Attorney Information Request Form
Prior to being admitted to PTC’s Trust Attorney Database, we will complete a due diligence review of your experience. In order to complete our due diligence review, we require the information requested on this form. Please note, we may request additional information. Portions of this form may be “pre-populated” based on the information provided to us by the LPL investment advisor who referred you to the Trust Attorney Database, if any. Please review the pre-populated questions for accuracy and complete all blanks with the appropriate response. Upon completion and execution of this form, please return it to: Mr. Ergun Pascu, The Private Trust Company, N.A, 9785 Towne Centre Drive, San Diego, CA92121.
1-Name (first/middle/last): ______
2-State(s) of Bar Admission and State bar number(s): ______
3-Firm name: ______
4-Telephone number: ______
5-Physical address (street address/city/county/state/zip): ______
______
6-Email and website address: ______
7-Number of years you have practiced law: ______
8-Percentage of your work in the area of trusts and estates: ______
9-Have you previously worked with PTC: ______
10-If you have previously worked with PTC, the name of the account(s) : ______
______
11-Your Martindale Hubbell® rating, if any: ______
12-Name(s) of estate planning organizations you belong to, if any: ______
Please complete the following statements by circling the appropriate response:
1-I refer my clients to investment advisors never / infrequently / sometimes / frequently.
2-I am / amnot willing to refer my clients to a investment advisor.
3-My trust documents do / donot authorize the trustee to delegate investment duties to an investment advisor.
4-I am / amnot licensed and in good standing with the attorney regulatory entity in each state where I provide legal services.
By signing below, I hereby certify that the information on this Attorney Information Request Form is true and correct to the best of my knowledge and that I consent to being admitted to the PTC Trust Attorney Database with the understanding that PTC reserves the right to revise the Trust Attorney Database and/or the terms applicable thereto at any time in its sole discretion with or without cause. I certify that I will update PTC regarding any changes to the information contained herein (e.g., my licensing or standing with the attorney regulatory entity in each state where I provide legal services). I hereby authorize PTC to use and share the information I have provided with investment advisors who request it.
Dated: ______By: ______
Name: ______
1
THE PRIVATE TRUST COMPANY, N.A.