Submit your completed form to the Central Bank of Belize via post at P.O. Box 852, Belize City, BELIZE. Alternatively, you can email the form to investment@centralbank.org.bz or fax it to (501) 223-1738. Ensure all fields are filled accurately and the form is signed before submission. It is advisable to keep a copy of the submitted form for your records.

The key dates for submission in 2024 and 2025 are June 26, 2024, and June 26, 2025. Ensure your form is submitted before these dates to avoid any delays in processing your investment.

The purpose of this form is to facilitate the application and allotment process for the Government of Belize 6.5% USD Five Year Treasury Note. The form collects necessary information from prospective investors, including the investment amount, personal details, and bank information for payment processing. By submitting this form accurately, investors commit to purchasing the allocated Treasury Notes and agreeing to the terms set by the Central Bank of Belize.

• 1. Amount: Enter the investment amount in figures and words.
• 2. Full Name: Provide your full name or company name in block letters.
• 3. Registration Number: Fill out your company registration number or social security number.
• 4. Date of Birth: Provide your date of birth or company registration date.
• 5. Address: Enter your full address, including street, city, state, and zip code.
• 6. Signature: Sign the form to validate your application.
• 7. Date: Date the form with the current date.
• 8. Telephone Number: Include your contact phone number with the area code.
• 9. Email Address: Provide a valid email address for correspondence.
• 10. Beneficiary Bank Information: Fill in the beneficiary bank's name, address, SWIFT BIC, and routing number if applicable.
• 11. Account Number: Provide the account number for payments in respect of your holdings.

Failing to submit this form may result in missing the opportunity to invest in the Belize 6.5% USD Five Year Treasury Note.

• Missed Investment Opportunity: Failure to submit the form will prevent you from participating in the Treasury Note investment.
• Unsuccessful Application: Incomplete or late submissions will not be processed, and your application will be considered invalid.

• 1. New Investment: Fill out this form when making a new investment in Belize Treasury Notes.
• 2. Updating Information: Use the form to update your personal or bank information related to the investment.
• 3. Reinvestment: Submit the form again if you are reinvesting in additional Treasury Notes.