Last Will / Power of Attorney Questionnaire
Complete before your first meeting with your lawyer. Compliments of Keill & Associates | (613) 253-8934 | www.keillandassociates.ca
Personal Information
Your Legal Name
*
Your Current Name (best known as)
Legal Name at Birth
Current Residential Address
City
Postal Code
Date of Birth
-
Month
-
Day
Year
Date
Place of Birth
Marital Status
Please Select
Single
Married
Common-Law
Divorced
Widowed
Separated
Date of Marriage
-
Month
-
Day
Year
Date
Place of Marriage
Spouse's Name
If Previously Married
Name of Ex-Spouse
*
First Name
Middle Name
Last Name
Date of Previous Marriage
*
-
Month
-
Day
Year
Date
Date of Separation or Divorce
*
-
Month
-
Day
Year
Date
Support and Dependents
Are you currently paying or receiving spousal or child support of any kind? If yes, describe the type, to whom, amount, and how long it has been paid or received.
Children/Dependents
Existing Wills and Estate Documents
Do you have a current Will?
*
Yes
No
Does your spouse have a current Will?
Yes
No
If yes, who prepared it and when?
Where is the original Will located?
Who was your previous executor?
Are you named as executor on any existing estates or wills?
Power of Attorney and Directives
Do you have a current Power of Attorney for Personal Care?
*
Yes
No
Does your spouse have a current Power of Attorney for Personal Care?
*
Yes
No
If so, who is your current Power of Attorney for Personal Care?
Do you currently have a Power of Attorney for Financial Matters?
*
Yes
No
Does your spouse have a Power of Attorney for Financial Matters?
*
Yes
No
If so, whom?
Do you have a health care directive in place?
*
Yes
No
Are you the beneficiary, donor, and/or trustee of any Wills or Trusts?
Does anyone in your immediate family, or anyone that depends on you for financial support, have a disability?
Funeral and End of Life
Have you prearranged your funeral?
*
Yes
No
If yes, where are your funeral arrangements recorded?
Are your executor of choice or family members aware of your funeral wishes?
*
Yes
No
Have you signed an organ donor card?
*
Yes
No
Do your family members know about your organ donor wishes?
*
Yes
No
Registered Accounts — RRSP / RRIF / TFSA or Other Registered Accounts
Registered Accounts
*
Life Insurance Policies
Policies
*
Assets and Things of Value
Assets and Things
*
Executor
Who do you wish your Executor(s) to be?
Executor's relationship to you
Executor's approximate age
Where does the executor reside in Canada?
Beneficiaries of Your Estate
Registered Accounts
*
Any special notes about your wishes for these beneficiaries?
Guardian and Special Wishes
Who would you like the guardian for the children to be? Name
Guardian's City of Residence
Guardian's Relationship to you
Do you have any special bequest or legacy such as specific gifts of property or money?
What do you want to happen if the beneficiaries you list die before you?
Do you wish to appoint someone other than your executor to administer any resulting or existing trusts? If so, who?
Alternate Executor
Should your chosen executor die before you or elect not to act, whom would you choose as an alternate? Name
Alternate executor's relationship to you
Alternate executor's approximate age
Where do they live in Canada?
Do you wish to leave money to any charities? Describe the charities and the desired amounts or share.
Power of Attorney Appointments
Who would you like to be your financial Power of Attorney? This person will be responsible for making sure all financial matters are dealt with if you become incapacitated.
Financial Power of Attorney — Name
Financial Power of Attorney — Relationship to you
Who would you like to be your personal care Power of Attorney? This person will be responsible for making sure all your personal health care decisions are dealt with in a way that you would have wanted.
Personal Care Power of Attorney — Name
Personal Care Power of Attorney — Relationship to you
If either of these people are not able to act as Power of Attorney for you, who would you like to be your alternate(s)?
Alternate Financial POA — Name
Alternate Financial POA — Relationship to you
Alternate Personal Care POA — Name
Alternate Personal Care POA — Relationship to you
Final Notes
Other special notes for your lawyer completing your Will and Power of Attorney
Thank you for completing this questionnaire. Note: This is not an estate plan, nor does it constitute or replace any existing estate document. We strongly recommend any Will and/or Power of Attorney should be completed by a lawyer. If you do not have a lawyer, Keill & Associates will be pleased to provide a referral. (613) 253-8934 | www.keillandassociates.ca | 81 Bridge Street, Carleton Place, ON K7C 2V4
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