Belize Asset Protection Trust

Please complete the following application with all information that applies to you to order your new trust. If you wish to order more services, you will be given that option after submitting this form.

IMPORTANT: The following application will provide us with enough information to finalize the forms for your trust, therefore saving time in the activation process. Completing this application DOES NOT commit you to the trust, and ALL information is kept confidential and stored on our secure servers for a minimal amount of time.


Contact Information

Business Name (if company)
Contact Title
*Contact Name
*Contact Surname
*Contact E-mail
*Contact E-mail Confirmed
*Telephone
Mobile Telephone
Alternative/Business Telephone
Best Time to Call
Facsimile
*Address
Address
*City
*State/Province
*Postal/Zip Code
*Country
Shipping Information (if different from above)
Name
Address
Address
City
State/Province
Postal/Zip Code
Country
Telephone

Personal Information
Date of Birth (dd/mm/yy)	dd 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 mm 01 02 03 04 05 06 07 08 09 10 11 12 yyyy 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Occupation
Nationality
Domicile
Legal Country of Residence

Name of Trust

Trust Beneficiaries

Do you wish to be named as a beneficiary?

yes no

Do you wish your spouse to be named as a beneficiary?

yes no

*If yes, please complete the Beneficiary (Spouse) section below. If no, skip to the First Additional Beneficiary section.

Inquiry

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