Affidavit Of Existence Of Trust Form
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1
2AFFIDAVIT OF EXISTENCE OF TRUST
Policy Number ______________________________
Trust Taxpayer Identification Number (TIN) _______________________
Yes
No
Is the Trust TIN different from the Grantor(s)’s Social Security Number?
The undersigned being duly sworn, on oath certifies the following:
1. The Legal Name of the Trust is
2. The date the Trust was established is: ___________________________________
3. T
he above-named Trust has been established as and shall be treated for tax purposes as
(
):
Choose One
Grantor Trust - List name(s) and date(s) of birth of each grantor.
_____________________________________________
Date of Birth: ___/____/____
Grantor’s First Name/ Last Name
(Please Print)
_____________________________________________
Date of Birth: ___/____/____
Grantor’s First Name/ Last Name
(Please Print)
NON-Grantor Trust - List name(s) and date(s) of birth of each Beneficiary
_____________________________________________
Date of Birth: ___/____/____
Beneficiary’s First Name/ Last Name
(Please Print)
_____________________________________________
Date of Birth: ___/____/____
Beneficiary’s First Name/ Last Name
(Please Print)
_____________________________________________
Date of Birth: ___/____/____
Beneficiary’s First Name/ Last Name
(Please Print)
4. The name and address of each trustee empowered to act under the trust instrument at time
of execution of this Certificate of Trust is/are:
Please Print (Name and Address of Trustee)
Please Print (Name and Address of Trustee)
5. The trustee/trustees is/are authorized by the trust instrument to carry out the fiduciary
responsibilities and terms of the trust.
All trustee(s) must sign
Trustee(s) may sign solely
03/01/2016
AFFIDAVIT OF TRUST
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Parent category: Business