Authorized By Date Received Reference

For Official Use

Trusts (Amendment) Act, 2013

(No. 16 of 2013)

Application for
REGISTRATION OF A DOMESTIC TRUST

NOTES:

1. Complete all sections as fully as possible.

2. Completed application form and supporting documentation, such as a

certified copy of the trusts instrument, together with the appropriate
registration fee, should be submitted to:

THE REGISTRAR OF THE SUPREME COURT

Domestic Trust Registry
Supreme Court of Belize Registry
Treasury Lane
Belize City, Belize, C.A.
Telephone: 501-227-0045 Fax: 501-227-0553
Email: legalsecretary@belizejudiciary.org

I. Name of the trust

______________________________________________________________________________

II. Date of settlement of the trust or declaration of trust

______________________________________________________________________________
III. Name(s) of the settlor(s)

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

IV. Name(s) of the trustee(s)

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

V. Documents submitted with the application:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

VI. State below any other material information which you consider relevant to the registration of
the trust.

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

VII. I undertake to inform the Registrar forthwith of any material change to the information
supplied on this form.

Name (block capitals)

______________________________________________________________________________

Capacity
______________________________________________________________________________
(State whether applying as a settlor, trustee or authorized agent)

Signed __________________________________ Date _________________________________

N.B.
It is an offence to give any false or misleading information.

Amount enclosed .................................................................................BZD $ _________________