The Ultimate Business Checkup
Business Overview
Business Name
EIN
Business Structure
Please Select
LLC
S-Corp
C-Corp
501c3
Other
Certifications
Minority-owned
Veteran Owned
Woman Owned
Other
Licenses & Certifications
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Insurance Inventory
Types of Insurance
Homeowners
Auto, Boat, RV, etc.
Personal L
Type option 4
What is your full name and title?
Date of Birth
-
Month
-
Day
Year
Date
Name
First Name
Last Name
What is your title with the company?
Primary Address/ Headquarters or Location
Street Address
Apt. or Suite #, Store Number, Etc.
City
State / Province
Postal / Zip Code
Emergency Contact Names, Numbers, and any other ways to contact them.
Please let us know what your relationship is.
Do you have primary care physicians or specialists you'd like to list? If yes, share details here.
Indicate any other names these professionals might know you by.
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Estate Planning
Make your plans clear so that your wishes may be honored.
Do you currently have an of the following legal documents in place?
Will (instructions for who receives your assets)
Living Trust (a trust to manage your assets)
Power of Attorney (Legal- allows someone to handle your legal matters
Power of Attorney (Medical- allows someone to make healthcare decisions for you)
Advanced Directive (Outlines your healthcare wishes if you can't communicate)
None
Upload copies of any existing legal documents:
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Who will be the executor of your estate? (This is the person carrying out your will)
Have you designated a legal power of attorney? If so, provide their name and contact information.
Have you designated a medical power of attorney? If yes, provide their name and contact info
Would you like resources to help you avoid probate? (Probate is the legal process of settling a distributing your estate if you don't have a will when you pass away.)
Please Select
Yes
No
Do you need a referral to an estate or business attorney?
Please Select
Yes
No
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Insurance & Financial Inventory
Do you currently have any of the following insurance policies?
Life Insurance (pays out to your loved ones when you pass away)
Health Insurance (covers medical expenses)
Disability Income Replacement (provides income if you're unable to work)
Property Insurance (protects your home and belongings
Cancer Insurance (provides financial support if diagnosed with cancer)
Long-term Care Insurance (covers costs for extended care, like nursing homes)
Business Owners Policy (covers small business risks)
Umbrella Liability (extra coverage beyond regular policies
None
Upload copies of your insurance policies
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Do you have any retirement accounts or annuities? If so, list providers and policy numbers.
Upload retirement account documents.
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Would you like more information on tax-free savings vehicles like annuities? (These help grow your saving without paying taxes on the growth)
Please Select
Yes
No
On a scale of 1 to 10, how well do you understand the coverages you currently have in place?
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Document Storage and Access
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