Estate Planning Questionnaire

1Client Information

2Marital Status

3Children and Other Family

4Current Estate Planning Documents

5Advisor Contact Information

6Miscellaneous

7Property

8Your Estate Plans

Name(Required)

First Middle Last Maiden

Address(Required)

Street Address Address Line 2 City State ZIP Code

Primary Phone(Required)

Business Phone

Cell Phone

E-mail Address(Required)

WE WILL NOT CONTACT YOU BY ELECTRONIC COMMUNICATION PRIOR TO YOUR APPROVAL

Social Security No.: (Please bring to initial meeting)

Date of Birth(Required)

Age(Required)

Please enter a number from 1 to 100.

Occupation/Employer

Business Address

Street Address Address Line 2 City State ZIP Code

Are you a U.S. citizen?(Required)

Yes

Are you currently married?(Required)

Do you have children or other living relatives?(Required)

Spouse's Name(Required)

First Middle Last Maiden

Primary Phone(Required)

Business Phone

Cell Phone

E-mail Address(Required)

WE WILL NOT CONTACT YOU BY ELECTRONIC COMMUNICATION PRIOR TO YOUR APPROVAL

Social Security No.: (Please bring to initial meeting)

Date of Birth(Required)

Age(Required)

Please enter a number from 1 to 100.

Occupation/Employer

Business Address

Street Address Address Line 2 City State ZIP Code

Is Spouse a U.S. citizen?(Required)

Yes

Date of your marriage(Required)

Location of Marriage(Required)

City State / Province / Region Country

Were you or your spouse married to other individuals previously?

Yes

If yes, please indicate which of you was previously married, whether the marriage(s) ended by reason of death or divorce (and the date), and provide any information which might have a bearing on your estate plan (e.g. Premarital Agreement, Divorce Decree obligations).(Required)

Children(Required)

Child's Name

Date of Birth

SS #

Adopted?

Born of Prior Marriage?

Married?

Do any of your children have any special considerations we should be aware of, such as a disability, marital concerns, financial irresponsibility, or legal issues?(Required)

Yes

Please deatil your childrens special considerations (disability, marital concerns, financial irresponsibility, and/or legal issues)(Required)

Nearest Living Relatives

Please include the names, addresses, and relationship of any parents, grandchildren, siblings, etc. of each of you:

Name

Relationship

Address

Advisors

Type

Name

Phone

Address

Estate Planning Questionnaire

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