Financial Trust Checks

FINANCIAL TRUST CHECKS

Use this form to request issuance, reordering, or reconciliation of checks drawn on a trust account. Completion of this form constitutes a written authorization by the trustee(s) identified below for the institution named in the Bank Acknowledgment section to process check issuance, reorders, and related transactions in accordance with the trust instrument and applicable law.

Trust and Trustee Information

Trust Name:

Bank Account Details

Checking Savings

Check Issuance / Reorder Request

Request Type: Issue New Checks Reorder Check Stock Void / Reconcile

If issuing individual checks, list up to four items below. Use additional sheets if necessary and attach supporting documentation for each payee.

Supporting Documents & Attachments

Required attachments as applicable: trust instrument excerpt authorizing distributions, beneficiary consents, invoices, or other supporting vouchers.

Attachments provided: Trust Instrument Excerpt Beneficiary Authorization Invoice / Voucher Other

Representations, Authority and Indemnification

The undersigned Trustee(s) represent and warrant that they have full authority under the terms of the trust instrument and applicable law to direct payments and ordering of checks from the trust account identified above. The Trustee(s) certify that the funds requested are properly payable from trust assets and that the requested payments comply with fiduciary duties, the trust instrument, and any court orders or statutory restrictions.

The Trustee(s) agree to indemnify, defend and hold harmless the depository institution, its officers, employees, and agents for any liability, loss, or expense, including reasonable attorneys’ fees, arising from reliance on this authorization, including claims by beneficiaries or third parties asserting lack of authority or improper payment.

Trustee(s) acknowledge responsibility for review of cancelled checks, reconciliation of trust records, and prompt notification to the depository institution of any disputed items, suspected fraud, or required stop payments. Requests to stop payment or to place holds must be submitted in writing as required by the depository institution's policies.

Bank Acknowledgment and Processing Terms

By signing below, the institution acknowledges receipt of this written authorization and agrees to process check issuance and related services in accordance with the account agreement, check stock specifications, and applicable clearing rules. The institution may require additional documentation before processing large disbursements or reorders and may impose customary fees for check printing, expedited production, or stop payment services.

The institution's acceptance of this form does not constitute a determination that the requested disbursements are consistent with the trust instrument; such determinations are the sole responsibility of the Trustee(s).

Voided / Stale / Reconciled Checks (Record)

Certification and Authorization

I/We, the undersigned Trustee(s), certify under penalty of perjury that the information contained herein is true, that I/we are authorized to make the requests set forth, and that all attachments are genuine and complete to the best of my/our knowledge. I/We authorize the depository institution to rely on this form until receipt of a written amendment or revocation signed by an authorized Trustee.

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