T
Form T pursuant to Art. 41 CDB 16
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Declaration for Trusts
Last name(s), first name(s), Company (Contracting Partner)
Client no.(CIF) or account/safekeeping account number(s)
Pursuant to Art. 41 of the Agreement on the Swiss banks’ code of conduct with regard to the exercise of due diligence
(CDB 16), the undersigned hereby declare(s) that as trustee or a member of the highest supervisory body of an underlying
company of a trust known as:
and, in such capacity, provide(s) the Bank with the following information to the best of his/her knowledge:
1. Name and information pertaining to the trust
(tick the two boxes applicable)
Type of trust:
Discretionary trust
or
Non-discretionary trust
Revocability:
Revocable trust
or
Irrevocable trust
2. Information pertaining to the (ultimate economic, not fiduciary) settlor of the trust (individual(s)
or entity/-ies):
Last name(s)/Company
First name(s)
Date of birth
Date of death (if deceased)
Nationality(-ies)
Domiciliary state (no abbreviations)
Actual residential address/registered office address
In case of a revocable trust: does the settlor have the right to revoke the trust?
Yes
No
To be completed by the Bank
Rel. of Settlor:
Rel. of Beneficiary 1: ____________________________________
____________________________________
Rel. of Beneficiary 2: ____________________________________
Rel. of Beneficiary 3: ____________________________________
01005
Signature and stamp of
Relationship Manager
Client no. (CIF)
134946
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