GEOFFREY W. WHITE LAW CORPORATION

GEOFFREY W. WHITE LAW CORPORATION ESTATE ADMINISTRATION QUESTIONNAIRE The information requested in this questionnaire is required in order to obtain the necessary personal information of the Deceased and information on assets owned by the Deceased for Probate purposes. Please complete this questionnaire to the best of your ability. PART I: DECEASED S FAMILY AND ASSOCIATES PERSONAL Name in full: Other names used: Date of death: Date of birth: Name at birth (if different from above): Residence: Domicile (where permanently resident): Place of death: Place of birth: Social Insurance Number: DECEASED S PRESENT SPOUSE Married Date of marriage: Common-Law Date of commencement of relationship: Name of spouse: Cell phone: Date of birth: Place of birth: Social Insurance Number: If separated, date of separation: Marriage agreement: Yes No Date of agreement: Separation agreement: Yes No Date of agreement:

of 16 PREVIOUS MARRIAGES/COMMON-LAW RELATIONSHIPS Married Common-Law Name of former spouse: Date of birth: Cause of Termination: Date of marriage: Date of commencement of relationship: Death: Yes No Date of Death: Divorce: Yes No Date of Divorce: Cell phone: Place of birth: Social Insurance Number: PROVISIONS FOR FAMILY LAW AGREEMENTS OR ORDERS Please state nature of provision, whether it is under an Agreement or Order, and the date of the Agreement/Order. Maintenance: Support: Custody/Access: OTHER Was the Deceased the sole executor of any unadministered estates? Yes No Specify: Had the Deceased granted a Power of Attorney to anyone?: Yes No Details: Did the Deceased have a Committee?: Yes No Details:

of 16 DECEASED S CHILDREN Please fill out the following information for all children, adopted children, and children born outside of marriage. Any special circumstances relating to disability, adoption, custody, and whether they predeceased the Deceased should be noted. 3.

of 16 4. 5. PART II: DETAILS OF THE WILL WILLS AND CODICILS Please complete for each document. Will Codicil Date of Document: Location: Will Codicil Date of Document: Location: Will Codicil Date of Document: Location:

of 16 EXECUTOR(S) NAMED IN WILL Please complete for each Executor Email: Email: OTHER TRUSTEES OR GUARDIANS NAMED IN THE WILL Role: Email: PART III: BENEFICIARIES/ INTESTATE SUCCESSORS (IF THERE IS NO WILL) BENEFICIARIES OF THE WILL

of 16 3. 4.

of 16 5. INTESTATE SUCCESSORS (IF THERE IS NO WILL)

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PART IV: ASSETS OF THE DECEASED REAL ESTATE: Geoffrey W. White Law Corporation Page 9 of 16 Principal Residence Recreational Civic Legal Description: Market Value (approx.): Current Assessed Value: Other name(s) on title: Owned as: Joint tenants Tenants in common Mortgage on property: Yes No Amount of mortgage: Mortgage Life insured: Yes No Holder of mortgage: Insurance company: Insurance policy number: Expiry date: Is property vacant? Yes No Is insurer aware of vacancy? Yes No Rental Status of Lease: Who collects rents: Principal Residence Recreational Civic Legal Description: Market Value (approx.): Current Assessed Value: Other name(s) on title: Owned as: Joint tenants Tenants in common Mortgage on property: Yes No Amount of mortgage: Mortgage Life insured: Yes No Holder of mortgage: Insurance company: Insurance policy number: Expiry date: Is property vacant? Yes No Is insurer aware of vacancy? Yes No Rental Status of Lease: Who collects rents:

of 16 BANK ACCOUNTS, INVESTMENT ACCOUNTS, AND TERM DEPOSITS Bank & address Owner of account (joint account?) Type and account number Value INVESTMENT ACCOUNTS/RRSPS/RRIFS/TFSAS Bank: Type of account: Value: Account number: Joint account? Yes No Registered owner (s): Designated beneficiaries: Bank: Type of account: Value: Account number: Joint account? Yes No Registered owner (s): Designated beneficiaries:

of 16 3. Bank: Type of account: Value: Account number: Joint account? Yes No Registered owner (s): Designated beneficiaries: 4. Bank: Type of account: Value: Account number: Joint account? Yes No Registered owner (s): Designated beneficiaries: 5. Bank: Type of account: Value: Account number: Joint account? Yes No Registered owner (s): Designated beneficiaries: LIFE INSURANCE POLICIES HELD BY DECEASED ON OWN LIFE OR OTHERS Insurer: Type of policy: Value: Policy number: Death benefit? Yes No Registered owner (s): Beneficiaries:

of 16 Insurer: Type of policy: Value: Policy number: Death benefit? Yes No Registered owner (s): Beneficiaries: 3. Insurer: Type of policy: Value: Policy number: Death benefit? Yes No Registered owner (s): Beneficiaries: STOCKS, BONDS, AND SHARES IN PRIVATE COMPANIES Issuer: Number of shares Type of shares: Certificate number: Owner: Cost base per share: Current value per share: Issuer: Number of shares Type of shares: Certificate number: Owner: Cost base per share: Current value per share: 3. Issuer: Number of shares Type of shares: Certificate number: Owner: Cost base per share: Current value per share:

of 16 4. Issuer: Number of shares Type of shares: Certificate number: Owner: Cost base per share: Current value per share: 5. Issuer: Number of shares Type of shares: Certificate number: Owner: Cost base per share: Current value per share: MOTOR VEHICLES Year, make, & model: Value: Registered owner: VIN: Registration Number: Year, make, & model: Value: Registered owner: VIN: Registration Number: OTHER PERSONAL PROPERTY (BOATS, RVS, FARM EQUIPMENT, ECT.) Type Year, make, & model Serial number Value

of 16 PERSONAL EFFECTS: (Household furnishings, clothing, jewelry, ect.) Total value of personal effects: OTHER SUBSTANTIAL ASSETS: Item Value PENSION/ANNUITY INCOME: Pension Provider Monthly Payments Survivor Benefits Value Canada Pension Plan Yes No Old Age Pension Yes No Yes No Yes No SAFETY DEPOSIT BOX Location: Registered owner(s): Joint? Yes No Box number: Date contents listed: IS ANY OF THIS PROPERTY LOCATED OUTSIDE OF BRITISH COLUMBIA? YES NO ESTIMATED GROSS VALUE OF ESTATE:

PART V: LIABILITIES OF THE DECEASED MAJOR LIABILITIES (Other than mortgages listed above) Geoffrey W. White Law Corporation Page 15 of 16 Liability Value GUARANTEES/INDEMNITIES Liability Value LIABILITIES INCURRED SINCE DEATH Liability Value LITIGATION (list any litigation that the Deceased was involved in at death or which has arisen or may arise as a consequence of death) Details:

of 16 PART VI: INCOME TAX Last tax return filed: Who filed last return: Who will file terminal return: Who will file estate returns: PART VII: PROFESSIONAL ADVISORS: Advisors Name Address Telephone Financial Advisor: Life Insurance: Accountant: Other Lawyer: Other: