Estate Planning Questionnaire Section 1: Your Personal Information Your Full Name * Your Spouse's Name * Other Names: * List any other names you or your spouse are or were known by: Address * Home Phone * Your Cell Phone * Spouse's Cell Phone * Email Address * Spouse's Email Address * Citizenship * Spouse's Citizenship * End Section Marriage Information Marital Status * Single Married Divorced Separated Widowed Date & Place of Marriage Previous Marriages? * Yes No If Yes, Name of Previous Spouse(s) including date of separation, divorce or death If Single, Are you planning on marrying in near future? Yes No If Yes. Name of person? If Single, Are you co-habitating with anyone? Yes No If Yes. Name of person? End Section Children: How many children? * 0 1 2 3 4 5 6 7 8 Are all the children from current marriage? Yes No Details of all Children Provide full name, address, date of birth, marital status and names of their children if any. Are there any deceased children? If yes, provide name(s) and date of death. End Section Section 2: Financial Information Does anybody owe you money ( e.g. personal loans, promissory notes, mortgages for sale)? * Yes No If Yes. Please Describe End Section Real Estate Main Residence Address * Names on Title? * Ownership * Joint Tenancy Tenancy in Common Is Mortgage Life Insured? * Yes No Do you have any other property? If Yes. Add the details of the properties answering same questions from above: End Section Financial Information Bank Accounts? * List bank accounts type below with Institution and Address of Bank. i.e. Checking Account - TD BANK - 112 Main St. Anytown, Canada T1T 1T1 Guaranteed Investment Certificates and Term Deposits? If Yes, List Bank Institution & Address Pension Plans? Company Name & Named Beneficiary Registered Retirement Saving Plans & Registered Retirement Income Funds? If Yes, Name the Financial Institution, Address & Named Beneficiary Shares in Private Corporations? If Yes, Provide: Company Name, Shareholders (you or spouse), Number and Type of Shares Owned, and Nature of Business Shares in Public Corporations, Mutual Funds, Bonds and Debendtures? (Do not list all shares if portfolio changes regularly) List: (Shares in, Shareholder (you or spouse), Number and Type of Shares owned, and Nature of Business Valuable Personal Property? (i.e. art, coins, jewelry, vehicles, heirlooms etc.) Please provide: Description, Location of Property, Acquisition Cost, Current Value Safety Deposit Box? If Yes, Provide: Location, Box Number, Registered Name, Location of Keys End Section Section 3: Instructions for Will Do you have a Will? * Yes No Reason for a new Will? End Section Executor(s) If your spouse is the sole beneficiary of your estate, it may be preferable to name him/her as the primary executor. One primary and one alternate executor will likely be sufficient, depending on your circumstances. For tax reasons it is not advisable to choose an executor who resides outside of Canada. At least one executor should be a resident of Alberta, particularly where beneficiaries are under age 18. Executor Information * Please provide: Full Name, Age, Relationship, Address & Phone # Alternate Executor Information Please provide: Full Name, Age, Relationship, Address & Phone # Have all your executors been asked and are they willing to act? Yes No End Section Guardian(s) (If you appoint a couple to act as guardians, you may wish to consider what is to happen in the event that they divorce, separate or one of them dies or is unable to act.) Guardian Information Please provide: Full Name, Age, Relationship, Address & Phone # Alternate Guardian Information Please provide: Full Name, Age, Relationship, Address & Phone # Have all your guardians been asked and are they willing to act? Yes No Specified Gifts or Legacies? If you would like to list specific amounts or items, please attach a list to this questionnaire. (Caution do not list any items unless they are definitely valuable or of great sentimental value unless you are prepared to pay your lawyer to draft the will and change it when an item is sold or replaced.) End Section Remainder/All of Estate Please Choose: * Remainder of Estate All of Estate Based on Answer Above, It will go to Spouse: * Yes No If No. Specify Name(s) Below: If Spouse Predeceases me: Answer in field below whether you'd like: 1) Equally to all children? 2) All to children in different percentages as follows: At what age are your children to receive their share of your estate? 1) _____ all at 18 years 2) _____ % at ___ years, ___% at ___ years, ___% at ___ years. 3) Other (please specify): The age of majority is 18 in Alberta. Unless otherwise specified, the Will should be drafted so that your Executor will hold each child’s share in trust until the specified age with power to encroach on income and capital for education, maintenance and support. If one child dies before you do, or before obtaining the age at which he/she is entitled to their share, who should receive that share or the amount remaining? 1) The children of the deceased child (my grandchildren) at age _______ 2) My surviving children only 3) Other (please specify): Family Demise: How is your estate to be divided if you and your spouse and all your children and grandchildren are killed in a common accident, or if any of your children or grandchildren survive you but die before becoming entitled to receive their portion of your estate? 1) ½ to my parents and ½ to spouse’s parents 2) ½ to my brothers and sisters and ½ to my spouse’s brothers and sisters whoa are alive in equal shares 3) To my nephews and nieces and my spouse’s nephews and nieces in equal shares 4) Charities (specify): 5) Other (specify): End Section Funeral Arrangements: Have you pre-arranged your funeral? * Yes No If Yes, Please provide information on funeral arrangements? If retained by you. Where will you be storing it? Home office, Safety Deposit box etc. Please Indicate where you'd like the will to be stored? * Lawyer Retained By You Do you wish to be buried or cremated? * Buried Cremated End Section Enduring Power of Attorney & Personal Directive: Do you wish your Enduring Power of Attorney to be immediate (takes effect immediately) * Yes No Do you wish your Enduring Power of Attorney to be Springing (only takes effect when you become incapacitated) * Yes No Attorney: For Enduring Power Of Attorney Please Provide: Full Name, Address, Phone #, Age, Relationship Alternate Attorney: For Enduring Power Of Attorney Please Provide: Full Name, Address, Phone #, Age, Relationship Agent for Personal Directive: Please Provide: Full Name, Address, Phone #, Age, Relationship Alternate Agent for Personal Directive: Please Provide: Full Name, Address, Phone #, Age, Relationship Do you wish your life to be prolonged by artificial means when you are in a coma or persistent vegetative state and in the opinion of your physician you have no hope of regaining awareness and higher mental functions? * Yes No Do you wish to be kept comfortable and free from pain by use of pain medication that may dull your consciousness and indirectly shorten your life? * Yes No Do you wish to give authorization for the removal of tissue from your living body for implementation in the body of another living person pursuant to Part II of the Human Tissue Gift Act for medical, education, and research purposes? * Yes No Do you wish to give authorization for the removal of organs and tissues from your dead body for implementation in the body of another living person pursuant to Part II of the Human Tissue Gift Act for medical, education, and research purposes? * Yes No If your instructions conflict or are ambiguous or if your Agent and your Attorney cannot agree, you direct your Attorney/Agent (name one below) to have final decision-making power in a situation where funds are required to be made available to implement any decisions regarding your person. * End Section reCAPTCHA If you are human, leave this field blank.