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CLIENT APPLICATION FORM
(Every beneficial owner must complete a form)
The information provided herein is subject to the confidentiality
provisions of the relevant Panamanian laws
Trust Services, S.A. does not provide either legal or foreign tax advice and this should be obtained from professionals licensed to render such advice before making offshore commitments.
The application cannot be processed until the completed original of this form,
the original copies of the two references and the notarised ID are received and
we reserve the right to reject an application without explanation.
NAME: __________________________________________
ADDRESS: __________________________________________
__________________________________________
TELEPHONE: __________________________________________
TELEFAX: __________________________________________
E-MAIL: __________________________________________
I understand that business cannot be accepted before all preliminary paperwork per page 2 has been provided and I confirm the accuracy of the information given herein and that all assets detailed in section 3 hereof belong to me and no one else. I acknowledge that TRUST SERVICES, S.A. (“the firm”) shall not be responsible unless otherwise provided by the terms of a trust or foundation for any investment decisions made which shall be the sole responsibility of me AND IT IS FURTHER acknowledged herein that I will familiarise myself with the firm’s fee schedules and that I understand that the firm does not receive any commissions or other incentives from third parties (including brokers, bankers and other professionals) and does not offer advice or recommendations of any description whatsoever to its clients in respect of investments or banking and the choice, therefore, of investments, banks, investment professionals or any other professional service providers to be utilised shall be the sole decision and responsibility of me unless otherwise provided for by the terms of a trust or foundation. It is understood that I will be required to sign a Client Agreement, a copy of which appears on the website of the firm, which will be prepared by the firm and without which I cannot be represented.
_______________________________________
Signature
Date: __________________________________
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PURPOSE OF OFFSHORE STRUCTURE:
SOURCE OF ASSETS:
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NOTES
HSBC Bank USA N.A.
140 Broadway
ABA 021001088
Swift MRMDUS33
For credit: HSBC Bank (Panama), S.A.
Torre Hong Kong Bank, Ave. Samuel Lewis
Panama, Republic of Panama.
Account #000141186
For further credit to: OMS Ltd.
Balboa Ave., Panama City, Rep. of Panama
Account: #048-105704-041
Cod. No. 061
Ref: *
*Please use the initials of your name
Courier packages should only be sent to: Edificio Balboa Plaza, Oficina 522, Avenida Balboa, Panama, Republic of Panama. Tel. +507-269-2438.
2 p.m. – 5:00 p.m.