Estate Planning Questionnaire

  1. Personal Data
  2. Client's Full Name*
    Please type your full name.
  3. Phone*
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  4. E-mail*
    Invalid email address.
  5. Address
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  6. City, State, Zip
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  7. Date of Birth
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  8. Citizenship
    Invalid Input
  9. Current Marital Status*



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  10. Current Spouse's Full Name
    Invalid Input
  11. Phone
    Invalid Input
  12. Date of Birth
    Invalid Input
  13. Citizenship
    Invalid Input

  14. Former Spouse Full Name
    Invalid Input
  15. Invalid Input
  16. Phone
    Invalid Input
  17. Date of Birth
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  18. Citizenship
    Invalid Input
  19. Date of Death
    Invalid Input
  20. Additional Former Spouse
    Invalid Input

  21. Second Former Spouse Full Name
    Invalid Input
  22. Invalid Input
  23. Phone
    Invalid Input
  24. Date of Birth
    Invalid Input
  25. Citizenship
    Invalid Input
  26. Date of Death
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  27. Additional Former Spouse
    Invalid Input

  28. Third Former Spouse Full Name
    Invalid Input
  29. Invalid Input
  30. Phone
    Invalid Input
  31. Date of Birth
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  32. Citizenship
    Invalid Input
  33. Date of Death
    Invalid Input
  34. Additional Former Spouse
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  35. Fourth Former Spouse Full Name
    Invalid Input
  36. Invalid Input
  37. Phone
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  38. Date of Birth
    Invalid Input
  39. Citizenship
    Invalid Input
  40. Date of Death
    Invalid Input

  41. Children Information >>
  42.  
  1. Number of Children
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  2. First Child's Information
  3. First Child's Name
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  4. Date of Birth
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  5. Address
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  6. Marital Status



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  7. First Child's Spouse's Name
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  8. Number of Children
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  9. Child's Name
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  10. Age
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  11. Child's Name
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  12. Age
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  13. Child's Name
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  14. Age
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  15. Child's Name
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  16. Age
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  17. Child's Name
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  18. Age
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  19. Second Child's Information
  20. Second Child's Name
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  21. Date of Birth
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  22. Address
    Invalid Input
  23. Marital Status



    Invalid Input
  24. Second Child's Spouse's Name
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  25. Number of Children
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  26. Child's Name
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  27. Age
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  28. Child's Name
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  29. Age
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  30. Child's Name
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  31. Age
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  32. Child's Name
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  33. Age
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  34. Child's Name
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  35. Age
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  36. Third Child's Information
  37. Third Child's Name
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  38. Date of Birth
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  39. Address
    Invalid Input
  40. Marital Status



    Invalid Input
  41. Third Child's Spouse's Name
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  42. Number of Children
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  43. Child's Name
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  44. Age
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  45. Child's Name
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  46. Age
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  47. Child's Name
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  48. Age
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  49. Child's Name
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  50. Age
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  51. Child's Name
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  52. Age
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  53. Fourth Child's Information
  54. Fourth Child's Name
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  55. Date of Birth
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  56. Address
    Invalid Input
  57. Marital Status



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  58. Fourth Child's Spouse's Name
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  59. Number of Children
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  60. Child's Name
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  61. Age
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  62. Child's Name
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  63. Age
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  64. Child's Name
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  65. Age
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  66. Child's Name
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  67. Age
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  68. Child's Name
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  69. Age
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  70. Fifth Child's Information
  71. Fifth Child's Name
    Invalid Input
  72. Date of Birth
    Invalid Input
  73. Address
    Invalid Input
  74. Marital Status



    Invalid Input
  75. Fifth Child's Spouse's Name
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  76. Number of Children
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  77. Child's Name
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  78. Age
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  79. Child's Name
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  80. Age
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  81. Child's Name
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  82. Age
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  83. Child's Name
    Invalid Input
  84. Age
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  85. Child's Name
    Invalid Input
  86. Age
    Invalid Input

