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Shareholders Request

New Business Venture Series Setup Request Form

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Full Name of Requestor

First

Last

Title/Role in Venture

Email Address

Phone Number

Mailing/Corporate Address

Address Line 1

Address Line 2

City

State

Zip Code

Proposed Legal Name of Series (Choice 1)

Proposed Legal Name of Series (Choice 2)

Brief Description of the Business Venture

Primary Industry / Sector

Real Estate (Acquisition/Holding)
E-Commerce / Digital Assets
Private Equity / VC Investments
Technology / SaaS
Operational Business
Other

Designated Series Manager(s) / Trustee Delegate(s) - Name (1)

Designated Series Manager(s) / Trustee Delegate(s) - Title (1)

Designated Series Manager(s) / Trustee Delegate(s) - Name (2)

/ - /

Designated Series Manager(s) / Trustee Delegate(s) - Title (2)

Beneficial Owners / Equity Holders - Name (1)

Beneficial Owners / Equity Holders - Allocation % (1)

Beneficial Owners / Equity Holders - Name (2)

Beneficial Owners / Equity Holders - Allocation % (2)

Beneficial Owners / Equity Holders - Name (3)

Beneficial Owners / Equity Holders - Allocation % (3)

Estimated Initial Capital Contribution

Source of Initial Capital

Cash
Crypto
Real Property
IP/Other

Do you require a new dedicated corporate bank account established for this series?

Yes
No, internal ledger segregation only

Preferred Banking Institution (if applicable)

Target Launch / Operational Date

Anticipated Tax Classification for this Series

Disregarded Entity (Single-member pass-through)
Partnership (Multi-member pass-through)
C-Corporation Election

Will this series hire independent W-2 employees?

Yes
No

Will this series operate or hold physical assets outside the State of Wyoming?

Yes
No

If yes, list target states

Date

For Internal Trust Operations Use Only

Master Trust Check: Active & In Good Standing (Wyoming SOS)
Series Designation Document Generated
Registered Agent Notification Sent (Wyoming Financial Center Hub)

Assigned Series Identifier

Approved By

Approval Date

GONEN CORP Corporate Finance

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Disclosure and Disclaimer for Gonen Capital Series Portal; This section and all content provided through the Gonen CapitaL Series Portal are for informational and educational purposes only. They do not constitute an offer to sell or a solicitation of an offer to buy any securities, financial products, or services. Any investment involves risks, and past performance is not a guarantee of future results. The information presented should not be viewed as legal, tax, or financial advice. Before making any investment decisions or financial moves, you should consult with your own legal and accounting professionals to ensure that your actions are aligned with your individual circumstances and financial goals. Gonen Capital Series Portal makes no representations or warranties, express or implied, regarding the accuracy, completeness, or suitability of the information provided.

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