Estate Planning Form

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Estate Plan Client Questionnaire

Congratulations, this form will provide you with a copy of your answers. It is a tool to help identify your needs & goals.

If you don't have all of the answers that's okay. You can revisit the form to complete it later.
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The purpose of this is to gather information. We are not making any decisions at this time. If you make a mistake or don't have all of the information please go ahead and complete the form.
3
Are you married?* This field is required.
Yes
No
4
Your Name* This field is required.
First Name
Middle Name
Last Name
Jr., Sr. III etc
5
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
6
Your Information
Your Email
Your Phone
Your Date of birth
7
Spouse's Information
Spouse's name
Spouse Email
Spouse Phone
Date of birth
8
Couple: Questions about childrenClick all that apply
We have no children
We have children together (check if spouse adopted other's child)
Husband has children from a previous relationship
Wife has children from a previous relationship
One or more of the children is deceased
Other
9
Do you have children?
Yes, all are living.
Yes, but one or more are deceased.
No Children.
10
Children Info: Please include information about living childrenPlease include at least the name and date of birth for each. If a child is deceased we'll ask about that later.
Name
Date of Birth
Address
City/State/Zip
Phone
Email
Child 1
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Child 2
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Child 3
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Child 4
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Child 5
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Child 6
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Name
Row 0, Column 0
Date of Birth
Row 0, Column 1
Address
Row 0, Column 2
City/State/Zip
Row 0, Column 3
Phone
Row 0, Column 4
Email
Row 0, Column 5
Name
Row 1, Column 0
Date of Birth
Row 1, Column 1
Address
Row 1, Column 2
City/State/Zip
Row 1, Column 3
Phone
Row 1, Column 4
Email
Row 1, Column 5
Name
Row 2, Column 0
Date of Birth
Row 2, Column 1
Address
Row 2, Column 2
City/State/Zip
Row 2, Column 3
Phone
Row 2, Column 4
Email
Row 2, Column 5
Name
Row 3, Column 0
Date of Birth
Row 3, Column 1
Address
Row 3, Column 2
City/State/Zip
Row 3, Column 3
Phone
Row 3, Column 4
Email
Row 3, Column 5
Name
Row 4, Column 0
Date of Birth
Row 4, Column 1
Address
Row 4, Column 2
City/State/Zip
Row 4, Column 3
Phone
Row 4, Column 4
Email
Row 4, Column 5
Name
Row 5, Column 0
Date of Birth
Row 5, Column 1
Address
Row 5, Column 2
City/State/Zip
Row 5, Column 3
Phone
Row 5, Column 4
Email
Row 5, Column 5
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Our Children Info: Please include information about living childrenPlease include at least the name and date of birth for each. If a child is deceased we'll ask about that later.
Name
Date of Birth
Address
Phone
Email
Child 1
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Child 2
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Child 3
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Child 4
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Child 5
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Child 6
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Name
Row 0, Column 0
Date of Birth
Row 0, Column 1
Address
Row 0, Column 2
Phone
Row 0, Column 3
Email
Row 0, Column 4
Name
Row 1, Column 0
Date of Birth
Row 1, Column 1
Address
Row 1, Column 2
Phone
Row 1, Column 3
Email
Row 1, Column 4
Name
Row 2, Column 0
Date of Birth
Row 2, Column 1
Address
Row 2, Column 2
Phone
Row 2, Column 3
Email
Row 2, Column 4
Name
Row 3, Column 0
Date of Birth
Row 3, Column 1
Address
Row 3, Column 2
Phone
Row 3, Column 3
Email
Row 3, Column 4
Name
Row 4, Column 0
Date of Birth
Row 4, Column 1
Address
Row 4, Column 2
Phone
Row 4, Column 3
Email
Row 4, Column 4
Name
Row 5, Column 0
Date of Birth
Row 5, Column 1
Address
Row 5, Column 2
Phone
Row 5, Column 3
Email
Row 5, Column 4
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Husband's Children Info: Please include information about living childrenPlease include at least the name and date of birth for each. If a child is deceased we'll ask about that later.
Name
Date of Birth
Address
Phone
Email
Child 1
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Child 2
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Child 3
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Child 4
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Child 5
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Child 6
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Name
Row 0, Column 0
Date of Birth
Row 0, Column 1
Address
Row 0, Column 2
Phone
Row 0, Column 3
Email
Row 0, Column 4
Name
Row 1, Column 0
Date of Birth
Row 1, Column 1
Address
Row 1, Column 2
Phone
Row 1, Column 3
Email
Row 1, Column 4
Name
Row 2, Column 0
Date of Birth
Row 2, Column 1
Address
Row 2, Column 2
Phone
Row 2, Column 3
Email
Row 2, Column 4
Name
Row 3, Column 0
Date of Birth
Row 3, Column 1
