Personal Intake Form for Estate Planning The information you are about to provide will be the basis for your discussions with your lawyer and other financial advisers about your will and other estate and personal planning. You do not need evaluations or appraisals for listing assets and liabilities — your best estimates should be sufficient for most discussions. However, how you own the legal title to your assets is important and, if you are not sure whether, for example, your house is owned jointly with another person, ask your lawyer to investigate since assumptions can cause later problems. Also, if possible, check with your financial institutions for beneficiary designations on life insurance policies and pension plans. Step 1 of 1010%Submission Date Date Format: MM slash DD slash YYYY Part 1 - Personal InformationName (as is on government issued ID) First Middle (include all) Last Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Ontario Postal Code Date of Birth Date Format: MM slash DD slash YYYY Place of BirthCitizenshipPhone (Home)Phone (Business)Email Are you a status Indian Yes NoMarital StatusSingleMarriedCommon LawSeparatedDivorcedWidowerDate of Marriage Date Format: MM slash DD slash YYYY Spouse's Name First Last Spouse's Date of Birth Date Format: MM slash DD slash YYYY Spouse's CitizenshipHow many children do you have?Please enter a number greater than or equal to 0.Use the arrow keys (up and down) to change the value.Children Child's Name EditDelete There are no Children. Add Child Maximum number of children reached.Other Financial Dependants? Yes No(Do you have any legal obligation to support another person in addition to your spouse and children, or have you been providing actual support to anyone other than your spouse and children?)Have you ever promised someone a share of your estate in exchange for that person assisting you personally or with your finances or assets? Yes NoPart 2 - GeneralDo you have a will? Yes NoAre you presently receiving benefits from an estate or trust Yes NoHave you set up a trust to benefit another person? Yes NoDo you have your own financial planner? Yes NoAre you presently acting as an executor or trustee of any estate? Yes NoDo you have your own investment adviser? Yes NoDo you have your own accountant? Yes NoDo you have your own life insurance agent? Yes NoDo you own or have an interest in a business (i.e., sole proprietorship, partnership or limited company)? Yes NoPlease provide copies of business agreements. Please give details.Name of ComanyDo you and your spouse have a marriage contract or prenuptial agreement? Yes NoIf yes, please provide a copy.Have you been married more than once? Yes NoIf yes, please provide copies of final decree, separation agreement, etc.Part 3 - AssetsDo you have any automobiles/boats?If yes, please provide details and in whose name the vehicle/boat is in.Approximate value of household goods and contents.Do you have any antiques, artwork, jewelry of significant value? Please provide details.Do you own any real estate (Including a cottage)?YesNoAdd Real Estate Property Information EditDelete There are no Real Estates. Add Real Estate Maximum number of real estates reached.Do you have any bank accounts in YOUR name only?YesNoAdd Bank Account Bank Account Information EditDelete There are no Bank Account. Add Bank Account Maximum number of bank account reached.Do you have any joint bank accounts?YesNoAdd Joint Bank Account Joint Bank Account Information EditDelete There are no Joint Bank Accounts. Add Joint Bank Account Maximum number of joint bank accounts reached.Do you have a safety deposit box? Yes NoDo you have any RRSP's, RIF's, Pensions and/or Annuities?YesNoIf there is more than one, please click the button to add another beneficiary.Named Benificiary First Name Last Name EditDelete There are no Beneficiaries. Add Beneficiary Maximum number of beneficiaries reached.Make sure ALL beneficiaries are named to avoid probateDo you have any RESP's, RDSP's, TFSA's?YesNoIf there is more than one add beneficiaryNamed beneficiary First Name Last Name EditDelete There are no Beneficiaries. Add Beneficiary Maximum number of beneficiaries reached.Make sure ALL beneficiaries are named to avoid probateDo you have any investments?YesNoPlease list all stocks and/or bonds, their original costs, estimated market values and names of registered owners:Part 4 - LiabilitiesDo you have any mortgages?YesNoAdd Mortgage InformationDo you have any other debts?YesNoAdd Debts InformationDoes anyone or company owe you money? Yes NoPart 5 - Will InstructionsExecutor(s) and trustee(s) - First Pick (Usually Spouse) First Last Please include full names and addresses:Executor(s) and trustee(s) - Second Pick First Last Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Are both spouses picking the same second pick? Yes NoWill you make a memorandum or list to help your family make a fair division? Yes NoDisposition of residence and/or cottage:Cash gifts (to a person or charity):Disposition of Air Miles: **Please provide account number**Disposition of residue (the person who will be the beneficiary [usually spouse])Disposition of Alternative Residue - If first beneficiary is not alive.Is there any Executor/Beneficiary who lives outside Ontario? Yes NoIf a specific gift to a named beneficiary is an asset on which the estate will have to pay income tax, should the estate pay that tax or should the tax be borne by the named beneficiary? Yes NoAre executors to have broad powers for retention, sale and investment of assets and, if a trust company, investment in own securities, etc.? Yes NoName of Guardians and Custodians for Children First Last Address for Guardians and Custodians for Children Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Ontario Postal Code Alternate Guardians and Custodians for Children First Last Address of Alternate Guardians and Custodians for Children Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Ontario Postal Code Funeral, burial and other special instructions:Part 6A - Powers of Attorney for Property/AssetsContinuing Power of Attorney for Property (Financial Power of Attorney) - First Pick (Usually Spouse) First Last Address of Continuing Power of Attorney for Property (Financial Power of Attorney) - First Pick Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Ontario Postal Code Name of Alternate Pick for Power of Attorney for Property First Last Address of Alternate Pick for Power of Attorney for Property Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Ontario Postal Code Name First Last Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Ontario Postal Code NotesPart 6B - Powers of Attorney for Personal Care (Medical)Continuing Power of Attorney for Personal Care (To make medical decisions if you are unable to) - First Pick (Usually Spouse) First Last Alternate Pick For Power of Attorney for Personal Care First Last Address of Alternate Pick for Power of Attorney for Personal Care Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Ontario Postal Code If there is “no reasonable hope for recovery” do you want to be kept alive by artificial means: Yes - If so, choose below Life Support IV Hydration Feeding Tube No - No heroic measures should be takenIf you are in pain, do you want pain medication to be comfortable? Yes NoAre you an Organ Donor? Yes NoIf there is something that you feel has not been covered or have any concerns, please write them in the box below.Would you like to subscribe to our newsletter?*YesNoReview{all_fields}UntitledPlease select a form and fields to display in this Nested Form field.Untitled This iframe contains the logic required to handle Ajax powered Gravity Forms.
