Estate Planning Questionnaire

Your Name *

First Name

Last Name

Preferred Phone Number *

(###)

###

####

Spouse's Name

First Name

Last Name

Spouse's Phone Number

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Marriage

MM

DD

YYYY

Do you have a Pre or Post Nuptial Agreement?(If Applicable)

Yes

No

Do your assets total over $5,000,000?

Yes

No

Are you and your spouse U.S. Citizens?

Yes - my spouse and I are both US Citizens

No

Are you or your spouse a Veteran?

Yes - Self

Yes - Spouse

Both

Neither

Employment Status (Self)

Currently Employed

Retired

Disabled

Employment Status (Spouse)

Currently Employed

Retired

Disabled

Do any of your children have special needs?

Yes

No