Acis | Declaration of Trust Order Form

Name

Phone

Firm

E-mail

Company or Trust Details

Company/Trust Name

(include Trust and Trustee details if applicable)

ACN

Trustees (Non Beneficial Owner)

IMPORTANT: Full, verifiable names are required.

Corporate Trustee

(if applicable)

ACN

Officer Names
and Roles

(First Officer listed to be Chairperson, first 2 Officers to be signatories)

DirectorSecretary

Individual Trustee/s

(First person listed to be Chairperson)

Individual Trustee/s

Address

No. of Shares/Units

Class of

Shares/Units

Paid $1.00/Unit

Beneficial Owner

Beneficiary Name

(include Trust and Trustee details if applicable)

Additional Information/Special Instructions