Foundation Form

Application Form for Foundation

1. Proposed name of Foundation:
(a Foundation name must end with the word “Foundation” or “Found.” or “Fdn.” as abbreviation thereof) or its equivalent in any language )

Please give two (2) alternative names in order of priority:
(for use in the event that the primary name is unavailable)

Prohibited Names:
Pursuant to the International Foundations Act, no foundation shall be formed under a name that:
(a)contains the words “Building Society”, “Chartered”, “Cooperative”, “Imperial”, “Municipal”, “Royal”, or a word conveying a similar meaning, or any other word that, in the opinion of the Registrar, suggests or is calculated to suggest:
(i) the patronage of Her Majesty or that of a member of the Royal Family; or
(ii) a connection with the Government of Belize or a department, agency, authority or branch thereof, any political party or any university or professional except with the approval of the Registrar in writing;
(b) is indecent, offensive or, in the opinion of the Registrar, objectionable;
(c) contains the words “Assurance”, “Bank”, “Insurance” or “Trust”, or any of their derivatives or cognate expressions, unless it is licensed under an enactment authorising it to carry on such business or activities;
(d) is the same as or similar to the name of any other legal entity registered under the laws of Belize or reserved under this or any other Act, unless such other legal entity consents in writing to the use of that name;
(e) is prohibited by regulations made under this Act or by any other law in force in Belize.

2. Purpose(s) of the Foundation:
(a) Standard Purposes: Yes No 
These purposes are drafted in general terms and are capable of wide application.
(please select appropriate box. Proceed to question 3 if the answer is yes)
(b) Special Purposes:
If non-standard purposes are desired, please provide the relevant details of your specific requirements.

(c) If the Foundation will be engaged in internet activity, please insert all relevant/intended websites/URL addresses:

3. Foundation Council Members:
The minimum number of Foundation Council Members shall be 1. At least 1 Member of the Foundation Council must be a Belize Resident

(a) Will you require Alpha Services Limited to provide 1 Belize Resident Foundation Council Member: Yes No 
(please select appropriate box. Proceed to question 3(b) if the answer is No)
*Only Natural persons may be selected as Resident Members.
*At least 1 Member of the Foundation Council must be a Belize Resident.
*We recommend not less than 4 Foundation Council Members.
(b)(If questions 3(a) do not apply);Please provide us the names, nationalities, addresses and identification of the proposed Foundation Council Members.

Copy the following text below into the text area and fill out; repeat for President, Treasurer and Secretary. ----------------------------------------------------- Position: Name: Address: Nationality: Identification Type: Natural Person | Corporate Entity -----------------------------------------------------  

If Natural Person - provide notarised copies of Passports.
If Corporate Entity - provide notarised copies of Constitutional Documents.
(c) Do you wish the Foundation to have a common seal: Yes No 

4. Signatory Powers to bind Foundation Council Members: (please tick appropriate boxes)
President: Solely Jointly with: 
Treasurer: Solely Jointly with: 
Secretary: Solely Jointly with: 
If there are other instructions, enter them below:

5. Foundation Capital: Yes No 
Unless instructed to the contrary, the Foundation will be established with an initial minimum capital of US$10,000.00. Do you require these standard provisions?
If the answer is No, please provide details below:

6. Protector:
(a) Required? Yes No 
(b) Natural Person (Proceed to question 6(c) if the answer is No) Yes No 
If “Yes” Please provide the following information:

Copy the following text below into the text area and fill out. ----------------------------------------------------- Name: Address: Telephone: Fax Number: E-Mail Address: Notarised copy of Passport sent via email attachment : Yes or No -----------------------------------------------------  

(c) (If questions 6 (b) do not apply)Corporate Entity: Yes No 
If “Yes” Please provide the following information:

Copy the following text below into the text area and fill out. ----------------------------------------------------- Name: Address: Notarised copy of Constitutional Document sent via email attachment : Yes or No Contact Person: Telephone: Fax Number: E-Mail Address: Notarised copy of Passport sent via email attachment : Yes or No -----------------------------------------------------  

(d) Successor Protector required? (Proceed to question 7 if the answer is No) Yes No 
If yes, Upon death, refusal, or inability of the Foundation Protector to act, the Successor Protector shall be as follows:

Copy the following text below into the text area and fill out. ----------------------------------------------------- Name: Address: Telephone: Fax Number: E-Mail Address: -----------------------------------------------------  

7. Powers of Protector (if any): Yes No 
If the answer is Yes, please provide details below:

8. Power of Attorney (if any): Yes No 
If the answer is Yes, please provide details below:

Copy the following text below into the text area and fill out. ----------------------------------------------------- Name: Address: Telephone: Fax Number: E-Mail Address: Notarised copy of Passport sent via email attachment : Yes or No -----------------------------------------------------  

9. Details of Founder:

(a) Copy the following text below into the text area and fill out; repeat as many times as needed. ----------------------------------------------------- Name: Address: Home Telephone: Office Telephone: Fax Number: E-Mail Address: Occupation: Nationality: Date Of Birth: Residence: Notarised copy of Passport sent via email attachment : Yes or No -----------------------------------------------------  

(b) Do you wish to be named as a beneficiary? Yes No 
If the answer is yes, please insert % share of benefit in the Foundation: %.
(c) Do you wish to be irrevocably excluded as a beneficiary? Yes No 
(d). Do you wish your spouse (if any) to be named a beneficiary? Yes No 
If the answer is Yes, please provide details below:

Copy the following text below into the text area and fill out; ----------------------------------------------------- Name: Address: Home Telephone: Office Telephone: Fax Number: E-Mail Address: Occupation: Nationality: Date Of Birth: Residence: Share (in percentage): Notarised copy of Passport sent via email attachment : Yes or No -----------------------------------------------------  

10. Details of Beneficiaries:
Please provide the following information on each Beneficiary of the Foundation, if identifiable.

