ESTATE PLANNING: NEW CLIENT QUESTIONNAIRE

ESTATE PLANNING: NEW CLIENT QUESTIONNAIRE
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Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Personal Information
YOUR INFORMATION
Full Legal Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Country(s) of Citizenship
Home Address

Street Address

Street Address Line 2

CityState

Zip Code
County
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Military/Veteran Status
Marital Status
Employer
Work Address

Street Address

Street Address Line 2

CityState

Zip Code
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
SPOUSE'S INFORMATION
Spouse's Legal Name

First NameLast Name
Spouse's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Spouse's Citizenship
Spouse's Home Address

Street Address

Street Address Line 2

CityState

Zip Code
Spouse's County
Spouse's Phone
Please enter a valid phone number.Format: (000) 000-0000.
Spouse's Email
example@example.com
Spouse's Military/Veteran Status
Spouse's Employer
Spouse's Work Address

Street Address

Street Address Line 2

CityState

Zip Code
Spouse's Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Beneficiaries
How many beneficiaries will you have?

Beneficiary One : Legal Name

First NameLast Name
Beneficiary One : Address

Street Address

Street Address Line 2

CityState

Zip Code
Beneficiary One : Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Relationship to Beneficiary One

Beneficiary Two : Legal Name

First NameLast Name
Beneficiary Two : Address

Street Address

Street Address Line 2

CityState

Zip Code
Beneficiary Two : Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Relationship to Beneficiary Two

Beneficiary Three : Legal Name

First NameLast Name
Beneficiary Three : Address

Street Address

Street Address Line 2

CityState

Zip Code
Beneficiary Three : Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Relationship to Beneficiary Three

Beneficiary Four : Legal Name

First NameLast Name
Beneficiary Four : Address

Street Address

Street Address Line 2

CityState

Zip Code
Beneficiary Four : Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Relationship to Beneficiary Four

Beneficiary Five : Legal Name

First NameLast Name
Beneficiary Five : Address

Street Address

Street Address Line 2

CityState

Zip Code
Beneficiary Five : Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Relationship to Beneficiary Five

Beneficiary Six : Legal Name

First NameLast Name
Beneficiary Six : Address

Street Address

Street Address Line 2

CityState

Zip Code
Beneficiary Six : Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Relationship to Beneficiary Six

Family and Estate Questions
Have you or your spouse been married before?
If previous marriage was terminated by divorce, do you or your spouse pay any support, retirement plans, or insurance obligations TO the former spouse?
If previous marriage was terminated by divorce, do you or your spouse receive any support, retirement plans, or insurance obligations FROM the former spouse?
Do you and your current spouse have a pre-nuptial agreement?
Do you or your spouse receive Social Security, disability, or other governmental benefits?
Have you or your spouse signed a will, trust, or any other estate planning legal documents?
If yes, please list the benefits:
Are you interested in including any charitable gifts in your estate plan?
If yes, please list the charities:
Are there any children or grandchildren that are not listed as a beneficiary here?
If yes, please list their names and indicate if you or your spouse is the parent or grandparent:
Are there any children or grandchildren you wish to specifically omit from the estate plan?
If yes, please list their names and indicate if you or your spouse is the parent or grandparent:
Do you have any deceased children?
If yes, please list their names and indicate if you or your spouse is the parent:
Did any of your deceased children have children?
Do any of your children or grandchildren have a disability and receive government benefits?
If yes, please list their names and indicate if you or your spouse is the parent:
Do any of your children or grandchildren have special educational, medical or physical needs?
If yes, please describe and indicate if you or your spouse is the parent:
Do you or your spouse provide primary or financial support to adult children or others?
Your Estate
Your estate is equal to the value of all of your personal assets less the value of all of your personal liabilities. In order for us to prepare your estate planning documents properly, we must have an accurate idea as to the size of your estate and the types of assets that comprise your estate. Below, please list each of your assets and liabilities and indicate whether the asset or liability is personal to either of you or owned jointly.
ASSETS

Real Estate:

Rows	Owned by you	Owned by your spouse	Owned jointly
Residence Value $
Other $
Other $
Other $

