ESTATE PLANNING QUESTIONNAIRE

Transcription

1 ESTATE PLANNING QUESTIONNAIRE Date Referred By: Your Name (full name): U.S. Citizen: Yes No Citizenship: Address: Date of Birth: / / Telephone No.: ( ) Cellular No.: ( ) Other No.: ( ) Fax No.: ( ) County of Residence: Spouse/Partner s Name (full name): Citizen: Yes No Citizenship: Address: U.S. Date of Birth: / / Telephone No.: ( ) Cellular No.: ( ) Other No.: ( ) Fax No.: ( ) County of Residence: Insurance: Do you have ARAG legal insurance? Yes included in your coverage? Yes No Do Not Know No If so, is your spouse/partner Page 1 of 6

2 FAMILY INFORMATION Are you married or in a registered Domestic Partnership? Yes No CHILDREN(S): NAME BIRTH DATE CHILD OF: Deceased Children? Yes No If yes, please provide name(s) and date(s) of death: Prior marriages? Yes No Marriage was terminated by Death Dissolution of Marriage Date of death of spouse Date of Dissolution Please provide full name of former spouse(s): Use extra sheet if more room needed. Children of former marriage? Yes No (Indicate if named above.) NAME BIRTH DATE Page 2 of 6

3 ASSET INFORMATION It is crucial you provide all asset information. This will allow Bolander Cook & Associates to (1) assess your estate tax liability and (2) advise you on how to hold title to assets. These asset pages will be discussed in depth at your initial Estate Planning meeting. Please indicate your current net worth, broken down as follows: REAL PROPERTY: Fair market value $ Mortgage: $ NET: $ Address: Fair market value $ Mortgage: $ NET: $ Fair market value $ Mortgage: $ NET: $ Check box if you have additional real property and attach information. Banking Institution(s): Type of Account Average Balance Example: Wells Fargo Checking/Savings $1,500/$7500 Check box if additional banking information is attached Investments & Institution Type of Account Value (List all CDs, Stocks, Bonds, Mutual Funds, Securities, etc.) Check box if additional investment information is attached Retirement & Insurance Type of Account/Policy Value/Death Benefit (List all IRAs, employee retirement, 401(k)s, life insurance, etc.) Page 3 of 6

4 Check box if additional retirement/insurance information is attached Business Interests: (LLCs, Sole Proprietorships, Corporations, Partnerships) Type of Entity: Stock or Ownership Interest: Partners, Members or Shareholder/Director(s) Names: Buy/Sell Agreement? Yes No Number of Employees: Do you have the following for your business entity? ESOP (Employee Stock Ownership Plan) 401(k) Defined Benefit Pension Plan Profit Sharing Business Succession Planning Other Assets: (Tangible personal property of significant value, expected inheritance, promissory notes, mineral rights, etc.) OTHER ADVISORS As your Estate Planning advisors, is our obligation to, not only ensure your estate planning goals are achieved, but also to ensure your overall financial well-being is properly cared for. I would like to honor this responsibility by making sure you have the highest level of professional advisors in place to provide maximum progress to achieve your financial goals. It is also important that, if you already have advisors that you would rate as exceptional, I am aware of who they are. Knowing one another, during your lifetime, can greatly minimize problems and unnecessary expenses after your death or incapacity. Accordingly, please take the time to provide us with this valuable information: FINANCIAL ADVISOR: Do you have a written financial plan? Yes No Do you have a financial advisor? Yes No Please rate your Financial Advisor: Page 4 of 6

5 MORTGAGE ADVISOR: Your real estate is one of your largest assets, if not the largest. How you structure your debt and equity become a critical part of your financial plan. Do you have a relationship with a mortgage advisor? Yes No Do you meet with your mortgage planner annually to review your plan? Yes No Please rate your Mortgage Advisor: LIFE & DISABILITY INSURANCE: Life and Disability insurance are a crucial part of your financial plan and your estate plan. Do you have adequate Life and Disability Insurance to protect the ones you love and those who depend on you? Yes No Do you have a Life and Disability Insurance advisor? Yes No Do you meet with your Insurance advisor annually to review your plan? Yes No Do you have Health Yes No and/or Long-Term Care Insurance Yes No Please rate your Life and Disability Insurance Advisor: DWELLING AND AUTOMOBILE INSURANCE: Are your assets adequately insured in the event of fire, earthquake, a lawsuit or major accident? Yes No Do you have a Dwelling and Auto Insurance advisor? Yes No Page 5 of 6

6 Do you meet with your Insurance advisor annually to review your plan? Yes No Please rate your Insurance Advisor: Thank you for providing this information. It is extremely important that your professional advisors are aware of one another s existence and the planning each of us is doing for you. We will discuss this in more detail during our meeting. CLIENT ACKNOWLEDGMENT & AUTHORIZATION I/we have provided all information regarding our assets. I/we hereby give our consent to be contacted by the professionals requested above, if applicable. I/we have read the foregoing and fully understand the statements contained herein. Date: Signature Signature Printed Name Printed Name Best phone number to call: ( ) Best time (during business hours): A.M. P.M. Page 6 of 6