Trust Application Form
Trust Name
Type of Trust
Jurisdiction
Country of Tax
Residency
US FATCA Status
Global Intermediary
Identification Number
(GIIN) if applicable
Tax Identification
Number – if applicable
Date of Settlement
Name(s) of Settlor(s)
Name(s) of Trustee(s)
Names of Beneficiaries
Contact Number
Email Address
Asset(s) to be stored
(if known)
Financial Information
The Guernsey Financial Services Commission requires that we take all precautions to prevent
the laundering of monies for the purposes of Terrorism or Crime (the Handbook for Financial
Services Businesses on Countering Financial Crime and Terrorist Financing and as such Network
Securities Ltd is required by Law to determine the source of wealth & funds that you have used
to purchase the “Deposit” that is to be stored with Network Securities Limited. We may also at
times in the future, at trigger points, be required to request additional information.
Please provide an explanation in relation to the source of funds used to purchase the assets
being deposited with Network Securities Limited. Please note we may request documentary
evidence to support this. Please refer to Appendix 1 of this Form for instruction on details
required.
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Network Securities is registered in Guernsey. No. 49267
Registered Office: Network House, 3 Jubilee Terrace, South Esplanade, St Peter Port, Guernsey, GY1 1AH
Verification of Identity
As with the financial information, in order to be compliant with our local fiduciary authority
regulations, we are required to obtain due diligence.
Please provide the following:
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Extract from the Trust Deed confirming legal status, name and date of establishment;
Proof of Identity and address of the Trustees;
Proof of Identity and address of the Settlor(s);
Proof of Identity and address of any Beneficiary with a vested interest/likely to receive
benefit.
For each individual, we require the following:
(1)
(2)
(3)
An individual Application Form;
A Certified Copy of current passport or National Identity card;
Original or Certified copy of Proof of Permanent Residential Address (not more
than 3 months old).
Authorised examples include:
 Utility Bills (not mobile telephone);
 Personal Tax Assessment;
 Statement of Bank Account/Credit Card Accounts;
 Local Tax Bill.
The documents must be certified by an authorised individual operating in an equivalent
jurisdiction to Guernsey. For these purposes, an authorised individual should be one of the
following:
Lawyer, Chartered Accountant, Serving Police or Customs Officer, Notary Public ‘Member of
Judiciary, Senior Civil Servant, Actuary, an Embassy, Consulate or High Commissioner of the
country of issue of the document, Director, Officer or Manager of a regulated financial services
business (e.g. Bank Manager).
Additional information may be required in some cases.
Network Securities is registered in Guernsey. No. 49267
Registered Office: Network House, 3 Jubilee Terrace, South Esplanade, St Peter Port, Guernsey, GY1 1AH
In addition to this, the certifier should also provide the following information:
Full Name: _____________________________________________________________________
Position Held: ___________________________________________________________________
Telephone Number: ______________________________________________________________
Permanent Address: _____________________________________________________________
______________________________________________________________
Business stamp:
Disclaimer / Declaration
By signing and dating this document, you hereby agree to the following:
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All information given by you is true;
You confirm that you are not involved in any criminal or money laundering activity and
the funds used to purchase your deposit are not derived from any illegal activities; and
You authorise Network Securities Limited to obtain independent verification of any
information you have supplied.
Name of Signatory: ______________________________________________________________
Position: _______________________________________________________________________
Signature: ______________________________________________________________________
Date: __________________________________________________________________________
Network Securities is registered in Guernsey. No. 49267
Registered Office: Network House, 3 Jubilee Terrace, South Esplanade, St Peter Port, Guernsey, GY1 1AH
Appendix 1 – Guidance for Source of Funds
Categories
Details Required
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Savings from Employment Income
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Annual income and bonuses this year and last
year
Nature of Employer’s business
Employer’s name/address
Additional Documents potentially required
(depending on value)
 Last 3 months pay slips, or
 Confirmation from Employer of income
and bonuses for last 2 years, or
 Bank Statements that clearly show receipt
of the most recent 3 months regular salary
payments from the named employer, or
 Latest accounts if self employed.
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Letter/contract note from previous
investment company giving notification of
proceeds of maturing investment/ claim
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Legal sale document(s) (e.g. contract
notes)
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Amount received
From which company
Date received
How long held
Sale value of shares sold
Description of shares/funds
How sold (i.e. through stockbroker or bank
etc.) and name/address
Date of sale
How long each investment held
Sale value of property sold
Full address of property sold
How sold (i.e. through agent, by auction,
private sale , including name/address )
Date of sale
How long property held
Signed letter from Solicitor
Completed sale contract
Company sale or sale of an interest in
company
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Name & address of Company
Total sale price
Applicant’s share
Nature of business
Date of sale
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Signed letter from Solicitor, or
Signed letter from UK Regulated
Accountant, or
Copy of contract of sale and sight of
investment monies on Bank Statement
Inheritance
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Total amount received
Name of benefactor
Relationship to benefactor
Date received
Loan
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Amount of loan
Why required
Name & address of Loan Provider
Date of loan
Gift
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Total amount
Details of benefactor
Reason for gift
Relationship to benefactor
Source of donated funds
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Copy of latest accounts, or
A letter from a Regulated Accountant giving details of company profits over the last 2 years
Nature of Income
 Appropriate supporting documentation, or
Amount
 Signed letter detailing funds from a
Date Received
Regulated Accountant
Received from whom
Maturing Investments or Encashment Claim
Share Sale
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Property Sale
Company Profits
Other income sources
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Grant of Probate (with a copy of the will)
which must include the value of the estate,
or
Bank Statements or
Solicitor’s letter
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Loan agreement or
Recent loan statements
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Letter from donor confirming details of gift
and acknowledging the source of the
donated funds
Based on the SOW specified, the donor
needs to provide supporting
documentation as per the provisions of this
table
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Network Securities is registered in Guernsey. No. 49267
Registered Office: Network House, 3 Jubilee Terrace, South Esplanade, St Peter Port, Guernsey, GY1 1AH