  87. Annual Income >>
  88.  
  1. Client's Income Sources
    (choose all that apply)




    Invalid Input
  2. Employment $
    Invalid Input
  3. Social Security $
    Invalid Input
  4. Pension $
    Invalid Input
  5. Investment $
    Invalid Input
  6. Other $
    Invalid Input
  7. Spouce's Income Sources
    (choose all that apply)




    Invalid Input
  8. Employment $
    Invalid Input
  9. Social Security $
    Invalid Input
  10. Pension $
    Invalid Input
  11. Investment $
    Invalid Input
  12. Other $
    Invalid Input
  13. Total Annual Income $
    Invalid Input

  14. Assets & Liabilities >>
  15.  
  1. A. Cash Accounts
  2. Number of Cash Accounts?
    Invalid Input
  3. 1. Name of Bank
    Invalid Input
  4. Type of Account
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  5. Value
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  6. Owner
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  7. 2. Name of Bank
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  8. Type of Account
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  9. Value
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  10. Owner
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  11. 3. Name of Bank
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  12. Type of Account
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  13. Value
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  14. Owner
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  15. 4. Name of Bank
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  16. Type of Account
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  17. Value
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  18. Owner
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  19. 5. Name of Bank
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  20. Type of Account
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  21. Value
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  22. Owner
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  23. Total Cash Accounts $
    Invalid Input

  24. B. Brokerage Accounts
  25. Number of Brokerage Accounts?
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  26. 1. Account Description
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  27. Value
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  28. Owner
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  29. 2. Account Description
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  30. Value
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  31. Owner
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  32. 3. Account Description
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  33. Value
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  34. Owner
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  35. 4. Account Description
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  36. Value
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  37. Owner
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  38. 5. Account Description
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  39. Value
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  40. Owner
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  41. Total Brokerage Accounts $
    Invalid Input

  42. C. Stocks and Bonds (held outside of Brokerage Accounts)
  43. Number of Holdings?
    Invalid Input
  44. 1. Name of Company or Issuer
    Invalid Input
  45. # of Shares or Amount
    Invalid Input
  46. Value
    Invalid Input
  47. Owner
    Invalid Input

  48. 2. Name of Company or Issuer
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  49. # of Shares or Amount
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  50. Value
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  51. Owner
    Invalid Input

  52. 3. Name of Company or Issuer
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  53. # of Shares or Amount
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  54. Value
    Invalid Input
  55. Owner
    Invalid Input

  56. 4. Name of Company or Issuer
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  57. # of Shares or Amount
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  58. Value
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  59. Owner
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  60. 5. Name of Company or Issuer
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  61. # of Shares or Amount
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  62. Value
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  63. Owner
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  64. 6. Name of Company or Issuer
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  65. # of Shares or Amount
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  66. Value
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  67. Owner
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  68. 7. Name of Company or Issuer
    Invalid Input
  69. # of Shares or Amount
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  70. Value
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  71. Owner
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  72. 8. Name of Company or Issuer
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  73. # of Shares or Amount
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  74. Value
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  75. Owner
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  76. 9. Name of Company or Issuer
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  77. # of Shares or Amount
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  78. Value
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  79. Owner
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  80. 10. Name of Company or Issuer
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  81. # of Shares or Amount
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  82. Value
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  83. Owner
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  84. Total Stocks & Bonds $
    Invalid Input

  85. D. Real Estate
  86. Number of Properties?
    Invalid Input
  87. 1. Address
    Invalid Input
  88. Approximate Value
    Invalid Input
  89. Outstanding Mortgage Balance
    Invalid Input
  90. Equity
    Invalid Input
  91. Owner
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  92. 2. Address
    Invalid Input
  93. Approximate Value
    Invalid Input
  94. Outstanding Mortgage Balance
    Invalid Input
  95. Equity
    Invalid Input
  96. Owner
    Invalid Input

