NEW DISCRETIONARY TRUST DETAILS FORM

We kindly ask that you consider the following questions and provide your instructions.

* NOTE: all fields are required to be completed

What is the preferred name for your new trust?

What is your full name (including middle name, if applicable)?

What is your residential address?

Who is the trustee of the trust? This may be an individual or a company.

Will you be the appointor of the trust?

Yes No

If no, who will be the appointor of the trust?*

Will you be the named beneficiary of the trust?

Yes No

If no, who will be the named beneficiary of the trust?*

In what State or Territory is the trust to be formed?