Estate Planning Intake Form
Tell us about Yourself
First Name
*
Middle Name (optional)
Last Name
*
Date of birth
*
What’s the best number to reach you?
*
What’s the best email address to reach you?
*
Advisor Email
A copy will be sent to your Advisor to review.
Primary Address
Street Address
City
State
Country
Enter your country
Postal Code
General Information | Marital Info
Relational Status
Married
Unmarried
Separated
Is the Primary Person of the Trust the Husband or Wife?
Husband
Wife
Tell us about your Family
Do you have and/or your spouse have children?
Yes
How many children you/or your spouse have?
Do you/your spouse have adult children?
No
Your Child Full Name - Adult
AdultChild1 DOB
Your Child Full Name - Adult
AdultChild2 DOB
Your Child Full Name - Adult
AdultChild3 DOB
Your Child Full Name - Adult
AdultChild4 DOB
Do you have minor children?
Yes
No
Your Child Full Name - Minor
MinorChild1 DOB
Your Child Full Name - Minor
MinorChild2 DOB
Your Child Full Name - Minor
MinorChild3 DOB
Your Child Full Name - Minor
MinorChild4 DOB
Do you have Pets?
Yes
No
Do you want to add your pets to your estate plan?
Yes
No
Let’s create a Plan
What will be the name of your revocable trust?
Trustee of your Estate
Do you want your wife/husband to also be a co-trustee of your family trust?
Yes
No
Successor First Name
Successor Last Name
Do you want a second Successor Trustee for your Family Trust if your Successor Trustee is unable to act?
Yes
No
Secondary Successor First Name (optional)
Secondary Successor Last Name (optional)
State (optional)
Postal Code (optional)
Street Address (optional)
City (optional)
1st Beneficiary First Name
1st Beneficiary Last Name
1st Beneficiary Amount
Do you want to add a 2nd beneficiary to equal 100%
Yes
No
2nd Beneficiary First Name
2nd Beneficiary Last Name
2nd Beneficiary Amount
Do you want to add a 3rd beneficiary to equal 100%
Yes
No
3rd Beneficiary First Name
3rd Beneficiary Last Name
3rd Beneficiary Amount
Do you want to add a 4th beneficiary to equal 100%
Yes
No
4th Beneficiary First Name
4th Beneficiary Last Name
4th Beneficiary Amount
Do you want to add a 5th beneficiary to equal 100%
Yes
No
5th Beneficiary First Name
5th Beneficiary Last Name
5th Beneficiary Amount
Do you want to add a 6th beneficiary to equal 100%
Yes
No
6th Beneficiary First Name
6th Beneficiary Last Name
6th Beneficiary Amount
Do you want to add a 7th beneficiary to equal 100%
Yes
No
7th Beneficiary First Name
7th Beneficiary Last Name
7th Beneficiary Amount
Do you want to add a 8th beneficiary to equal 100%
Yes
No
8th Beneficiary First Name
8th Beneficiary Last Name
8th Beneficiary Amount
Do you want to add a 9th beneficiary to equal 100%
Yes
No
9th Beneficiary First Name
9th Beneficiary Last Name
9th Beneficiary Amount
Do you want to add a 10th beneficiary to equal 100%
Yes
No
10th Beneficiary First Name
10th Beneficiary Last Name
10th Beneficiary Amount
If your primary beneficiary passes away do you want to choose a secondary beneficiary? Total Allocation must be 100
Yes
No
1st Secondary Beneficiary First Name
1st Secondary Beneficiary Last Name
1st Secondary Beneficiary Amount
Do you want to a 2nd Secondary Beneficiary
Yes
No
2nd Secondary Beneficiary First Name
2nd Secondary Beneficiary Last Name
2nd Secondary Beneficiary Amount
Describe a specific asset you want to pass down to a specific beneficiary
Do you want to pass down a specific asset to a specific beneficiary
Yes
No
Name of Specific Asset
Description of Asset
Beneficiary First Name
Beneficiary Last Name
Do you want to add another asset to pass down to a specific beneficiary
Yes
No
Name of Specific Asset (optional)
Description of Asset(optional)
Beneficiary First Name(optional)
Beneficiary Last Name(optional)
Describe a specific vehicle you want to pass down a specific beneficiary.
Do you want to pass down a specific vehicle to a specific beneficiary?
Yes
No
Vehicle Beneficiary First Name
Vehicle Beneficiary Last Name
Description of Gift
Trustee's Personal Representative
Should you choose to create a Will, do you appoint your spouse to administer your estate?
Yes
No
N/A
If No or N/A:
Personal Representative First Name
Personal Representative Last Name
Do you want to add a secondary Personal Representative for your Will if the primary is unable to act?
Yes
No
If yes:
2nd Personal Rep First Name
2nd Personal Rep Last Name
For the secondary spouse, do you want your spouse to be the Personal Representative for your Wills?
Yes
No
If no:
3rd Personal Rep First Name
3rd Personal Rep Last Name
Does the secondary spouse want to add a secondary Personal Representative for your Will if the primary is unable to act?
