Irrevocable Life Insurance Trust Checklist
1. Full
Name of Insured/Grantor:__________________________________________________
2. County of Residence: ________________________________________________________
3. Full Name of Spouse, if applicable, or other Trustee and successor Trustee(s)—may be family member(s) or trust companies:
_______________________________________________________________________
4. Full Names and Current Ages of designated beneficiaries (typically include Grantor’s Spouse, children, and grandchildren, if any currently):
5. After
deaths of the Grantor and Spouse (both parents), policy proceeds go outright to
Grantor’s children free of trust or be held in trust for benefit of children
and their children?
(Please circle your choice): Trust Terminate OR Trust protections continue for Children’s lifetime?
Existing Policy transferred to new Trust OR new policy to be purchased by the Trust?
6. Insurer Name and Address:___________________________________________________
Face Amount of Policy: $_______________ Policy No.:___________________________
Policy Premiums: $___________________ How often paid (annually, etc.):_____________
Premium Due Date:_______________________
Cash Value if an existing Policy being transferred into the new Trust: $_______________
7. Any other information you believe helpful regarding your insurance program, or questions:
Closely Held Business Interests
(Please use a separate sheet for each business interest)
Entity Name:______________________________ Business
Address:______________________________
Business Phone Number: __________________ and Fax Number:_____________________
Please Check Appropriate Entity: S Corporation Partnership Sole
Proprietorship ______
LLC
______ C Corporation Other
(please specify) _________________________
Percentage Owned by: Yourself: Spouse: Jointly:
Children,
by name: Others
(please name):________________
Buy/Sell or Ownership Redemption Agreement
Triggered by Death or Disability?
Yes No
_____
Explain
terms in brief detail:________________________________________________________
Your wishes for sale or bequest of interest upon
your death if permitted by buy/sell agreement:
_______________________________________________________________________________________
_______________________________________________________________________________________
Key-man life insurance and other life insurance dedicated to business needs:
Owner of Policy Employee Insured
Face Value
Cash Value
1. ____________________________________________________________________________________
2. ____________________________________________________________________________________
3. ____________________________________________________________________________________
Most recent transfer of any equity by an owner: Transfer Date and
Total Price $____________ for the Percentage
or Number of Shares sold (agreed-upon market value if other than sold).
Please indicate if the transfer was made to a related party, such as a family
member or to another entity such as a corporation or LLC in which you or a
family member also had an ownership interest.
Fair Market Value of Business, before debts (amount you believe business sells for):$________________
Total Amount of Business Debts:$____________ Amount personally guaranteed by you: $___________
Total Cost Basis In Your Ownership Interest:
$______ Date(s) acquired by you:______________
Other Remarks or Information You Believe Helpful
or Questions Regarding Business and/or Ownership Agreements:__________________________________________________________________
________________________________________________________________________________________
Copyright © 2013 Herbert E. “Chip” Browder