Copy the following text below into the text area and fill out; repeat as many times as needed. -----------------------------------------------------  Name: Address: Home Telephone: Office Telephone: Fax Number: E-Mail Address: Occupation: Nationality: Date Of Birth: Residence: Relationship: Share (in percentage): Notarised copy of Passport sent via email attachment : Yes or No -----------------------------------------------------  

11. Details of Class of Beneficiaries or Purpose (Charitable or Non-Charitable), etc. Or if the Foundation will have no specific Beneficiaries
Please provide details below.

12. Income under the Foundation shall be distributed as follows:
(i) Quarterly Semi-Annually Annually Other 
(ii)  Accumulated and added to capital until a particular event or events
(ii)  Another way
For any of the above options, (if necessary) please also provide further details below.

13. Upon your death do you wish the Foundation to be:-
(i)  A. Continued
(ii)  B. Continued if the surviving beneficiaries so desire
(iii)  C. Dissolved and the accrued income and capital distributed to the following persons:
Please provide the following information on each Beneficiary of the Foundation, if identifiable.

Copy the following text below into the text area and fill out; repeat as many times as needed. ----------------------------------------------------- Name: Address: Home Telephone: Office Telephone: Fax Number: E-Mail Address: Occupation: Nationality: Date Of Birth: Residence: Relationship (if any): Share (in percentage): Notarised copy of Passport sent via email attachment : Yes or No -----------------------------------------------------  

For any of the above options, (if necessary) please also provide further details below.

14. Special Instructions regarding Foundation Establishment:-
(a) Legalisation (please check the appropriate box)
(i)  Notarization
(ii)  Notarization and Apostille
(iii)  Legalisation by Embassy/Consular Office
(iv)  Any other?
If (iii) or (iv) selected please provide details below:

(b) Indicate which of the following documents you require to be legalised (please check the appropriate box)
(i)  Foundation Charter
(ii)  Foundation Bylaws
(iii)  Any other?
If (iii) is selected please provide details below:

15. Accounting Records: The Company is required to maintain accounting records for a minimum of five (5) years. Indicate the name and address of the place where the accounting records will be kept, whether within or outside of Belize. In the event of a change, you are required to notify us within 14 days of such change, in default your company may be struck from the register.

*Please include the following: Name/Company, Address

16. Communication Details:(Should this information change at any time, please ensure that it is communicated to Alpha Services Limited)
(a) Details of Primary Contact Person (who do you want Alpha Services Limited to contact regarding the affairs of the Foundation and payment of fees, annual or otherwise?)

*Please include the following: Name, Address (include any other if needed)
(b) Alpha Services Limited is requested to communicate using the following methods (please check appropriate box and provide details)
(i)  Mail
(ii)  Telephone
(iii)  Fax
(iv)  Email
Details of selection:

DUE DILIGENCE REQUIREMENTS

Provide a copy of EACH director, shareholder, beneficial owner, member, manager, settlor, trustee, protector, founder and all persons requesting the registration of the Corporation:
I. Notarized copy Passport with picture and signature data pages
II. In the alternative a notarized copy of any government/official issued form of identification with picture and signature
III. In the alternative if a Company will hold any of the above positions, then copy of the Corporate documents, a Certificate of Good Standing and Certificate of Incumbency detailing the directors/officers and shareholders/members of the Company
IV. Recent Utility bill within 3 months
V. Two Character references from an attorney or accountant or business associate which you have done business with for more than 2 years
VI. Bank reference- only if requesting a bank account

*I/We declare and confirm the above information is true and correct and that the company will not be used for money laundering, terrorist activities, or any other illegal activity or in a manner likely to damage the good name of Alpha Services Limited or the jurisdiction of incorporation. I/We acknowledge the requirements of your AML/CFT Compliance Policy and agree to comply therewith. I/We will take independent legal advice before proceeding and I am/We are aware, and intend, to honour my/our legal responsibilities in my/our jurisdiction.

I/We confirm and agree that should any changes occur in the information contained herein I/We will inform Alpha Services Limited.

Signature of Beneficial Founder:
Dated this day of , 20

WIRING INSTRUCTIONS FOR ALPHA SERVICES LIMITED
Bank of America International
100 W. 33rd St.
New York, NY 10001, USA
ABA No: 026-009-593
Swift No. BOFAUS3N
Beneficiary Bank: British Caribbean Bank International Limited
Account No.: 6550-8-260-58 for further credit to Alpha Services Limited A/C #: 200-11-1-3361

For: Insert Invoice Number/Contact Person or Company Name