Securities Values (not held in IRA or a retirement plan):

Rows	Owned by you	Owned by your spouse	Owned jointly
Publicly Traded Stocks $
Publicly Traded Stocks $
Publicly Traded Stocks $
Non-Public Stock $
Bonds $
Mutual Funds $
Mutual Funds $
Mutual Funds $
Other $
Other $

Cash, Bank Accounts, and Certificates of Deposit:

Rows	Owned by you	Owned by your spouse	Owned jointly
Money Market Funds $
Money Market Funds $
Bank Accounts $
Bank Accounts $
Certificates of Deposit $
Certificates of Deposit $

Retirement Benefits:

Rows	Owned by you	Owned by your spouse	Owned jointly
IRAs (Traditional) $
IRAs (Roth) $
Qualified Annuities $
Non-Qualified Annuities (Non-IRA) $
Retirement Plan – Profit Sharing $
Retirement Plan – Keogh $
Retirement Plan – ESOP SEP $
Retirement Plan – 457(b) $
Retirement Plan – 401(k) $
Retirement Plan – 403(b) $

Businesses:

Rows	Owned by you	Owned by your spouse	Owned jointly
Partnerships / LLCs $

Promissory Notes:

Rows	Owned by you	Owned by your spouse	Owned jointly
Promissory Notes Payable to You $

Insurance (Group and Individual):

Rows	Owned by you	Owned by your spouse	Owned jointly
Death Benefit / Cash Value $
Death Benefit / Cash Value $

Anticipated Gifts and Inheritances:

Rows	Owned by you	Owned by your spouse	Owned jointly
Anticipated Gifts / Inheritances $

Personal Property:

Rows	Owned by you	Owned by your spouse	Owned jointly
Automobile $
Automobile $
Jewelry, Art, Furs, Guns, Antiques $ (in excess of $10,000 market value)

TOTAL ASSETS:
Your Total Assets   $

Spouse's Total Assets   $

Joint Total Assets   $
LIABILITIES

Mortgages Payable:

Rows	Owned by you	Owned by your spouse	Owned jointly
Address One $
Address Two $
Address Three $

Address One:

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Address Two:

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Address Three:

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Outstanding Loans:

Rows	Owned by you	Owned by your spouse	Owned jointly
Loan One $
Loan Two $

Describe Loan One:
Describe Loan Two:

Other Liabilities:

Rows	Owned by you	Owned by your spouse	Owned jointly
Other $
Other $

Describe Other Liabilities:
TOTAL LIABILITIES:
Your Total Liabilities   $

Spouse's Total Liabilities   $

Joint Total Liabilities   $
NET VALUE OF ESTATE
Your Total Assets $

Your Total Liabilities (-) $

Your Net Estate (=) $
Spouse's Total Assets $

Spouse's Total Liabilities (-) $

Spouse's Net Estate (=) $
Joint Total Assets$

Joint Total Liabilities (-) $

Joint Net Estate (=)$
SOURCES OF INCOME

Income Source:

Rows	Owned by you	Owned by your spouse	Owned jointly
Salary $
Pension $
Bonus / Commissions
Dividends / Interest
Other (SS, IRA, distributions, etc.)
Net Rental Income

TOTAL INCOME:
Your Total Income   $

Spouse's Total Income   $

Joint Total Income   $
Advisors
ACCOUNTANT
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
FINANCIAL ADVISOR
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
LIFE INSURANCE AGENT
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
OTHER
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Successor Trustee
The successor trustee is the individual or trust company who would have title to all of your property and will administer your property during your disability or after your death according to the terms of your living trust. The trustee is responsible for the management and investment of all of your trust property. Please consider the person you would choose to act as your Successor Trustee with great care.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to you
Signature
The information provided above is a complete and total list of all of my/our assets and income, that I/we am/are presently aware of at this time.
Your Signature
Spouse's Signature
Please choose your status:
How did you hear about us?
If a referral, please list their name:
Should be Empty:

ESTATE PLANNING: NEW CLIENT QUESTIONNAIRE

Personal Information

Beneficiaries

Family and Estate Questions

Your Estate

Advisors

Successor Trustee

Signature