Trust Change Authorization Form

TRUST CHANGE AUTHORIZATION FORM

Client Name:   Trust Name:

Trust Tax ID (if applicable):   Account/Reference Number:

RECITALS

WHEREAS, the Client is the settlor, beneficiary, and/or a duly appointed trustee of the Trust identified above and seeks to effect certain authorized changes to the Trust's administration and account records held by the Institution; and

WHEREAS, the Institution maintains records and accounts relating to the Trust and requires written authorization, certifications, and representations to process requested changes to trust ownership, trustee designation, beneficiary designation, or account administration; and

WHEREAS, the parties intend this Trust Change Authorization to constitute a binding instruction to the Institution upon acceptance consistent with the terms set forth herein.

SCOPE OF WORK

Type of Change(s) (check all that apply):

Change Trustee    Change Beneficiary    Amend Trust Terms    Update Trust Address/Contact    Other:

AUTHORIZATIONS, REPRESENTATIONS AND CERTIFICATIONS

The undersigned hereby authorizes the Institution to make the changes specified above. The undersigned certifies that they possess the necessary authority under the Trust instrument to request and approve the specified changes and that all signatures, consents and instruments required to effect the change have been or will be obtained and maintained with the Institution's records. The undersigned further represents that no additional party has rights that would be adversely affected by the requested changes except as disclosed in writing to the Institution.

PAYMENT TERMS

For services rendered in connection with processing the requested trust change, the Client agrees to pay the Institution fees as set forth below. Fees may include administrative processing fees, document review fees, and any third-party vendor costs.

All fees are payable in United States dollars unless otherwise agreed in writing. The Client shall remain responsible for taxes, levies or assessments imposed by any governmental authority in connection with the changes. The Institution may suspend processing until all required fees are received.

TERM AND TERMINATION

This Authorization is effective as of the Start Date below and shall remain in effect until the End Date below or until completion of the requested changes, whichever occurs first, unless earlier terminated in accordance with this section.

Start Date:   End Date:   Notice Period (days):

Either party may terminate this Authorization for convenience upon written notice to the other party given at least the number of days set forth above. Termination shall not relieve the Client of its obligation to pay fees accrued through the effective date of termination or to reimburse third-party costs incurred prior to termination.

CONFIDENTIALITY

The parties acknowledge that, in connection with the performance of this Authorization, each party may disclose non-public, confidential or proprietary information ("Confidential Information"). Each party agrees to hold Confidential Information in strict confidence, to use it solely to perform its obligations under this Authorization, and not to disclose it to third parties except as required by law or with the other party's prior written consent. Confidentiality obligations survive termination of this Authorization for a period of three (3) years, except with respect to trade secrets, which shall be protected for as long as such information qualifies as a trade secret under applicable law.

GOVERNING LAW AND DISPUTE RESOLUTION

This Authorization shall be governed by and construed in accordance with the laws of the state identified below, without regard to that state's conflict of law principles. Any dispute arising out of or related to this Authorization shall be resolved by binding arbitration if the parties mutually agree; otherwise disputes shall be resolved in the courts located in the governing state.

ENTIRE AGREEMENT

This Authorization, together with any attachments, schedules, and supporting documentation executed in connection herewith, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, negotiations and communications, whether oral or written. No amendment or modification shall be effective unless in writing and signed by authorized representatives of both parties.

ADDITIONAL NOTICES

The undersigned certifies under penalty of perjury that the information provided in this Authorization is true, complete, and correct to the best of their knowledge, that they are authorized to execute this Authorization on behalf of the Trust, and that any documents submitted in support of this Authorization are genuine and accurate copies of the originals.

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