PHI TRUST SET-UP FORM

1) Custodian:
  • Name_____________________________
  • Address___________________________
  • Phone____________________________
  • Email____________________________
  • Contact Person______________________
  • Name and Number of IRA                                       

2) Trustee:

  • Name____________________________
  • Address___________________________
  • Phone____________________________
  • Email_____________________________
  • Contact Person                                                            

3) Successor Trustee

  • Name_____________________________
  • Address___________________________
  • Phone_____________________________
  • Email_____________________________
  • Contact Person_______________________

4) Trust Name                                                                                                

5) EIN Number                                                                                              

6) Beneficiary:

  • Name_____________________________
  • Address____________________________
  • Phone_____________________________
  • Email______________________________

7) Type Of IRA                                                                                             

8) Submitted by:                                                                                            

Date:                                              

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