Yes
No
Additional Instructions for their Trust
What Limits or Restrictions do you want to put in your Trust
If you are not alive, who do you want to be the Guardian of your Pets to be?
Pet(s) Name
First Name of Pet Guardian
Last Name of Pet Guardian
What if any provisions do syou want for your Pets?
List assets you want to include in your trust. This includes real estate, businesses, bank accounts, retirement accounts, etc.
Joint Assets ( Home, Bank Accounts)
Name of Asset
Description of Asset
Name of Asset #2
You can leave this blank
Does the Primary Spouse have assets just in their name
Yes
No
Non Joint Schedule of Assets - Spouse
Name of Asset #1
Description of Asset #1
Name of Asset #2
Description of Asset #2
Name of Asset #3
Description of Asset #3
Name of Asset #4
Description of Asset #4
Name of Asset #5
Description of Asset #5
You can leave this blank
Does the Secondary Spouse have assets just in their name
Yes
No
Non Joint Schedule of Assets - Second Spouse
Name of Asset No.1
Description of Asset No.1
Name of Asset No.2
Description of Asset No.2
Name of Asset No.3
Description of Asset No.3
Name of Asset No.4
Description of Asset No.4
Name of Asset No.5
Description of Asset No.5
You can leave this blank
Medical Power of Attorney
Do you want your spouse to be your primary Power of Attorney?
Yes
No
First Name
Last Names
Street Address
City
State
Zip Code
Phone
Do you want a secondary Power of Attorney if the primary Power of Attorney is unable to act?
Yes
No
First Name
Last Name
Street Address
City
Zip Code
Phone Number - (000) 000-0000
When will the Medical Power of Attorney become effective?
Immediately
The Power of Attorney becomes effective on my disability or incapacity
Do you want your spouse to be your primary Financial Affairs?
Do you want your spouse to be your primary Financial Affairs?
Yes
No
N/A
If no/NA:
Primary Financial Power of Attorney First Name
Primary Financial Power of Attorney Last Name
Do you want a sescondary Power of Attorney if the primary Power of Attorney is unable to act?
Yes
No
If yes:
Second Financial Power of Attorney First Name
Seconds Financial Power of Attorney First Name
When will the Financial Power of Attorney become effective?
Immediately
The Power of Attorney becomes effective on my disability or incapacity
Do you want your medical power of attorney to receive your healthcare records if you become incapacitated?
Yes
No
If no:
Hippa First Name
Hippa Last Name
Do you want a second person to receive your health information if you become incapacitated?
Yes
No
If yes:
Secondary Hippa Person’s First Name
Secondary Hippa Person’s Last Name
If you are incapacitated and diagnosed with a terminal illness.
All treatment other than those needed to keep me comfortable be discontinued
Request to be kept alive during this terminal condition using available life sustaining treatment
Family Decide
If you are incapacitated and diagnosed with a irreversible condition.
All treatment other than those needed to keep me comfortable be discontinued
Request to be kept alive during this irreversible condition using available life sustaining treatment
Family Decide
Funeral Arrangements
Ground Burial
Cremation
Donate Body to Science
Mausoleum Burial
Family Decide
Ceremony Wishes
Funeral Service
Memorial Service
Family Decide
None
Does the secondary spouse want their spouse to be primary Power of Attorney?
Yes
No
If no:
First Name
Last Name
Street Addre
City
State
Zip Code
Phone Number - (000) 000-0000
Do you want a secondary Power of Attorney if the primary Power of Attorney is unable to act?
Yes
No
If yes:
First Name
Last Name
Street Addre
City
State
Zip Code
Phone
When will the Medical Power of Attorney become effective?
Immediately
The Power of Attorney becomes effective on my disability or incapacity
Does the Secondary Spouse want their spouse to be your primary Financial Affairs?
Yes
No
If no:
First Name
Last Name
Do you want your spouse to receive your healthcare records if you are incapacitated?
Yes
No
If Yes:
First Name
Last Name
When will the Financial Power of Attorney become effective?
Immediately
The Power of Attorney becomes effective on my disability or incapacity
Do you want a secondary financial power of attorney if the primary financial Power of Attorney is unable to act?
Yes
No
If no:
First Name
Last Name
Do you want a second person to receive your health information if your are incapaciated?
Yes
No
If yes:
First Name
Last Name
If you are incapacitated and diagnosed with a terminal illness.
All treatment other than those needed to keep me comfortable be discontinued
Request to be kept alive during this terminal condition using available life sustaining treatment
Family Decide
If you are incapacitated and diagnosed with a irreversible condition.
All treatment other than those needed to keep me comfortable be discontinued
Request to be kept alive during this irreversible condition using available life sustaining treatment
Family Decide
Funeral Arrangements
Ground Burial
Cremation
Donate Body to Science
Mausoleum Burial
Family Decide
Ceremony Wishes
Funeral Service
Memorial Service
Family Decide
None
Submit