Will & Estates Intake Form

PART 1: YOUR DETAILS

Full Legal Name

Previous Name (if relevant)

Date of Birth

Email

Phone Number

Address

City

State

ZIP code

Country

Afghanistan Albania Algeria Andorra Angola Anguilla Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia & Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo - Brazzaville Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Côte d’Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau SAR China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mexico Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Qatar Réunion Romania Russia Rwanda Samoa San Marino São Tomé & Príncipe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka St. Helena St. Kitts & Nevis St. Lucia St. Pierre & Miquelon St. Vincent & Grenadines Sudan Suriname Svalbard & Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis & Futuna Western Sahara Yemen Zambia Zimbabwe

Postal Address (if different)

Referred by?

Do you have an existing will?

Yes No

Do you have an existing financial power of attorney?

Yes No

Do you have an existing medical treatment decision maker?

Yes No

Do you have any health concerns?

yes no

If so, please provide further details.

PART 2: YOUR RELATIONSHIPS

Current relationship status

Married De facto Separated or divorced Single or never married It's complicated

If in a relationship, please provide your partners full name and date of birth below.

Do you have children from your current relationship?

Yes No

If so, please provide full names, date of birth, current address:

Do you have children from a previous relationship?

Yes No My partner has children from a previous relationship

If so, please provide full names, date of birth, current address and parent details:

Do you have grandchildren you would like to include in your will? If so, please provide their full names, dates of birth and current address below:

Does anyone else live with you? If so, please list details and their relationship to you below:

Other than the people listed above, is there any one else who you financially support?

Is there anyone who will be EXCLUDED from your will? Please provide full name, relationship to you and some further details below:

PART 3: ASSETS AND LIABILITIES

REAL ESTATE: Do you own real estate solely or jointly with another person? Please provide property address, whether it is owned solely or jointly.

BANK ACCOUNTS:Please provide financial institution, account holder details, type of account and estimated value.

MOTOR VEHICLES:Please provide make, model, year

OTHER INVESTMENTS:Shares, Managed portfolios, Whisky Barrels - please provide details.

Are you the director of a business or a trustee of a trust? Please provide details below:

LIABILITIES

Please provide details of any mortgage or loan you have

Does anyone owe you money?Please advise whether there is a loan agreement in place, relationship to borrower and whether the debt is to be forgiven in the will.

PART 4: EXECUTOR/TRUSTEE

Appointment of Executor:
Please provide your executors full name, address, and relationship to you below (up to 4):

If the above executor(s) is unavailable or pre-deceases you, do you have an alternative executor you wish to appoint?Please provide your alternative executors full name, address, and relationship to you below (up to 4):

GUARDIAN OF MINOR CHILDREN:
If you have children under 18 years old, who would you like to take care of your children should something happen to you?Please provide your guardian's full name, address, and relationship to you below:

SPECIFIC GIFTS:
Have you promised any specific gifts to anyone?Please provide details of gift, full name of beneficiary, and their relationship to you below.

RESIDUE BENEFICIARIES:
Who do you wish to receive the balance of your estate? and in what portions? (often parents will leave the balance of their estate to their children in equal shares)Please provide your beneficiaries full names, addresses, and relationship to you below:

PART 5: ENDURING POWER OF ATTORNEY AND MEDICAL TREATMENT DECISION MAKERS

Enduring Power of Attorney

An enduring power of attorney is a legal document that lets you appoint someone to make decisions about personal or financial matters. This person is called an attorney. The power endures - or continues - if and when you are unable to make decisions.Please provide your attorney's full name, address, and relationship to you:

Alternative Attorneys:In the event the above attorneys are unwilling or unable to act, please provide your alternative attorney's full name, address, and relationship to you:

Medical Treatment Decision Maker

A person to make medical decisions if you cannot give consent. Your medical decision maker is the first person on the list who is reasonably available, and willing and able to make the decisionPlease provide your medical treatment decision makers Full Name, Date of Birth, Address and relationship to you (up to 4)

Is there anything else we need to know about your estate planning matter??

Please provide your ID documents (such as passport or licence):

Send