  97. 3. Address
    Invalid Input
  98. Approximate Value
    Invalid Input
  99. Outstanding Mortgage Balance
    Invalid Input
  100. Equity
    Invalid Input
  101. Owner
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  102. 4. Address
    Invalid Input
  103. Approximate Value
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  104. Outstanding Mortgage Balance
    Invalid Input
  105. Equity
    Invalid Input
  106. Owner
    Invalid Input

  107. Total Real Estate Equity $
    Invalid Input

  108. E. Business Interests
  109. Number of Business Interests?
    Invalid Input
  110. 1. Name of Business
    Invalid Input
  111. Value
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  112. Owner
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  113. 2. Name of Business
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  114. Value
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  115. Owner
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  116. 3. Name of Business
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  117. Value
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  118. Owner
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  119. 4. Name of Business
    Invalid Input
  120. Value
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  121. Owner
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  122. Total Business Interests $
    Invalid Input

  123. F. Family Limited Liability Companies / Family Limited Partnerships
  124. Number of Family LLC or LP interests?
    Invalid Input
  125. 1. Name of Business
    Invalid Input
  126. Value
    Invalid Input
  127. Owner
    Invalid Input

  128. 2. Name of Business
    Invalid Input
  129. Value
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  130. Owner
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  131. 3. Name of Business
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  132. Value
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  133. Owner
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  134. 4. Name of Business
    Invalid Input
  135. Value
    Invalid Input
  136. Owner
    Invalid Input

  137. Total Family LLC & LP $
    Invalid Input

  138. G. Notes and Accounts Receivable
  139. Number of Notes/Accounts Receivable?
    Invalid Input
  140. 1. Name of Borrower
    Invalid Input
  141. Value
    Invalid Input
  142. Owner
    Invalid Input

  143. 2. Name of Borrower
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  144. Value
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  145. Owner
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  146. 3. Name of Borrower
    Invalid Input
  147. Value
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  148. Owner
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  149. 4. Name of Borrower
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  150. Value
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  151. Owner
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  152. Total Notes & Accounts Receivable Value $
    Invalid Input

  153. H. Other Assets
  154. Number of Other Assets?
    Invalid Input
  155. 1. Description of Asset
    Invalid Input
  156. Value
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  157. Owner
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  158. 2. Description of Asset
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  159. Value
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  160. Owner
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  161. 3. Description of Asset
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  162. Value
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  163. Owner
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  164. 4. Description of Asset
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  165. Value
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  166. Owner
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  167. 5. Description of Asset
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  168. Value
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  169. Owner
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  170. Total Other Assets $
    Invalid Input

  171. I. Life Insurance
  172. Number of Policies?
    Invalid Input
  173. 1. Insurance Company Name
    Invalid Input
  174. Owner
    Invalid Input
  175. Insured
    Invalid Input
  176. Designated Beneficiary
    Invalid Input
  177. Type
    Invalid Input
  178. Death Benefits
    Invalid Input
  179. Cash Value
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  180. 2. Insurance Company Name
    Invalid Input
  181. Owner
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  182. Insured
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  183. Designated Beneficiary
    Invalid Input
  184. Type
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  185. Death Benefits
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  186. Cash Value
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  187. 3. Insurance Company Name
    Invalid Input
  188. Owner
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  189. Insured
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  190. Designated Beneficiary
    Invalid Input
  191. Type
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  192. Death Benefits
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  193. Cash Value
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  194. 4. Insurance Company Name
    Invalid Input
  195. Owner
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  196. Insured
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  197. Designated Beneficiary
    Invalid Input
  198. Type
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  199. Death Benefits
    Invalid Input
  200. Cash Value
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  201. 5. Insurance Company Name
    Invalid Input
  202. Owner
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  203. Insured
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  204. Designated Beneficiary
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  205. Type
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  206. Death Benefits
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  207. Cash Value
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  208. 6. Insurance Company Name
    Invalid Input
  209. Owner
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  210. Insured
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  211. Designated Beneficiary
    Invalid Input
  212. Type
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  213. Death Benefits
    Invalid Input
  214. Cash Value
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  215. Total Insurance Death Benefit $
    Invalid Input

