Estate Planning

Personal Information

Full Name


Home Phone Number



Alternate Phone Number







Do you already have a will?

 Yes No


Are you receiving benefits from an estate or trust? If so, please provide particulars


Have you set up a trust to benefit another person? If so, please provide particulars


What is your Nationality?






Place of Birth


Date of Birth

/ /


Marital Status


Date of Marriage

* Leave blank if this does not apply to you


Place of Marriage

* Leave blank if this does not apply to you


Details of any domestic contracts


Details of any divorce decrees or dissolutions


Full Name of Spouse


Nationality of Spouse


Citizenship of Spouse


Full Name(s) of ex-spouse(s)


Full Names of all children, including Address, Date of Birth and Citizenship


Full names and Addresses of any Beneficiaries


Details of any support obligations


Details of any extraordinary personal situations, eg., disability


Residence for Income Tax Purposes


Domicile ( Country of Permanent Residence ):


Name of Accountant


Name of Investment Advisor


Name of Insurance Advisor


Safety Deposit Boxes




Box Number


Registered Name


Location of the key

Real Estate

Principal Address


Municipal Address


Names on title


Location of Deed


Current Market Value





Assessed Value





Are there any other properties?

 Yes No

Insuarance, Annuities, RRSP’S and Pensions


No. of Policy


Issued By


Is your spouse named as a beneficiary?

 Yes No


If no, name of beneficary


Value of benefit of Estate


Money on Deposit


Name of Bank


Address of Bank


Type of Account


Account No.:




Approximate Value



Are accounts jointly held with your spouse?

 Yes No

Shares, Bonds, Debentures, Guaranteed Investment Certificates


Approximate value of portfolio



Description including number


Acquisition Cost and Date


Current Value



Physical Location


Are there any restrictions on transfer?


Are shares subject to a Purchase and Sale Agreement?

 Yes No


If a purchase and sale is in force, is it funded?

 Yes No

Shares in Private Companies


Name of Company


Number and type of shares


Are there any restrictions on the transfer of shares?


Are the Shares subject to any Purchase and Sale Agreements

 Yes No


In relation to the Shares, if a Purchase and Sale Agreement is in force, is it funded

 Yes No
* Please obtain copies of all relevant agreements

Automobiles, Boats and Recreational Vehicles




Value and Ownership


Farm Machinery, Live Stock, Tools and Quotas


Heirlooms, Artwork, Plate, Jewelery, and any collections etc.


Household goods and furniture


Other Assets

Debt Including Mortgages


Please List all debts, please provide name of Creditor, Maturity date, Principal and Interest


Total Value of Debts



Approximate Net value of Estate


Will Instructions




Relationship to you



Power of Attorney for Personal Care


Who would you like to appoint as your power of attorney for personal care?


If the person you appoint cannot act or will not, who would you like to appoint?

Power of Attorney for Property


Who would you like to appoint as your power of attorney for property?

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