21P-4706c

Court Appointed Fiduciary’s Account

Agency
VA
Revision
October 2024
Fillable fields
363
Pages
4
Official source
VA form page
Checked
October 20, 2026
Fill 21P-4706c online
Page 1 of form 21P-4706c

VA Form 21P-4706c: Court Appointed Fiduciary's Account

VA Form 21P-4706c is the U.S. Department of Veterans Affairs Court Appointed Fiduciary's Account. It is completed by a fiduciary appointed by a court for the estate of a minor or incompetent beneficiary, not by the beneficiary. It records receipts, expenditures and investments for the period of the account, with a sworn statement by the fiduciary and certificates from a financial institution and a certifying official.

The form is four pages. The Privacy Act notice says VA field examiners use the information to determine whether an individual fiduciary is properly using and maintaining an accounting of the VA beneficiary's compensation or pension payments.

You can fill out the PDF free in your browser on this page and download the result without an account.

Top of page 1 of VA Form 21P-4706c: Court Appointed Fiduciary's Account, as printed by VA

What's on VA Form 21P-4706c

Header: court, estate and period

The Veteran's name, the VA file number, the court, the estate of the minor or incompetent beneficiary, and the dates of the statement of account.

Section I: receipts

Each receipt by date, source and amount, with total receipts. The form says to report income from or liquidation of each investment separately.

Section II: expenditures

Each expenditure by date, to whom paid and purpose, and amount, with total expenditures.

Section III: summary of account

Cash balance from the last accounting, receipts, expenditures and the cash balance in the estate, then investments at cost value acquired and liquidated, and the total value of the estate, followed by the fiduciary's sworn statement.

Section IV: balance on deposit

The institution's name and address, the checking and savings balances and account numbers on a given date, interest paid during the period and its rate.

Section V: securities

Each bond or security by kind, interest rate, purchase date, face value and cost, with a certificate that the securities were exhibited by the fiduciary and are in the fiduciary's custody and control.

How to fill out VA Form 21P-4706c

  1. 1

    Fill in the header

    Enter the Veteran's name, VA file number, the court, the estate and the dates the statement of account covers.

  2. 2

    List receipts and expenditures

    Enter each receipt in Section I, with each investment's income or liquidation on its own line, and each expenditure in Section II with the payee and purpose.

  3. 3

    Complete the summary

    Carry the cash balance from the last accounting, add receipts, subtract expenditures, then total the investments to reach the total value of the estate.

  4. 4

    Sign the sworn statement

    The fiduciary signs the statement that it is a full and true account, and an official completes the Subscribed and Sworn to before me line with a signature and title.

  5. 5

    Get the certificates completed

    The financial institution completes Section IV with its seal or stamp. A certifying official the form names completes Section V for any securities.

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Where it goes and edition details

Mailing address

This edition of the form does not print a mailing address, and VA's form page offers the PDF download only.

Who may certify securities

The Judge or Clerk of Court of the appointment, an official of the safety deposit company or bank where securities are in a lock box, or any authorized official or agent of the company which is surety on the bond.

Privacy Act

The notice says a response is required to obtain or retain benefits per 38 U.S.C. 501, and that failure to furnish the information may result in the suspension of payments and/or appointment of a successor fiduciary.

Edition

The OCT 2024 edition supersedes VA Form 27-4706c, DEC 2021, which will not be used. It carries OMB Control No. 2900-0017, which expires 10/31/2027, with a respondent burden of 30 minutes.

Related forms

Who uses VA Form 21P-4706c?

  • Court appointed fiduciaries

    The fiduciary names the court and the estate of the minor or incompetent beneficiary, lists receipts and expenditures, and swears that it is a full and true account of the beneficiary's estate for the period.

  • The official before whom it is sworn

    Page 3 has a Subscribed and Sworn to before me line with a signature and title, under a State of and County of heading.

  • Financial institution officials

    Section IV is a certificate of balance on deposit signed by a certifying official of the institution, with its seal or stamp.

  • Securities certifying officials

    The form says the Section V certificate may be executed by the Judge or Clerk of Court of the appointment, an official of the safety deposit company or bank holding the securities, or an authorized official or agent of the surety company.

  • VA field examiners

    The Privacy Act notice says VA field examiners use the information to check how an individual fiduciary uses and accounts for the beneficiary's compensation or pension payments.

The form is completed by a court appointed fiduciary, with sections signed by other officials.

Official sources and the blank

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Questions about Form 21P-4706c

Who completes VA Form 21P-4706c?

A fiduciary appointed by a court for the estate of a minor or incompetent beneficiary. Sections of the form are also signed by an official who takes the sworn statement, the financial institution and a securities certifying official.

How does VA use the account?

The Privacy Act notice says VA field examiners use it to determine whether an individual fiduciary is properly using and maintaining an accounting of the beneficiary's compensation or pension payments.

How are investments reported?

Section I says to report income from or liquidation of each investment separately. Section III totals investments at cost value, and Section V lists each bond or security.

Who can sign the certificate as to securities?

The form says the Judge or Clerk of Court of the appointment, an official of the safety deposit company or bank holding the securities in a lock box, or an authorized official or agent of the surety company.

What does the bank complete?

Section IV, the certificate of balance on deposit: checking and savings balances with account numbers on a given date, interest paid during the period and its rate, with the institution's seal or stamp.

How is it different from VA Form 21P-4706b?

VA's form pages list each as related to the other. VA Form 21P-4706b is titled VA Fiduciary's Account and is returned to the VA Fiduciary Hub. VA Form 21P-4706c is titled Court Appointed Fiduciary's Account and opens with the court and estate.