SPEF Estate Gift Intention Form

Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Spouse Name

First NameLast Name
Spouse Date of Birth

MonthDayYear
Chapter Affiliation*
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Type of Gift*

WillLiving TrustLife InsuranceRetirement PlanOther
If Other, Please List What Type of Gift
Description of Gift*
As of today, I estimate the value of this provision in my estate plan to be:*
Is this a "contingent" gift? (Sigma Pi is an alternate beneficiary and will only receive the gift under certain circumstances.)*

YesNo
If so, please list the contingencies.
Is this an unrestricted gift?*

YesNo
If not, please list the specific purpose that this gift should be used for.
Signature*
Should be Empty: