ESTATE PLANNING QUESTIONNAIRE

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1 ESTATE PLANNING QUESTIONNAIRE Please bring a piece of photo ID to the meeting, as the Law Society requires us to take a copy of photo identification of all of our clients. COMMUNICATION: How do you wish us to (primarily) communicate with you? - By - By telephone o At your Work telephone number? o At your Home telephone number? o On your Mobile phone? PERSONAL INFORMATION: Full Name: Known by any other name (aka): Home telephone: Cell telephone: Work telephone: Occupation: Date of birth: Citizenship: Place of birth: MARITAL HISTORY: Marital status: Place and date of marriage: Marriage or cohabitation contract? If Yes, please provide a copy. Previous marriage? If divorced, please provide date and place: Obligations pursuant to previous marriage or obligations to children: Details: for adobe - June 2015 (C x9D71A).doc;1

2 - 2 - SPOUSE S INFORMATION: Spouse s full name (and aka): Home telephone: Cell telephone: Work telephone: Occupation: Date of birth: Citizenship: Place of birth: Previous marriage? If divorced, please provide date and place: Obligations pursuant to previous marriage or obligations to children: Details: INTERDEPENDENT PARTNER: Under the Adult Interdependent Relationships Act, a person may have certain rights with respect to your estate in certain circumstances (depending on length of relationship and cohabitation, existence of an Adult Interdependent Relationship Agreement, among other things). If there is any person with whom you may have an interdependent (though not necessarily conjugal) relationship, please include information regarding that person. Full name: Adult Interdependent Relationship Agreement: If yes, please provide a copy. Is this individual mentally or physically disabled? Length of relationship: CHILDREN: Have any of your children predeceased you? *Include all step-children, adopted children and estranged children. CHILD 1 Full name (and aka): for adobe - June 2015 (C x9D71A).doc;1

3 - 3 - Date of birth: Marital status: Date of death (if applicable): Spouse s name: Is this child mentally or physically disabled and by reason thereof unable to earn a livelihood? Particulars: CHILD 2 Full name (and aka): Date of birth: Marital status: Date of death (if applicable): Spouse s name: Is this child mentally or physically disabled and by reason thereof unable to earn a livelihood? Particulars: CHILD 3 Full name (and aka): Date of birth: Marital status: Date of death (if applicable): Spouse s name: Is this child mentally or physically disabled and by reason thereof unable to earn a livelihood? Particulars: CHILD 4 Full name (and aka): Date of birth: Marital status: Date of death (if applicable): Spouse s name: Is this child mentally or physically disabled and by reason thereof unable to earn a livelihood? Particulars: for adobe - June 2015 (C x9D71A).doc;1

4 - 4 - GRANDCHILDREN *Include all step-grandchildren and adopted grandchildren. Name Province of Residence Age/DOB Natural, Step- or Adopted? Are any of your grandchildren mentally or physically disabled and by reason thereof unable to earn a livelihood? Has a grandchild ever lived with you? If yes, for how long? Have you ever provided financial assistance to any of your grandchildren? Have you ever considered applying for guardianship of a grandchild? DEPENDENT ADULTS: Are you responsible for any dependent adults who are mentally or physically incapable of handing their own affairs? Details: US CITIZENSHIP QUESTIONS: Are you, your spouse, or any of your children a citizen of the United States? Particulars: Were any of you or your children born in the United States? Particulars: Is your or your spouse's parent(s) a US citizen? Do you vacation in the US or visit the US for any reason (i.e. business or personal) on a regular basis? Particulars: for adobe - June 2015 (C x9D71A).doc;1

5 - 5 - ASSETS/DEBT: 1) REAL PROPERTY (including mineral rights and real property outside of Alberta) Location/Address/Legal Description: Market value: Current amount owing on mortgage, if any: Mortgage insured? Location/Address/Legal Description: Market value: Current amount owing on mortgage, if any: Mortgage insured? Location/Address/Legal Description: Market value: Current amount owing on mortgage, if any: Mortgage insured? 2) CASH & BANK DEPOSITS Name of financial institution: Current value: Name of financial institution: for adobe - June 2015 (C x9D71A).doc;1

6 - 6 - Current value: Name of financial institution: Current value: 3) GUARANTEED INVESTMENT CERTIFICATES AND TERM DEPOSITS Bank: Principal Maturity Date: Bank: Principal Maturity Date: 4) SHARES IN PRIVATE COMPANIES Name of company: Is there a Unanimous Shareholders' Agreement? If Yes, is it life insurance or otherwise funded? Description of shares: Unit value per share: Total market value: Name of company: Is there a Unanimous Shareholders' Agreement? If Yes, is it life insurance or otherwise funded? for adobe - June 2015 (C x9D71A).doc;1

7 - 7 - Description of shares: Unit value per share: Total market value: 5) INVESTMENT ACCOUNTS Name of Investment Manager: Total market value: U.S. asset: Name of Investment Manager: Total market value: U.S. asset: Name of Investment Manager: Total market value: U.S. asset: 6) RRSPs / RRIFs Type of Plan: Registered Owner: Designated beneficiary: for adobe - June 2015 (C x9D71A).doc;1

8 - 8 - Type of Plan: Registered Owner: Designated beneficiary: Type of Plan: Registered Owner: Designated beneficiary: 7) TFSAs Registered Owner: Did you designate a Successor Holder? Registered Owner: Did you designate a Successor Holder? 8) RESPs Subscriber(s)/Owner(s): Beneficiary(ies): for adobe - June 2015 (C x9D71A).doc;1

9 - 9 - Subscriber(s)/Owner(s): Beneficiary(ies): 9) RDSPs Holder/Contributor(s): Beneficiary (Owner): 10) PENSION PLANS & ANNUITIES Type of Plan: Designated beneficiary: Type of Plan: Designated beneficiary: 11) FARMING INTERESTS Description & gross value Net value: Who is farming the land: What is the nature of above arrangement: 12) SIGNIFICANT PERSONAL EFFECTS (example: jewelry, art, antiques): Market Description of asset: for adobe - June 2015 (C x9D71A).doc;1

10 Market Description of asset: Market Description of asset: 13) LIFE INSURANCE POLICIES Company: Policy No.: Maturity Date: Designated Beneficiary: Company: Policy No.: Maturity Date: Designated Beneficiary: Company: Policy No.: Maturity Date: Designated Beneficiary: 14) PARTNERSHIP/UNINCORPORATED BUSINESS: Describe: 15) JOINT ASSETS Do you own any property (for example, bank accounts, recreational property, rental property, etc.) in joint names with another? uestionnaire - June 2015 (C x9D71A).doc;1

11 If yes, and not previously described above, please describe below: Type of Property Location of Property Names of Joint Owners 16) OTHER PROPERTY Do you have any other property not described above in any other jurisdiction? (i.e. in other provinces, in the United States or overseas) Describe: Do you have an interest in another estate or trust? Have you made any loans or advances to family members or others that are to be collected or that you wish to be forgiven? Are you the owner of a life insurance policy on the life of another person? 17) SAFETY DEPOSIT BOX Box Number: Registered Name(s): Location of Keys: DEBTS: 1) SIGNIFICANT LOANS Name of lender: Name of borrower(s): Joint or several: Insured? Any security granted: 2) OTHER DEBTS OR FINANCIAL OBLIGATIONS: Name of lender: Name of borrower(s): for adobe - June 2015 (C x9D71A).doc;1

12 Insured? Any security granted: 3) PERSONAL GUARANTEES: Lender: Debtor: Details: DIGITAL PROPERTY: Digital Property is a very broad term that refers to virtually anything in electronic or digital form. For many of our clients, it means accounts, digital music, digital photographs, digital videos, social networking accounts, file sharing accounts including photo and video sharing accounts such as YouTube, online financial accounts, domain name registrations, internet service accounts, web hosting accounts, online stores, escrow accounts (such as PayPal ), money transfer accounts, and digital currency accounts (such as BitCoin accounts). Please list any Digital Property for which you have specific instructions or wishes as to how it is to be distributed, or disposed of, on your death. Digital Property often raises issues of ownership and access; therefore, it is worth spending some time considering 1. If you have any specific wishes in respect of such property. 2. If you do have specific wishes, how can such wishes be accomplished? If your Devices (for example, personal computers, tablets, mobile phones, etc.) are password protected, you may wish to consider whether to provide the password(s) to your Executor(s) to allow them easy access to the files and other information on your Devices. Although, there is no requirement for you to do so. (Please do not include any passwords on this form.) I. Initial Matters YOUR WILL Ultimately, decisions relating to your funeral and burial arrangements are in the discretion of your named Executor. If you have specific wishes in this regard, you may wish to include them here and in your Will in order to assist your Executor. A. Funeral and Burial Arrangements Name of Funeral Director: Burial Instructions: Cremation Instructions: Donation of Eyes, Organs, Etc.: If yes, specify: B. Executor (Personal Representative) The Executor is the person who will gather your assets, pay debts and distribute the balance to your named beneficiaries. The Executor is generally also the Trustee if any trusts are established by your Will. (i) Executor s Full Name: for adobe - June 2015 (C x9D71A).doc;1

13 II. III. (ii) (iii) C. Guardians Executor s city of residence: Co-Executor s Full Name (if applicable). You may appoint two (or more) persons to act together as co- Executors to act together: Executor s city of residence It is prudent to appoint an alternate Executor who will act if your first named Executor(s) cannot or will not act. You may name more than one alternate Executor Alternate Executor s Full Name: Executor s city of residence: You may appoint guardians to take care of your minor children, subject to the rights of your child s natural guardian (i.e. his or her other parent). (i) Guardian(s): Guardian s city of residence: (ii) You may wish to appoint alternate guardians in the event your spouse or the primary guardian is unable or unwilling to act as guardian. Alternate Guardian(s): City where Alternate Guardian(s) presently resides: Specific Bequests A specific bequest may be an item of personal property such as jewellery or a vehicle to be given to an individual or it may be a specified cash gift or perhaps a portion of your RRSP or insurance policy proceeds to a favorite charity. Please indicate the nature or value of any such gift you wish to make and the beneficiary who should receive that gift. Special Distribution Instructions Personal Property may include household furnishings, vehicles, jewellery, art and personal effects. You may wish to leave a list separate from your Will governing the distribution of personal property. Please indicate how any remaining personal property should be distributed. for adobe - June 2015 (C x9D71A).doc;1

14 IV. Distribution of Estate How do you wish your remaining assets (the residue) to be distributed? The residue of your estate will be the balance of assets after payment of legally enforceable debts and expenses and any specific bequests. It will not include joint property you own with any other person (although it may if such property is held in joint tenancy between a parent and one or more of his/her adult children) or property that is subject to a beneficiary designation to another person if they survive you. (i) (ii) (iii) (iv) (v) If my Spouse is alive, all to Spouse outright If my Spouse is alive, to be held in trust (a) Spouse to receive all income during lifetime (b) Trustee to have authority to pay capital to spouse If my Spouse does not survive me: All to Children Do you wish your children s share to be held by your Executor until your children reach an appropriate age (at least 18 years) Age(s) for distribution of trust: (e.g. capital distributions of ½ at age 21 and balance at age 25, or subject to maximum amounts) Further details of trust: (if any) Other potential beneficiaries: If any of your children are deceased, do you wish their share to be paid to their children (your grandchildren)? Ages for distribution, if trust created for grandchildren. V. Alternate Beneficiaries In the event your spouse, children and grandchildren are deceased (for example, a common automobile accident) who is to receive the residue of your estate? 1. Charitable Bequest How would you like to be remembered? Is there one or more charitable organization or foundation which provides support for community needs which you would like to include as one of your beneficiaries? 2. Distribution of Residue Do you wish the estate to be divided among parents, siblings, in-laws or friends, and in what proportions? What is an Enduring Power of Attorney? YOUR ENDURING POWER OF ATTORNEY An Enduring Power of Attorney ( EPA ) allows you to appoint someone (your Attorney) to manage your financial affairs. An EPA endures even if you lose your mental capacity, meaning that the person you appointed can manage your financial affairs even though you become mentally incapacitated. It can be revoked by you at any time while you are mentally capable. An Enduring Power of Attorney may be drafted to provide that your Attorney does not have authority to deal with your financial affairs until a specific event defined by you has been triggered, such as a medical doctor confirming in writing that you are mentally unable to manage your financial affairs. for adobe - June 2015 (C x9D71A).doc;1

