Estate Planning Client Questionnaire

Full Name

First NameLast Name

Date of Birth

Date

Phone Number

Please enter a valid phone number.

Email Address

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Occupation

Employer

Marital Status

SingleMarriedDivorcedWidowed

List of Family Members

Executor of Estate

List of Beneficiaries

Are any of your children or intended beneficiaries physically or mentally challenged?

YesNo

Do any of your children or intended beneficiaries have any special education, medical or financial needs?

YesNo

Please Give Details

Do you presently have a Will?

YesNo

Living Trust?

YesNo

Durable Power of Attorney?

YesNo

Designation of Patient Advocate/Medical Durable Power of Attorney?

YesNo

Is probate avoidance one of your estate plan objectives?

YesNo

Have you ever filed a gift tax return?

YesNo

Accountant

Investment Counselor/ Financial Planner

Insurance Representative

Additional Comments

Estate Plan Client Questionnaire