  216. J. Retirement Plans, IRAs and 401(k) Plans
  217. Number of Retirement Plans, IRAs & 401K?
    Invalid Input
  218. 1. Company
    Invalid Input
  219. Plan Type
    Invalid Input
  220. Value
    Invalid Input
  221. Plan Owner
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  222. 2. Company
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  223. Plan Type
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  224. Value
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  225. Plan Owner
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  226. 3. Company
    Invalid Input
  227. Plan Type
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  228. Value
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  229. Plan Owner
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  230. 4. Company
    Invalid Input
  231. Plan Type
    Invalid Input
  232. Value
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  233. Plan Owner
    Invalid Input
  234. 5. Company
    Invalid Input
  235. Plan Type
    Invalid Input
  236. Value
    Invalid Input
  237. Plan Owner
    Invalid Input
  238. 6. Company
    Invalid Input
  239. Plan Type
    Invalid Input
  240. Value
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  241. Plan Owner
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  242. 7. Company
    Invalid Input
  243. Plan Type
    Invalid Input
  244. Value
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  245. Plan Owner
    Invalid Input
  246. 8. Company
    Invalid Input
  247. Plan Type
    Invalid Input
  248. Value
    Invalid Input
  249. Plan Owner
    Invalid Input
  250. Total Retirement, IRA, 401K Value $
    Invalid Input

  251. K. Non-Qualified Annuities (not IRAs)
  252. Number of Non-Qualified Annuities?
    Invalid Input
  253. 1. Company
    Invalid Input
  254. Owner
    Invalid Input
  255. Annuitant
    Invalid Input
  256. Beneficiary
    Invalid Input
  257. Basis
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  258. Value
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  259. 2. Company
    Invalid Input
  260. Owner
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  261. Annuitant
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  262. Beneficiary
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  263. Basis
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  264. Value
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  265. 3. Company
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  266. Owner
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  267. Annuitant
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  268. Beneficiary
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  269. Basis
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  270. Value
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  271. 4. Company
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  272. Owner
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  273. Annuitant
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  274. Beneficiary
    Invalid Input
  275. Basis
    Invalid Input
  276. Value
    Invalid Input
  277. Total Non-Qualified Annuities (not IRAs) $
    Invalid Input

  278. L. Liabilities (other than Mortgages)
  279. Number of Liabilities?
    Invalid Input
  280. 1. Name of Lender
    Invalid Input
  281. Type of Account
    Invalid Input
  282. Balance Owed
    Invalid Input
  283. 2. Name of Lender
    Invalid Input
  284. Type of Account
    Invalid Input
  285. Balance Owed
    Invalid Input
  286. 3. Name of Lender
    Invalid Input
  287. Type of Account
    Invalid Input
  288. Balance Owed
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  289. 4. Name of Lender
    Invalid Input
  290. Type of Account
    Invalid Input
  291. Balance Owed
    Invalid Input
  292. Total Liabilities $
    Invalid Input

  293. Summary & Submit >>
  294.  
  1. A. Cash Accounts
    Invalid Input
  2. B. Brokerage Accounts
    Invalid Input
  3. C. Stocks and Bonds
    Invalid Input
  4. D. Real Estate Equity
    Invalid Input
  5. E. Business Interests
    Invalid Input
  6. F. FLPs / FLLCs
    Invalid Input
  7. G. Notes / Accounts Receivable
    Invalid Input
  8. H. Other Assets
    Invalid Input
  9. I. Life Insurance
    Invalid Input
  10. J. Retirement Plans
    Invalid Input
  11. K. Annuities
    Invalid Input
  12. L. Liabilities
    Invalid Input
  13. Total Net Worth $
    Invalid Input
  14. Invalid Input

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