SWL Wills & Estate Information

Client Information
Title
Full Name & Surname
ID Number
If you do not have an SA ID, please complete your passport and date of birth.
Passport Number
Date of Birth
Email
example@example.com
Phone Number:
Gross Monthly Income (Before Any Deductions)
Highest Education
Do You Smoke? (e.g. cigarettes, vapes, hubbly bubbly etc.)
Do you consent to being contacted via Email, SMS & WhatsApp
Will Information
Do you have any worldwide assets
If “Yes” – please proceed to complete the table below:

Are there assets such as business interests and fixed property outside of South Africa (i.e. are there offshore assets that stand to be inherited)? If so, a single worldwide will is recommended. Please complete the required information below.

Rows	Asset Description	Country	Rand Amount
1
2
3

Please note that depending on the country (e.g. Portugal, Spain, France, etc.) a separate offshore will in the relevant territory will be required for these assets. If an offshore will is required, our Technical Advice Centre will make contact to assist with this process.
General Estate

Your general estate includes everything not specifically listed — for example, property, furniture, vehicles, and money in the bank.
Who would you like to inherit your general estate?
Please include the person’s FULL NAMES & SURNAME, relationship, and date of birth — e.g., “My wife, Anna South, born 12 March 1980.”
If that person passes away within 30 days of you, who should then inherit your general estate?
FULL NAMES & SURNAME, relationship, and date of birth — e.g., “My children, Peter and Mia South, to share 50/50.”
If you and your immediate family pass away within 30 days, who should inherit your general estate? When an entire immediate family passes away together in the same incident, keeping in mind it is only YOUR estate.
FULL NAMES & SURNAME, relationship, and date of birth — e.g., “My brother, David South, born 5 June 1985.”
Specific Items or Gifts

Please list any specific items you would like to leave to someone in particular.
Item / Description | Person to Receive It | Relationship | % Share (if applicable)
For example: “My gold watch to my son, Peter Liebenberg.”
Firearms: Please state whether you own any firearms. If you do, list each one separately and name the person you want to receive it. The person you nominate must also have a valid firearm licence.
Glock 19 (Licence No. 123456789) – to John Smith (brother).
Last Wishes
Trust and inheritance protection

Please complete the sections below, where applicable.
Children's Trust
A testamentary trust is required if minor children are or could inherit from you.
Beneficiary name
Relationship
Beneficiary name
Relationship
Beneficiary name
Relationship
Beneficiary name
Relationship
Beneficiary name
Relationship
At what age must the Testamentary/Children’s Trust stop:
18 Years + (Recommended 25 years)
Provider's Trust

It may be that a beneficiary has special needs. In such a case, we recommend that a separate lifelong trust be created for the interests of this beneficiary and to provide capital and income to support this beneficiary. The principal beneficiary of your will automatically inherits the balance of any remaining capital.

Please complete the information below to enable us to create such a trust in your will. This may include a spouse, children, adult dependants, or parents with mental or physical disabilities, family members struggling with substance abuse, or beneficiaries who cannot manage money responsibly.

Income and capital beneficiary
Beneficiary name
Relationship
Beneficiary name
Relationship
Beneficiary name
Relationship
Organ donor registration
Would you like to be an organ donor?
Have you been registered before?
Would you like us to register you?
If you selected 'Yes' for us to register on your behalf, you, herewith confirm and understand what it means to be an organ donor and you have registered by your own free will. Please note that more information can be obtained from the Organ Donor Foundation's website www.odf.org.za or by calling their toll-free telephone line 0800 22 66 11.
Next of kin details

(Details of your closest family member)
Full Name & Surname
Relationship
Email
example@example.com
Cell Number
Guardian, trustee and executor nominations

In the event of both biological parents being deceased, please provide full name(s) and relationship(s) of guardians for your minor children.
Guardian Full Name & Surname
Relationship
Alternate Guardian Full Name & Surname
Relationship
In addition to the company/person administering your Estate, we strongly recommend a personal co-trustee. Please provide name(s) and relationship(s). It is advisable to nominate a financially responsible person who knows the family well.
Co-trustee name
Relationship
Co-trustee name
Relationship
Please Complete the Combined Underwriting Medical Questionnaire for Estate Plans (Recommended)

