Estate Planning Questionnaire

Primary Client

First Name *

Middle Name (optional)

Last Name *

Date of Birth *

Social Security # (last 4 digits)

Email Address *

Phone Number *

Street Address *

City *

State

Zip Code

Occupation

Employer

Marital Status *

Prior Marriages?

Do you have children? YesNo

Do you have grandchildren? YesNo

Children

Child 1

Full Name

Date of Birth

Relationship

Special Needs?

Primary Beneficiaries

Who do you wish to receive your estate? (E.g., spouse, children, charity.)

Beneficiary 1

Full Name

Relationship

Share (%)

Executor / Personal Representative

Who do you wish to administer your estate after your passing?

Primary Executor — Full Name

Relationship to You

Alternate Executor — Full Name

Relationship to You

Guardian for Minor Children

Primary Guardian — Full Name

Relationship

Alternate Guardian — Full Name

Relationship

Real Estate

Do you own real estate? YesNo

Address(es) and estimated value(s) (Optional)

How is it titled?

Total Estimated Value

Financial Accounts

Checking / Savings

Investment / Brokerage

Retirement Accounts

Pension

Life Insurance

Do you have life insurance? YesNo

Policy Type(s) TermWholeUniversal

Total Death Benefit

Named Beneficiary on Policy

Business Interests

Do you own a business? YesNo

Business Name & Type

Estimated Value

Other Assets & Liabilities

Other Valuable Assets

Outstanding Debts

Healthcare / Medical Directives

Do you have a living will? YesNoNeed one

Healthcare Agent

Relationship

End-of-Life Preferences Do Not Resuscitate (DNR)No artificial nutrition/hydrationComfort / palliative care only

Financial Power of Attorney

Do you have a financial POA? YesNoNeed one

Financial Agent

Relationship

Trust Preferences

Interested in a trust? Yes — Revocable Living TrustYes — Irrevocable TrustUnsure, need guidanceNo

Funeral & Burial Wishes

Preference BurialCremationNo preferencePre-arranged

Additional Instructions

Additional Notes

Anything else?

How did you hear about us?

Best time to reach you

Review your entries above. Click Back to make changes, or Submit to send.

I confirm that the information provided is accurate and complete to the best of my knowledge. I understand that this questionnaire is for informational purposes and does not create an attorney-client relationship.

Estate Planning Questionnaire

Personal Information

Family & Beneficiaries

Assets & Property

Directives & Final Wishes

Review & Submit

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