BENEFICIARY DESIGNATION LETTER
(To be completed and signed by the client and signature to be verified by a Notary Public)
TO
Caye International Bank, Ltd.
P.O. Box 11, Coconut Drive, San Pedro Town
Ambergris Caye, Belize
From: _______________________________________________________________
(full name(s) of account holder(s) as shown on their account)
_______________________________________________________________
_______________________________________________________________
(complete address)
_______________________________________________________________
_______________________________________________________________
(date(s) of birth)
Re: Beneficiary Instructions for Account No. ________________________
Dear Sirs:
1. These instructions refer solely to account no.__________________even if I should hold,
now or in the future, other accounts with Caye International Bank Ltd.
2. I hereby declare to you that I am a non-Belizean citizen, that I have no place of
residence in Belize and that I am not residing in Belize; I also confirm to you that I am
the sole/joint owner of the above specified account. Should any of this change, I will
inform you immediately.
3. I herewith instruct you that, irrespective of my unrestricted right to handle and dispose
of the account during my lifetime, the beneficiary(ies)of this account shall be:
________________________________________________________________________
(complete names of beneficiary(ies)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
(complete address(es) of beneficiary(ies)
-_______________________________________________________________________________________________
_______________________________________________________________________________________________
(telephone and fax numbers of all beneficiary(ies)
_______________________________________________________________________________________________
(place and date of birth of all beneficiary(ies)
4. I am herewith granting power of attorney to the above named beneficiary(ies) to
handle, dispose of and, should he or she do desire, close the above specified account.
This power of attorney shall be valid and in full force after my death.
Page 2 of 2 BENEFICIARY DESIGNATION LETTER
5. All instructions and powers contained in this letter are freely revocable by me during
my lifetime by written instructions to you, but shall become irrevocable for anyone,
including possible successors of interest or mine, such as heirs, after my demise.
6. I hereby irrevocably release Caye International Bank Ltd. as toward any of the
beneficiary(ies) from all of her obligations under bank secrecy (whether such
obligations are now existent or may arise in the future) and specifically authorize Caye
International Bank Ltd. to the above named beneficiary(ies) with all and any
information, whether orally or in writing, which they would provide to an account
holder.
In particular, I specifically authorize Caye International Bank Ltd. to make payment to
the above named beneficiary(ies) out of the above specified account on his/her/their
written demand without examination or verification of any legal title of such
beneficiary(ies).
All and any obligations of the Bank, if any, to follow any of the instructions of the above
named beneficiary(ies) will arise and exist only if and after the beneficiary(ies) has/have
validly signed and accepted the declaration of indemnification to the Bank.
7. Nothing contained herein shall prevent the Bank from acting as prescribed by Belizean
Law should there ever be a dispute on or in connection with the above specified
account.
8. This instruction, power and declaration shall be exclusively governed by and
interpreted in accordance with Belizean Law. All other provisions of the account
relationship between myself and Caye International Bank Ltd. shall remain in full force
and effect.
________________________________________________________________________
(Signature of Account Holder(s))
________________________________________________________________________
(Complete name)s) of Account Holder(s)
I the undersigned Notary Public in and for the _________________________________
having an office situate at _________________________________________________
hereby confirm that the signature(s) above have been witnessed by me and I have
verified identity(ies) by viewing the Passport(s) of the signatory(ies).
________________________________________________________________________
Complete Name, Address, and Title of the Notary Public and telephone and fax
numbers)
