Liberty Mutual Fillable Forms
Liberty Life Assurance Company of Boston Service Center 100 Liberty Way Dover, NH 03820 Verification of Trust Form GENERAL INFORMATION Name of Insured: Name of Trust Agreement: Date of Trust Agreement: Name of Trustee(s): Street Address Policy/Contract Number(s): Trust Tax ID Number: City: State: Zip: The undersigned Trustee(s) and Settlor(s) hereby certify that: · A valid Trust has been established; and · The undersigned Trustee(s) has/have the authority, under applicable law, to purchase said life insurance policy on his/their sole signature(s) MoreRev 1/05. Verification of Trust Form. GENERAL INFORMATION. Name of Insured: Name of Trust Agreement: Date of Trust Agreement: Trust Tax ID Number: Less
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