Personal Health Details
What is your height (in centimeters)
and weight (in kilograms)?
Previous Insurance History: Have you ever been declined, charged an extra premium, or had an exclusion applied to any previous application for insurance that has not been reversed, whether issued or not?
If Yes, please provide details:
Infectious and Immune System Conditions
HIV Status: Have you ever tested positive for HIV?
Hepatitis and Liver-Related Conditions: Have you ever suffered from, been diagnosed with, received treatment for, or consulted a medical doctor regarding any disorder of the liver, pancreas, or related organs such as Hepatitis B or C; Liver disease, cirrhosis, or liver failure; Pancreatitis Polycystic kidney disease; Blood or protein in the urine; Chronic kidney infection or failure; Kidney stones; Bladder problems.
If you have answered yes to any of the above, please provide details:
Cardiovascular and Metabolic Health
Heart and Circulatory System Disorders: Have you ever suffered from, been diagnosed with, or received treatment for any cardiovascular disorder such as Heart attack, chronic heart failure, or stroke; Ischemic heart disease or angina Heart operations (bypass graft, angioplasty, or stenting); Palpitations, chest pains, or heart murmurs.
Blood Pressure and Cholesterol: Have you ever been prescribed or advised to take medication to control cholesterol or blood pressure levels, and within the last six (6) months, has your doctor changed your medication type or dosage?
Diabetes and Blood Sugar Disorders: Have you ever suffered from, or been diagnosed with, diabetes (Type 1 or Type 2), insulin resistance, persistently raised blood sugar, or sugar in the urine?
Blood and Coagulation Disorders: Have you ever suffered from or been diagnosed with any blood and/or coagulation (clotting) disorder, for which you have taken medication in the last five (5) years, such as anemia or polycythemia?
If you have answered yes to any of the above, please provide details:
Autoimmune, Mental, and Systemic Conditions
Autoimmune Disorders: Have you ever been diagnosed with, or received treatment for, any autoimmune disease such as rheumatoid arthritis or systemic lupus erythematosus (SLE)?
Mental Health Conditions:Have you ever been diagnosed with, received treatment for, or consulted a doctor regarding any mental or psychiatric condition, including but not limited to: Chronic major depression; Bipolar mood disorder; Schizophrenia
If you have answered yes to any of the above, please provide details:
Cancer and Serious Illness
Cancer: Have you ever been diagnosed with or received treatment for any form of cancer that was not benign?
If Yes, please provide details:
Digestive and Gastrointestinal Conditions
Have you ever been diagnosed with or received treatment for any of the following: Ulcerative colitis; Crohn’s disease; Barrett’s oesophagus
If Yes, please provide details:
Hospitalisation and Future Medical Plans
Recent Hospitalization or Extended Illness: In the past five (5) years, have you spent more than four (4) consecutive nights in hospital or been absent from work for more than three (3) consecutive weeks due to illness or surgery (excluding childbirth, dental surgery, bone fractures, gastroenteritis, or an appendectomy)?
Future Medical Consultations: In the next twelve (12) months, do you plan on seeing a doctor or specialist for any illness, symptoms, special investigations, or treatments other than minor conditions such as colds, influenza, gastroenteritis, or routine dentistry?
If you have answered yes to any of the above, please provide details:
POPIA Consent
Declaration

BMI / Acceptance Clause
Please note: if your Body Mass Index (BMI) exceeds 40.0 or you answer “Yes” to any of the above questions, the insurer reserves the right to apply additional terms or waiting periods as applicable.
SIGNATURE OF CLIENT
Date of Signature:
SWL FINANCIAL SERVICES – Licensed Financial Services Provider in terms of Section 8 of the Financial Advisory and Intermediary Services Act, 2002. (Act No 37 OF 2002) (Licence Number 34914)
Should be Empty:

Client Information

Will Information

General Estate

Specific Items or Gifts

Last Wishes

Trust and inheritance protection

Organ donor registration

Next of kin details

Guardian, trustee and executor nominations

Please Complete the Combined Underwriting Medical Questionnaire for Estate Plans (Recommended)

Infectious and Immune System Conditions

Cardiovascular and Metabolic Health

Autoimmune, Mental, and Systemic Conditions

Cancer and Serious Illness

Digestive and Gastrointestinal Conditions

Hospitalisation and Future Medical Plans