />

Residential Address (permanent physical address, P.O. Box is not acceptable):<br />

House Name: ____________________________________________________________________<br />

Street___________________________________________________________________________<br />

Town___________________________________________________________________________<br />

Post code__________________ Country___________________________________________<br />

Telephone:<br />

Facsimile:<br />

Home ___________________ Office: _____________________________<br />

Home ___________________ Office: _____________________________<br />

Mobile: ________________________________________<br />

Email address: ____________________________________________________________________<br />

Nature of relationship with other Founder (as applicable) ________________________<br />

________________________________________________________________________________<br />

________________________________________________________________________________<br />

Address for correspondence (if different to above):<br />

Name: _____________________________________________________________<br />

Address: ___________________________________________________________<br />

__________________________________________________________________<br />

__________________________________________________________________<br />

Telephone: _________________________________________________________<br />

Facsimile___________________________________________________________<br />

Please attach a certified true copy of Founder’s passport:<br />

Please refer to the last two pages of this <strong>Application</strong> <strong>Form</strong> for full details of our Client<br />

Due Diligence requirements<br />

<strong>Foundation</strong> application form – Aug 2012<br />

7

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