Estate Planning Information Title Mr. Mrs. Ms. Miss. Other Name * First Name Last Name Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth MM DD YYYY Citizenship Home Phone (###) ### #### Business Phone (###) ### #### Mobile Phone (###) ### #### Marital Status Married Single Common Law Separated Divorced Widow/Widower SPOUSE INFORMATION Title Mr. Mrs. Ms. Miss. Full Name First Name Last Name Email Date Of Birth MM DD YYYY Citizenship Home Phone (###) ### #### Business Phone (###) ### #### Mobile Phone (###) ### #### Marital Status Married Single Common Law Separated Divorced JOINT RETAINER AND CLIENT CONFIDENTIALITY Do you wish for me to act for both you and your spouse/partner Yes No Do you consent to treat information we discuss as not being confidential between the three of us Yes No Do you understand that if a conflict arises that we cannot resolve, you may need to hire separate lawyers? Yes No WE NEED TO KNOW TO ADVISE YOU BETTER Have you or your spouse/partner been married before Yes No Do you jointly own your own home? Yes No Do you own a business Yes No Do you own real estate other than your home? Yes No Do you own assets outside of Ontario? Yes No Do you have a marriage contract or separation agreement? Yes No Have you been recently hospitalized or diagnosed with a serious illness Yes No Can you identify your assets with designated beneficiaries? (Life Insurance policies, R.R.S.P's, pensions, etc.) Yes No Have you a child or beneficiary with special needs in receipt of government benefits? Yes No If not married, are you planning to get married in the next year Yes No Please identify any special concerns you wish to cover during our meeting? WHO IS IN CHARGE? PART A. : MY EXECUTORS AND GUARDIANS: My Executor will be my spouse or partner Yes No My Executor will be: Executor Name First Name Last Name Relationship Alternate Executor Will Be: First Name Last Name Relationship Guardian for minor children; First Name Last Name Relationship Alternate Guardian for minor children First Name Last Name Relationship MY SPOUSE'S /PARTNERS EXECUTORS AND GUARDIANS Same as above Yes No Spouse Partner Name (If Not Same) First Name Last Name Relationship Alternate Executor First Name Last Name Relationship Guardian for Minor Children First Name Last Name Relationship Alternate Guardian for Minor Children First Name Last Name Relationship MY BENEFICIARIES List Name, Relationship to you, and Age of Beneficiaries If Beneficiaries are minors, at what age is the money to be released? 18 21 25 If beneficiary is deceased, is their share to go to their children (your grandchildren)? Yes No Are you excluding a child or spouse? Yes No If yes, please provide the name of who you are excluding and a brief explanation of the reasons why MY SPOUSE'S/PARTNER'S BENEFICIARIES Same as Above yes If not same as above, Please provide name, relationship and age of all below If beneficiaries are minors, at what age is the money to be released 18 21 25 If beneficiary is deceased, is their share to go to their children (your grandchildren) Yes No Are you excluding a child or spouse Yes No If yes, please provide the name of who you are excluding and a brief explanation of the reasons why POWERS OF ATTORNEY - PERSONAL CARE AND PROPERTY My Choice for Attorney for personal care Is your spouse/partner to be your attorney? Yes No If No: Name First Name Last Name Relationship Name of choice for alternate Attorney for Personal Care First Name Last Name Relationship My Spouse's/Partner's Choice for Attorney for Personal Care Is your spouse/partner to be your attorney? Yes No If No: Name First Name Last Name Relationship Choice for an Alternate Attorney for Personal Care First Name Last Name Relationship POWERS OF ATTORNEY FOR PROPERTY My Choice for Attorney for Property Is your spouse/partner to be your attorney Yes No If No: Name First Name Last Name Relationship My choice for alternate attorney for property First Name Last Name Relationship My Spouse's/Partner's choice for Attorney for Property Is your spouse/partner to be your attorney Yes No If No Name First Name Last Name Relationship My Choice for an Alternate Attorney for Property First Name Last Name Relationship Thank you!