irrevocable life insurance trust information form

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irrevocable life insurance trust information form
Mary B. Galardi, Esq.
[email protected]
IRREVOCABLE LIFE INSURANCE TRUST INFORMATION FORM
Meeting Date: ____________________________________
Signing Date: _____________________________________
File No.: ______________________
BASIC TRUST INFORMATION
Grantor
Grantor’s Social Security Number
Name of Trust
The ______________________________________________________ Irrevocable Trust
Trustee
Trust Protector
Trust Beneficiaries
Terms of Trust (payout)
Trust assets
Face value of Policy:
Life Insurance Policy Number:
$
Type of Policy:
Cash value of Policy:
$
Any Loan against Policy:
Current Insured:
Current Beneficiary:
Policy Owner:
The ______________________________________________________ Irrevocable Trust
Policy Beneficiary:
The ______________________________________________________ Irrevocable Trust
Premium Due Date:
Annually each year on ____________________ or ______________________
Premium Amount:
$
1418 Dresden Drive NE / Suite 240 Atlanta, GA 30319

Office: (404) 812-9220

Fax: (404) 812-9423

www.GalardiLaw.com
Insurance Company:
Agent:
Federal Tax ID Number
ADDITIONAL INFORMATION
USE ADDITIONAL PAPER IF NECESSARY
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