Address
Row 3, Column 2
Phone
Row 3, Column 3
Email
Row 3, Column 4
Name
Row 4, Column 0
Date of Birth
Row 4, Column 1
Address
Row 4, Column 2
Phone
Row 4, Column 3
Email
Row 4, Column 4
Name
Row 5, Column 0
Date of Birth
Row 5, Column 1
Address
Row 5, Column 2
Phone
Row 5, Column 3
Email
Row 5, Column 4
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Wife's Children Info: Please include information about living childrenPlease include at least the name and date of birth for each. If a child is deceased we'll ask about that later.
Name
Date of Birth
Address
Phone
Email
Child 1
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Child 2
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Child 3
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Child 4
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Child 5
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Child 6
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Name
Row 0, Column 0
Date of Birth
Row 0, Column 1
Address
Row 0, Column 2
Phone
Row 0, Column 3
Email
Row 0, Column 4
Name
Row 1, Column 0
Date of Birth
Row 1, Column 1
Address
Row 1, Column 2
Phone
Row 1, Column 3
Email
Row 1, Column 4
Name
Row 2, Column 0
Date of Birth
Row 2, Column 1
Address
Row 2, Column 2
Phone
Row 2, Column 3
Email
Row 2, Column 4
Name
Row 3, Column 0
Date of Birth
Row 3, Column 1
Address
Row 3, Column 2
Phone
Row 3, Column 3
Email
Row 3, Column 4
Name
Row 4, Column 0
Date of Birth
Row 4, Column 1
Address
Row 4, Column 2
Phone
Row 4, Column 3
Email
Row 4, Column 4
Name
Row 5, Column 0
Date of Birth
Row 5, Column 1
Address
Row 5, Column 2
Phone
Row 5, Column 3
Email
Row 5, Column 4
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Did any deceased child have children or grandchildren?* This field is required.If a child died but left children of his or his own please complete.
YesNo
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Deceased child informationIf a deceased child left children please provide information here.
Name
Grandchild 1
Grandchild 2
Grandchild 3
Grandchild 4
Deceased Child 1
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Deceased Child 2
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Deceased Child 3
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Deceased Child 1
Deceased Child 2
Deceased Child 3
Name
Row 0, Column 0
Grandchild 1
Row 0, Column 1
Grandchild 2
Row 0, Column 2
Grandchild 3
Row 0, Column 3
Grandchild 4
Row 0, Column 4
Name
Row 1, Column 0
Grandchild 1
Row 1, Column 1
Grandchild 2
Row 1, Column 2
Grandchild 3
Row 1, Column 3
Grandchild 4
Row 1, Column 4
Name
Row 2, Column 0
Grandchild 1
Row 2, Column 1
Grandchild 2
Row 2, Column 2
Grandchild 3
Row 2, Column 3
Grandchild 4
Row 2, Column 4
Name
Row 3, Column 0
Grandchild 1
Row 3, Column 1
Grandchild 2
Row 3, Column 2
Grandchild 3
Row 3, Column 3
Grandchild 4
Row 3, Column 4
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Others to include in your estate plan. OptionalPlease list other persons, charities or entities to include in your estate plan. These may be beneficiaries or persons that may serve as a executor, power of attorney, etc. Remember we are just gathering information at this point.
Name
Connection to you
Address
Phone
Email
One
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Two
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Three
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Four
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Five
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
One
Two
Three
Four
Five
Name
Row 0, Column 0
Connection to you
Row 0, Column 1
Address
Row 0, Column 2
Phone
Row 0, Column 3
Email
Row 0, Column 4
Name
Row 1, Column 0
Connection to you
Row 1, Column 1
Address
Row 1, Column 2
Phone
Row 1, Column 3
Email
Row 1, Column 4
Name
Row 2, Column 0
Connection to you
Row 2, Column 1
Address
Row 2, Column 2
Phone
Row 2, Column 3
Email
Row 2, Column 4
Name
Row 3, Column 0
Connection to you
Row 3, Column 1
Address
Row 3, Column 2
Phone
Row 3, Column 3
Email
Row 3, Column 4
Name
Row 4, Column 0
Connection to you
Row 4, Column 1
Address
Row 4, Column 2
Phone
Row 4, Column 3
Email
Row 4, Column 4
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Special situations:Are any of the beneficiaries disabled, mentally challenged or would need assistance managing money?
Yes
No
18
Concerns: OptionalBriefly identify the individual and explain your concerns.
Huge
Large
Normal
Small
Ok
Ok
19
Current plan: If you have a current plan, please check any that apply. Click Next if you do not have a plan.
Will
Power of Attorney-Financial
Power of Attorney-Healthcare
Advanced Healthcare Directives
HIPAA Releases
Trust
Other
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What are your objectives?Click all that apply.
Keep in control
Get things set up to keep things simple for me and my family.
Avoid Probate
Avoid Guardianship
Medicaid Planning
Tax Savings
Asset Protection for Me or Children
Current Estate Plan Out of Date
21
Do you have any questions or concerns?
22
Check the box the click "SEND" so that your information can be delivered.* This field is required.
Should be Empty: