Estate Planning Questionnaire

CLIENT PERSONAL INFORMATION
Name*
First Middle Last
Date of Birth*
Month
Day
Year
Phone / Cell*
Phone / Business*
Email Address*
Military Service
Citizenship
Social Security Number
Status of Health
Mental Condition
Status of Health
Physical Condition

SPOUSE/PARTNER PERSONAL INFORMATION (if applicable)
Name
First Middle Last
Date of Birth
Month
Day
Year
Phone / Cell
Phone / Business
Email
Miitary Service
Citizenship
Social Security Number
Status of Health
Mental Condition
Status of Health
Physical Condition
Client's Address
Client's Address Client's Address 2 Client's City Client's State Client's Zip Code
Client’s Objective

CONTACT PERSON (if not client)
Name
First Last
Relationship
Address
Street Address Address Line 2 City State ZIP Code
Email
Phone / Home
Phone / Cell
Phone / Business
Note: Also, please bring the following Documents to our meeting, if available and applicable: (a) Will(s), (b) Power(s) of Attorney, (c) deed to residence and real properties with tax bills, (d) last two years tax returns, (e) life and health insurance policies, (f) Beneficiary designation on all retirement plans and life insurance policies and (g) any other documents or information you deem relevant

SUMMARY OF ASSETS AND LIABILITIES
ASSETS
Real Estate
Client Partner/Spouse Joint Other Total
Cash
Client Partner/Spouse Joint Other Total
Checking
Client Partner/Spouse Joint Other Total
Savings/Money Market
Client Partner/Spouse Joint Other Total
Certificates of Deposit
Client Partner/Spouse Joint Other Total

STOCKS AND BONDS
Individually held
Client Partner/Spouse Joint Other Total
Brokerage
Client Partner/Spouse Joint Other Total
Mutual Funds
Client Partner/Spouse Joint Other Total
Savings Bonds
Client Partner/Spouse Joint Other Total
Life Insurance (face value)
Client Partner/Spouse Total

RETIREMENT BENEFITS
Pension
Client Partner/Spouse Total
401 (K)
Client Partner/Spouse Total
IRA Accounts
Client Partner/Spouse Total
Annuities/Mortgages/Notes
Client Partner/Spouse Joint Other Total
Personal Property
Client Partner/Spouse Joint Other Total
Business Interests
Client Partner/Spouse Joint Other Total
Miscellaneous
Client Partner/Spouse Joint Other Total
Total Assests
Client Partner/Spouse Joint Other Total
LIABILITIES
Debt
Client Partner/Spouse Joint Other Total
Mortgage Payables
Client Partner/Spouse Joint Other Total
Total Liabilities
Client Partner/Spouse Joint Other Total
NET WORTH
Net Worth
Client Partner/Spouse Joint Other Total
Email
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Estate Planning Questionnaire

Step 1 of 6

CLIENT PERSONAL INFORMATION

SPOUSE/PARTNER PERSONAL INFORMATION (if applicable)

CONTACT PERSON (if not client)

MARITAL INFORMATION

CHILDREN/OR OTHER RELATIVES

ESTATE PLANNING CHECKLIST

SUMMARY OF ASSETS AND LIABILITIES

ASSETS

STOCKS AND BONDS

RETIREMENT BENEFITS

LIABILITIES

NET WORTH

Informational Pamphlets

Free Planning Guides

Name	Address	Phone	Email	Spouse/Partner	Notes

Name	Address	Phone	Email	D.O.B	Notes