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TC
Certification of Trust
Instructions: Submit this form along with the title page, signature page, and powers pages of the trust when establishing a trust account with LPL
Financial. In some cases, it may be necessary to provide a full copy of the plan or trust document to facilitate a transfer of securities. All trustees must
sign in Section VI.
Fax the completed form along with supporting documentation to New Accounts at (858) 546-0874.
Account Number
Rep ID
MD0C
New Trust Account (Complete Sections I, II, V [if applicable], VI, and VII)
Existing Trust Account Update (Select one of the below options)
Trust Title Update (Complete sections III, VI, and VII)
Trustee Update (Complete sections II, IV, VI, and VII)
Section I: Trust Information
1.
Provide the complete Title of the Trust to which this Certification applies:
This Trust is:
Revocable
Irrevocable
This Trust was established by:
Agreement, Dated
Will, Date of Death
Date on which this Trust was last amended (if applicable)
2.
Date on which this Trust was re-written (if applicable)
For Non-Qualified Trusts, complete the following:
Grantor/Decedent
Grantor
Grantor
Grantor
For Qualified Plans or Trusts, complete the following:
Employer Name
If this is a participant directed Self Sponsored Qualified Plan, please provide the name of the participant (FBO):
Section II: Trustee Information
Current Trustee(s) (Do not include successor trustee(s)):
1.
2.
3.
4.
If the Trust provides for less than the unanimous consent among the Trustee(s) to establish an account with respect to Trust assets, please
indicate the minimum number of consenting Trustee(s) required to sign any document to bind the Trust.
Minimum number of Trustee(s) required to sign any documents on behalf of trust:
If left blank, all current trustee(s) must sign all documents.
Member FINRA/SIPC
A Registered Investment Advisor
F29-0810
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LPL Account Number
Section III: Trust Title Update
Changing Trust Title/Plan Name Due to:
Amendment (Include copy of amendment)
Court Order (Include copy of court order)
Plan Minute Notes (Include copy of signed Plan minute notes)
Converting from Revocable to Irrevocable (Include copy of Trust amendment or other legal document to convert to irrevocable under the
provisions of the Trust)
New Trust Title/Plan Name:
Section IV: Trustee Update
SELECT ONLY ONE (BOLD) OPTION
Remove a co-trustee without replacement due to:
Death
(Include copy of death certificate and instructions to remove trustee)
Resignation
(Include copy of resignation letter(s) or Plan meeting notes and instructions to remove trustee)
Removal
(Include copy of Trust amendments or Plan meeting notes and instructions to remove trustee)
Incapacitation
(Include copy of letter(s) of medical opinion or court order and instructions to remove trustee)
Replace a trustee/co-trustee due to death
(Include copy of death certificate and updated New Account Form/Confidential Client Profile)
Replace a trustee/co-trustee due to resignation
(Include copy of resignation letter(s) or Plan meeting notes and updated New Account Form/Confidential Client Profile)
Replace a trustee/co-trustee due to incapacitation
(Include copy of letter(s) of medical opinion or court order and updated New Account Form/Confidential Client Profile)
Replace a trustee/co-trustee due to other circumstances
(Include copy of updated New Account Form/Confidential Client Profile)
Explanation (Provide copy of the supporting documentation):
Section V: Beneficial Owner Information (Optional)
Provide the names of all beneficial owners of the Trust (if applicable).
Beneficial Owner
Date of Birth
Beneficial Owner
Date of Birth
Beneficial Owner
Date of Birth
Beneficial Owner
Date of Birth
Member FINRA/SIPC
A Registered Investment Advisor
F29-0810
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LPL Account Number
Section VI: Certification
To: LPL Financial Corporation, 9785 Towne Centre Drive, San Diego, California 92121
I/We, the Trustee(s), acknowledge that I/we have received and reviewed thoroughly all account documentation, agreements and risk
disclosure forms.
I/We, the Trustee(s), hereby certify that I/we have the power under the Trust and applicable law to (1) open all types of accounts, (2) invest,
reinvest and enter into transactions, both purchases and sales, in all types of securities unless noted below, and (3) appoint LPL Financial
Corporation as Investment Adviser, pay the adviser reasonable compensation and give such adviser discretionary powers to invest Trust
assets as agreed to in writing.
Specify the types of securities not permitted in this Trust:
I/We, the Trustee(s), hereby certify that this Trust allows for marginable securities.
I/We, the Trustee(s), jointly and severally agree to indemnify and hold harmless LPL Financial Corporation, its agents and employees from
any liability that may result from relying on this Certification when opening accounts or effecting transactions of the type specified above,
pursuant to instructions given by any of the Trustee(s) listed in Section II. This indemnification shall survive termination of the Trust or of the
account(s).
I/We, the Trustee(s), agree at all times to retain the sole power to vote any corporate stock by proxy, to execute general or unrestricted
proxies as to one or more nominees, and to exercise any options or rights issued in connection with bonds or stocks as held as part of the
Trust property unless otherwise agreed in writing by all parties. I/We certify that if this is an account for a self-sponsored qualified retirement
plan and the plan instructs the trustee to deliver all proxies to another party having investment authority or discretion, we have amended the
client agreement to authorize the IAR to place trades on a non-discretionary basis only by executing the Non-Discretionary Amendment to
Client Agreement (form A1D). I/We certify that if this is an advisory Optimum Market Portfolios (OMP) account for a self-sponsored qualified
retirement plan, the plan does not instruct the trustee to deliver proxies to any other party having investment authority or discretion.
I/We certify that each Fiduciary of the Plan or Trust described herein, and each person who handles funds or other property of the Plan or
Trust, shall be bonded as provided in ERISA Section 412 and the regulations thereunder. No further bonding shall be required other than as
described by ERISA Section 412.
I/We, the Trustee(s), certify that this Trust is still in full force and effect as of the date signed below.
In consideration of your accepting one or more Trust accounts, the undersigned Trustee(s), jointly and severally, warrant and agree that all
of the information contained in this Certification is accurate and correctly details the terms of the Trust defined above. I/We further warrant
and agree that this Certification shall remain in full force and effect until such time as you are notified in writing of any change in the
information or authority contained herein. I/We hereby certify that the above information is correct and that the undersigned are all current
Trustees. I/We further certify that this Certification represents an amendment to the original Trust document or that we have taken all actions
necessary to so amend the original Trust document to conform with this Certification.
Note: All current trustees must sign this document.
Trustee’s Signature
Date
Trustee’s Signature
Date
Trustee’s Signature
Date
Trustee’s Signature
Date
Section VII: Advisor Acknowledgement
I further certify that all of the information provided on this form is true, correct, and complete and that I have reviewed a copy of
the client trust agreement and any amendments.
Richard Suder
MD0C
Financial Advisor Signature
Financial Advisor (print)
Rep ID
Date
Financial Advisor Signature
Financial Advisor (print)
Rep ID
Date
Member FINRA/SIPC
A Registered Investment Advisor
F29-0810
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