15 When appointing an Attorney under an Enduring Power of Attorney you should ensure that the person appointed as your Attorney is capable and trustworthy in that position, as the document grants your Attorney broad powers and your Attorney s actions may not be closely supervised. Why is an Enduring Power of Attorney Important? If you no longer have sufficient mental capacity to manage your finances, and you have not appointed an Attorney under an EPA, the only way that someone can manage your financial affairs is to obtain a Trusteeship Order under the Adult Guardianship and Trusteeship Act. The Trustee appointed under the Trusteeship Order may not have been the person that you would have chosen to manage your finances. The appointment process and continued administration related to a Trusteeship Order is typically expensive: the Trustee named under a Trusteeship Order must apply to the Court to pass the accounts of your estate on a regular basis and must make additional applications to the Court confirming the Trusteeship Order will continue to be in effect. Attorney s Full Name: Co-Attorney s Full Name: Alternate Attorney s Full Name: Second Alternate Attorney s Full Name: I wish to limit the powers granted to my Attorney? If yes, specify limitations placed on Attorney My Enduring Power of Attorney shall take effect: Other event (specify) I wish to authorize my Attorney to make gifts to my family members and charitable organizations I have benefited during my lifetime: Limits on amounts to be gifted (if any): (for example, in a manner consistent with your practice while you managed your own financial affairs?) My Attorney shall be compensated for acting as my Attorney: NOTE: at law, compensation is not allowed unless specifically mentioned Suggested amount or method of compensation (if applicable): for adobe - June 2015 (C x9D71A).doc;1

16 Why is a Personal Directive Important? YOUR PERSONAL DIRECTIVE If you no longer have mental capacity to make personal care and health care decisions, and you have not appointed an Agent under a Personal Directive, it will likely become necessary for someone to apply for a Guardianship Order pursuant to the Adult Guardianship and Trusteeship Act. As with applications for Trusteeship, this will generally be more costly and cumbersome than appointing an Agent and the person that is appointed may not be the person or persons that you would have chosen to make your personal care and healthcare decisions for you. By making a Personal Directive you exercise your right to make your own personal care and health care decisions and to name the person who will ensure those personal care and health care decisions are followed in the event that you become unable to make such decisions for yourself. Agent s Full Name: Telephone number: Co-Agent s or Alternate Agent s Full Name: Telephone number: I wish to include the following general statement of wishes: I recognize the possibility that I may, in the future, suffer from an incapacitating illness, disease or injury. If that occurs, with no reasonable medical expectation of me recovering from that condition, it is my wish that my Agent authorize artificial life-sustaining procedures to be withheld or withdrawn. In such an event, however, I do wish to receive palliative care measures as may be appropriate in the judgment of my attending physician in consultation with my Agent, even if the effect of such care may be to shorten my life. Other direction(s) to your Agent regarding your personal care and healthcare decisions (if any): for adobe - June 2015 (C x9D71A).doc;1

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