Trust Company Referral Form

Please note: This is a comprehensive form for gathering information necessary for MTC to complete our new business review and acceptance process, and determine if any follow up items are needed prior to acceptance. Please contact Mariner Trust Company if you need any assistance with this form.

REFERRING PARTY INFORMATION

Wealth Advisor Last Name*

Wealth Advisor First Name*

Have you referred a trust to MTC previously?*

Select

Have you reviewed the MTC Fee Schedule?*

Select

Attorney Name

TRUST INFORMATION

Full Trust Name*

Approximate Market Value*

Grantor's Last Name*

Grantor's First Name*

Your Client's Relationship to the Grantor(s)*

Is/are the Grantor(s) Living?*

Select or enter value

Is the trust irrevocable?*

Select

Current Trustee*

Will MTC serve as a:*

Select

If Co-Trustee, with whom will MTC serve?*

Background on why client is changing Trustee?

TRUST PARTY INFORMATION

Please provide the information requested below for the co-Trustee(s), grantor(s) and beneficiaries of the trust.

Party #1 Last Name*

Party #1 First Name*

Party #1 Date of Birth*

Party #1 Relationship to Grantor(s)*

Select or enter value

Party #1 Address*

Party #1 Social Security Number*

Party #2 Last Name

Party #2 First Name

Party #2 Date of Birth

Party #2 Relationship to Grantor(s)

Select or enter value

Party #2 Address

Party #2 Social Security Number

Party #3 Last Name

Party #3 First Name

Party #3 Date of Birth

Party #3 Relationship to Grantor(s)

Select

Party #3 Address

Party #3 Social Security Number

Party #4 Last Name

Party #4 First Name

Party #4 Date of Birth

Party #4 Relationship to Grantor(s)

Select

Party #4 Address

Party #4 Social Security Number

Other Parties Involved

If there are more than 4 parties involved with the Trust, please list those individuals and their respective roles below.

Trust Asset Information

Please select all asset types that are held in the trust; along with a statement of current trust assets (funded trusts) and/or detailed summary of assets to be transferred to the trust (unfunded trusts):

Type of Asset*

Select or enter value

Additional Asset Information/Comments*

CURRENT DISTRIBUTION INFORMATION (FOR EXISTING TRUSTS)

Is this beneficiary receiving distributions?*

Select

What type of distributions?*

Select

CHECKLIST OF DOCUMENTS REQUIRED FOR COMPLETE REFERRAL:

Upload Documentation*

To complete this request, please attach the following documents. 1) Copy of Executed Trust Agreement & all Amendments & Restatements 2) Copy of current trust statement(s) (for funded trusts) 3) Detailed Summary of assets to be transferred (for unfunded trusts) 4) Non-Standard Asset Information, as appropriate (entity docs, valuations, deeds, etc.)

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