THE LANGUAGE USED IN THIS DOCUMENT DOES NOT CREATE ANY CONTRACTUAL RIGHTS OR ENTITLEMENTS AND DOES NOT CREATE A CONTRACT BETWEEN THE MEMBER AND THE SOUTH CAROLINA PUBLIC EMPLOYEE BENEFIT AUTHORITY.  THE SOUTH CAROLINA PUBLIC EMPLOYEE BENEFIT AUTHORITY RESERVES THE RIGHT TO REVISE THE CONTENT OF THIS DOCUMENT. 

The undersigned trustee(s) does hereby confirm the existence of the within described Trust and certify the following:

 1. The undersigned is/are all of the currently serving trustee(s). 

 2. The Trust is in full force and effect and has not been revoked, terminated or otherwise amended in any manner which     

     would cause the representations in this Certification of Trust to be incorrect. 

 3. The Trust is revocable/irrevocable.  If revocable, define who can revoke the document. 

 4. The above designated trustee(s) is/are fully empowered to act for said Trust and is/are properly exercising the trustee's 

     authority under this Trust.  No other trustee or other individual or entity is required to execute any document for the Trust. 

 5. The signature(s) of                of the trustees is/are required for any action taken on behalf of the Trust. (Define signature 

     requirements)

 6. The proper manner for taking title to Trust property is: 

         , Trustee(s)

                                           (Name(s) of all current trustees)

                                                                                                                                                  , dated 

                                                         (Name of trust)                                                                                         (Date of Trust)

 7. To the undersigned's knowledge, there are no claims, challenges of any kind, or cause of action alleged, which contest or 

     question the validity of the Trust or the trustee's authority to act for the Trust.

 8. The trustee is authorized by the Trust Agreement to receive money, benefits, and payments on behalf of the following Trust

     beneficiaries to be distributed in accordance with the terms of the above-named Trust. (Provide the excerpt of the Trust

     reflecting all of the Trust beneficiaries.) YOUR RETIREMENT SYSTEMS BENEFICIARY DESIGNATIONS WILL NOT BE

     REVOKED UNDER SECTION 62-2-507 OF THE SOUTH CAROLINA CODE OF LAWS BY DIVORCE, ANNULMENT, OR

     ORDER TERMINATING MARITAL PROPERTY RIGHTS.  

 IN WITNESS THEREOF: the undersigned, being all of the trustees, do hereby execute this Certificate of Trust this ______day  

 of _____________________, 20____. 

 Witnesses:                                                                                       Trustee(s):                                  

Form 1113
Revised 11/1/2017
Page 1 of 2

CERTIFICATION OF TRUST

(pursuant to S.C. Code Ann. ? 62-7-1013)

STATE OF    _______________________          

                                                                                   ACKNOWLEDGMENT 

COUNTY OF _______________________

I,_________________________________________, do hereby certify that trustee(s) personally appeared before me this day and acknowledged the due execution of the foregoing instrument. 

Witness my hand and official seal this ______day of _____________________, 20____. 

_____________________________________

NOTARY PUBLIC OF     _____________________(SEAL)

My Commission Expires: _____________________

)

)

)

 (Name of Trust Beneficiary)                                    

 (SSN)

 (M or F) 

(DOB)

(Relationship)

(Relationship)

(DOB)

 (M or F) 

 (SSN)

 (Name of Trust Beneficiary)                                    

(Relationship)

(DOB)

 (M or F) 

 (SSN)

 (Name of Trust Beneficiary)