Trust Protector Supplement

Business Name:

(Named Insured on Policy)

1.

Please specify how many Trust Protector positions you:

anticipate

have currently

2.

What is the size of those specific trusts?

maximum

average

3.

With respect to any trusts for which you act as Trust Protector . . .

a.

Are there any pending or potential disputes?

Yes No

b.

Are you replacing another Trust Protector?

Yes No

c.

Are you a beneficiary, grantor or settlor?

Yes No

d.

Are any co-trustees currently serving?

Yes No

4.

Please explain your Trust Protector powers, how you were appointed, and any positive responses within question 3:

Signature

Signer's Name & Title

Date Executed

Trust Protector Supplement (03/19)

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