Trust Checklist

Your Name

First NameLast Name

Email

example@example.com

Phone Number

Area CodePhone Number

Client's Name (if different)

First NameLast Name

Your relationship to client

Optional: Submit a photo of power of attorney or other legal documentation showing your authority to represent insurance matters.

Questions

Rows	Answer:
Exact Legal Name of Trust:
Date of Trust (if not already included in the Legal Name above:
Type of Trust (Revocable, Irrevocable, etc):
Trustees: Person(s) designated to manage the trust
Grantors (if not the same as the Trustee): Person(s) who set up the trust
What assets have been transferred to the trust (include all):
Are any assets used for business purposes? (If yes, explain):
Who will be residing in the residence(s)?

Rows	Yes	No	Comments:
Is the trustee retaining control of mainenance and upkeep of the property?
Is it a Living Trust?
Is it a Testamentary Trust?
Are all assets owned by the Trust Insured by ISC?
If you have life insurance with ISC, does your beneficiary need to be changed to the Trust?
I understand that it is my responsibility to advise Insurance Service Center of any changes in the trust including trustee changes, asset changes, etc.

Please list any special comments or concerns.

No policy changes will be made until our office has made confirmation with a legal representative of the named insured. *Coverage subject to policy limitations and payable in the event of qualified claims. Subject to underwriting approval.

I have personally reviewed the answers above. I understand that this checklist is not meant to imply, in any manner, that these are the ONLY items that may be of concern to me. I understand it is my responsibility to advise Insurance Service Center of any special circumstances or insurance needs I may have, or as my situation changes.

Signature (on PC/Laptop use your mouse, on a mobile device, use your finger or stylus).