本信托声明书于19___年___月___日 由___（姓名，地址）（以下简称“受托人”）作出。
　　This DECLARATION OF TRUST is made the _______day of ____19__， by（name）（address）．（hereinafter referred to as " the Trustee"）

　　鉴于
　　WHEREAS：

　　1．（略）
　　1．（omitted）

　　2． 该项住宅事实上已转让给（姓名，地址）（以下简称“委托人”）

　　2． The said premises were in fact assigned to （name and address of
beneficiary） （hereinafter referred to as "the Principal "）

　　本文据证明，受托人在此宣称，从该转让日起，已为委托人以信托而持有并将继续持有该住宅，该住宅的收入和利润及销售或处理时所得的收益，受托人在此同意，在该委托人要求时将该住宅转让、转移或作其他处理给委托人，或按委托人指示或指定在其时或以其指定的形式转让给其指定的人。
　　NOW THE DEED WITNESSETH that the Trustee doth hereby DECLARE that the Trustee
has since the date of the said Assignment held and henceforth hold and stand
possessed of the said premises and the income and profits thereof and the proceeds
of sale thereof in case of the same shall be sold or disposed of UPON TRUST for
the Principal and the Trustee doth hereby agree to assign transfer or otherwise
dispose of the said premises to the Principal at the said (Principal) request or
to such person or persons at such time or times or in such manner as the said
Principal shall direct or appoint.

　　并在此声明，在本文据存在期间，一受托人有权指定新的或额外的受托人。
　　IT IS HEREBY FURTHER DECLARED that the Trustee shall，during the subsistence
of this Deed，have power of appointing new or additional trustees.

　　为昭信守，受托人于上述日期盖章签字
I　　N WITNESS whereof the Trustee hereto has hereunto set his hand and seal the
day and year first above written.